{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:44:16Z","timestamp":1790181856237,"version":"4.1.0"},"reference-count":147,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T00:00:00Z","timestamp":1680739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>The coronavirus pandemic has led to a wave of chronic disease cases; \u201cLong COVID-19\u201d is recognized as a new medical entity and resembles \u201cfibromyalgia\u201d which, likewise, lacks a clear mechanism. Observational studies indicate that up to 30%\u201340% of convalescent COVID-19 patients develop chronic widespread pain and fatigue and fulfill the 2016 diagnostic criteria for \u201cfibromyalgia.\u201d A recent study suggested a theoretical neuro-biomechanical model (coined \u201cFascial Armoring\u201d) to help explain the pathogenesis and cellular pathway of fibromyalgia, pointing toward mechanical abnormalities in connective tissue and fascia, driven by contractile myo\/fibroblasts and altered extracellular matrix remodeling with downstream corresponding neurophysiological aberrations. This may help explain several of fibromyalgia\u2019s manifestations such as pain, distribution of pain, trigger points\/tender spots, hyperalgesia, chronic fatigue, cardiovascular abnormalities, metabolic abnormalities, autonomic abnormalities, small fiber neuropathy, various psychosomatic symptoms, lack of obvious inflammation, and silent imaging investigations. Pro-inflammatory and pro-fibrotic pathways provide input into this mechanism <jats:italic>via<\/jats:italic> stimulation of proto\/myofibroblasts. In this hypothesis and theory paper the theoretical model of Fascial Armoring is presented to help explain the pathogenesis and manifestations of \u201clong COVID-19\u201d as a disease of immuno-rheumo-psycho-neurology. The model is also used to make testable experimental predictions on investigations and predict risk and relieving factors.<\/jats:p>","DOI":"10.3389\/fmed.2023.952278","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T05:53:08Z","timestamp":1680760388000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["\u201cLong COVID-19\u201d and viral \u201cfibromyalgia-ness\u201d: Suggesting a mechanistic role for fascial myofibroblasts (Nineveh, the shadow is in the fascia)"],"prefix":"10.3389","volume":"10","author":[{"given":"Shiloh","family":"Plaut","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"n1648","DOI":"10.1136\/bmj.n1648","article-title":"Long covid-mechanisms, risk factors, and 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