Longitudinal pain trajectories and social context in fibromyalgia.

for his thoughtful and constructive commentary on our article "Long-term examination of pain and health-related outcomes in people with fibromyalgia before, during, and after COVID-19" 3 and appreciate the opportunity to further clarify the conceptual framing of our work and to reflect on the role of social dimensions in fibromyalgia research.We fully agree that the social domain constitutes a central component of health and functioning, as conceptualized in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). 2 The perspective outlined by Dr. Pontes-Silva provides an important and timely reminder of the need for a more explicit and comprehensive integration of social determinants in chronic pain research.As correctly noted, the primary aim of our study was not to conduct a socially oriented or ICF-based analysis, but to examine the long-term longitudinal stability of pain-related outcomes and their psychosocial correlates across 3 measurement points spanning the prepandemic, pandemic, and postpandemic periods.Within this framework, social variables were operationalized using established subscales of the West Haven-Yale Multidimensional Pain Inventory, which capture aspects of social support and social activity at the individual level.We acknowledge that these measures reflect only a limited segment of the broader social domain as conceptualized by ICF frameworks. 5ur baseline assessment was originally conducted in the context of a genetic association study on microRNA-related genetic variations in fibromyalgia, 1 in which psychosocial and social factors were not the primary focus.Consequently, the selection of instruments at baseline prioritized feasibility and breadth over an in-depth assessment of specific psychosocial or social subdomains.This decision was guided not only by the exploratory nature of the study but also by the need to limit participant burden, particularly given the chronic symptom load and fatigue commonly experienced by individuals with fibromyalgia.Administering an extensive and