Sociodemographic factors, but not rurality, explain limited variance in fibromyalgia severity: a secondary analysis of 2 randomized clinical trials
Abstract
Objective: Fibromyalgia is characterized by a broad spectrum of symptoms such as pain, fatigue, and psychosocial impairments that collectively contribute to disease severity. This study aims to investigate the influence of living in rural versus urban settings on fibromyalgia severity.
Methods: This is a secondary analysis of baseline data from 685 participants combined from 2 clinical trials. Survey data collected at baseline included sociodemographic characteristics (sex, age, rurality, race, ethnicity, income, education, employment status), pain and pain interference, fatigue, pain catastrophizing, and the Fibromyalgia Impact Questionnaire-Revised (FIQR).
Results: Study participants were 50.6 ± 14.2 years, 96% female, and 44% resided in rural areas. FIQR was significantly associated with age (F = 5.511, P < 0.001), race (t = −3.628, P < 0.001), marital status (t = 3.410, P < 0.001), education status (F = 5.887, P = 0.003), employment status (t = −3.153, P = 0.002), and income (F = 13.147, P < 0.001) but not rurality (t = −0.350, P = 0.726). Cluster analysis based on rurality and sociodemographic variables resulted in 2 groups that differed by age, race, employment status, and income; FIQR was higher among those who were older, non-White, unemployed and with lower income. Using linear regression, sociodemographic variables contributed less than 10% of the variance in disease severity as measured by FIQR (R2 = 0.09) while rurality did not contribute. Additionally, sociodemographic variables contributed minimally to pain severity (9%) and interference (8%), widespread pain (4%), fatigue (6%), and pain catastrophizing (12%).
Conclusions: Rurality and sociodemographic characteristics had limited influence on pain, fatigue, and pain catastrophizing, suggesting that fibromyalgia disease severity is minimally influenced by sociodemographic variables and not by rurality.
Clinical Trials Registration: This study is a secondary analysis of baseline data from the Fibromyalgia Activity Study with TENS (FAST, NCT01888640, https://clinicaltrials.gov/study/NCT01888640) and the Fibromyalgia Transcutaneous Electrical Nerve Stimulation in Physical Therapy Study (FM-TIPS, NCT04683042, https://clinicaltrials.gov/study/NCT04683042) trial protocols. Patient enrolment started on September 30, 2013, for FAST and on January 22, 2021, for FM-TIPS.
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BibTeX
@article{gillette2026sociodemographic,
title = {{Sociodemographic factors, but not rurality, explain limited variance in fibromyalgia severity: a secondary analysis of 2 randomized clinical trials}},
author = {Ezgi Yarasir Gillette and Kari G Vance and Emine O Bayman and Dana L Dailey and Carol G T Vance and Ruth L Chimenti and Leslie J Crofford and Barbara J Van Gorp and Elizabeth M Johnson and Kristin R Archer and Heather Schacht Reisinger and Miriam Bridget Zimmerman and Kathleen A Sluka and Giovanni Berardi},
journal = {Pain Medicine: The Official Journal of the American Academy of Pain Medicine},
year = {2026},
month = jul,
doi = {10.1093/pm/pnag088},
url = {https://doi.org/10.1093/pm/pnag088},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Sociodemographic factors, but not rurality, explain limited variance in fibromyalgia severity: a secondary analysis of 2 randomized clinical trials
AU - Ezgi Yarasir Gillette
AU - Kari G Vance
AU - Emine O Bayman
AU - Dana L Dailey
AU - Carol G T Vance
AU - Ruth L Chimenti
AU - Leslie J Crofford
AU - Barbara J Van Gorp
AU - Elizabeth M Johnson
AU - Kristin R Archer
AU - Heather Schacht Reisinger
AU - Miriam Bridget Zimmerman
AU - Kathleen A Sluka
AU - Giovanni Berardi
PY - 2026
DA - 2026/07/11
JO - Pain Medicine: The Official Journal of the American Academy of Pain Medicine
DO - 10.1093/pm/pnag088
UR - https://doi.org/10.1093/pm/pnag088
AB - Objective: Fibromyalgia is characterized by a broad spectrum of symptoms such as pain, fatigue, and psychosocial impairments that collectively contribute to disease severity. This study aims to investigate the influence of living in rural versus urban settings on fibromyalgia severity. Methods: This is a secondary analysis of baseline data from 685 participants combined from 2 clinical trials. Survey data collected at baseline included sociodemographic characteristics (sex, age, rurality, race, ethnicity, income, education, employment status), pain and pain interference, fatigue, pain catastrophizing, and the Fibromyalgia Impact Questionnaire-Revised (FIQR). Results: Study participants were 50.6 ± 14.2 years, 96% female, and 44% resided in rural areas. FIQR was significantly associated with age (F = 5.511, P < 0.001), race (t = −3.628, P < 0.001), marital status (t = 3.410, P < 0.001), education status (F = 5.887, P = 0.003), employment status (t = −3.153, P = 0.002), and income (F = 13.147, P < 0.001) but not rurality (t = −0.350, P = 0.726). Cluster analysis based on rurality and sociodemographic variables resulted in 2 groups that differed by age, race, employment status, and income; FIQR was higher among those who were older, non-White, unemployed and with lower income. Using linear regression, sociodemographic variables contributed less than 10% of the variance in disease severity as measured by FIQR (R2 = 0.09) while rurality did not contribute. Additionally, sociodemographic variables contributed minimally to pain severity (9%) and interference (8%), widespread pain (4%), fatigue (6%), and pain catastrophizing (12%). Conclusions: Rurality and sociodemographic characteristics had limited influence on pain, fatigue, and pain catastrophizing, suggesting that fibromyalgia disease severity is minimally influenced by sociodemographic variables and not by rurality. Clinical Trials Registration: This study is a secondary analysis of baseline data from the Fibromyalgia Activity Study with TENS (FAST, NCT01888640, https://clinicaltrials.gov/study/NCT01888640) and the Fibromyalgia Transcutaneous Electrical Nerve Stimulation in Physical Therapy Study (FM-TIPS, NCT04683042, https://clinicaltrials.gov/study/NCT04683042) trial protocols. Patient enrolment started on September 30, 2013, for FAST and on January 22, 2021, for FM-TIPS.
SN - 1526-2375
SN - 1526-4637
ER -