Exploring the hypothetical role of cerebellar pain prediction errors in fibromyalgia-associated chronic pain

Despite growing evidence that the cerebellum contributes to sensory, motor, cognitive, and affective domains, its role in chronic pain remains poorly understood. Fibromyalgia (FM), a rheumatological condition in which chronic pain is a hallmark feature, offers a paradigmatic model. Although neuroimaging studies have reported increased cerebellar activity in response to nociceptive stimuli, its contribution to pain chronification has been largely overlooked. This perspective paper proposes that the cerebellum may play a central role in FM by generating persistent prediction errors. Dysregulation of this mechanism may result in a mismatch between sensorimotor inputs and expected outcomes, for both noxious and innocuous stimuli, progressively disrupting error-based learning. We term this hypothesized state 'cerebellar fragility', where the system becomes locked into maladaptive loops. Reconceptualizing cerebellar involvement in chronic pain opens new perspectives for research and therapeutic strategies.