Exploring Relationships Between Multimodal Lifestyle Factors, Inflammatory Biomarkers, and Pain Processing in Women with Fibromyalgia: An Exploratory Pilot Study
4 affiliations
- 1School of Allied Health and Exercise Sciences, Faculty of Health, Environment and Medical Sciences, Bournemouth University, Bournemouth BH8 8GP, UK
- 2Pain Science Research Group (PSRG), Centre for Wellbeing and Long-Term Health, Bournemouth University, Bournemouth BH8 8GP, UK
- 3Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels 1090, Belgium
- 4VItal Signs and PERformance Monitoring (VIPER), LIFE Department, Royal Military Academy, 1000 Brussels, Belgium
Abstract
Background: Fibromyalgia is a chronic pain condition characterised by altered pain processing, widespread pain, and symptoms including sleep disturbance, fatigue, and psychological distress. Emerging evidence suggests that modifiable multimodal lifestyle factors may influence inflammation and pain mechanisms; however, the relationships between multimodal lifestyle factors, systemic inflammatory biomarkers, and pain processing remain poorly understood. In this study we aimed to investigate the associations between lifestyle factors, inflammatory biomarkers, and experimental and clinical pain outcomes in women with fibromyalgia. Methods: Women with fibromyalgia were invited to participate in this exploratory cross-sectional study. Lifestyle factors included diet, perceived stress, sleep, physical activity, heart rate variability, and BMI. Plasma IL-6, IL-10, and TNF-α were measured. Pain outcomes included quantitative sensory testing and patient-reported outcome measures. Spearman’s rank correlations and multiple linear regression analyses adjusted for age and disease duration were performed. Bootstrap 95% confidence intervals were calculated for all estimates, and False Discovery Rate (FDR) corrections using the Benjamini–Hochberg procedure were applied as a sensitivity analysis. Results: Twenty patients were included. Correlation analyses demonstrated that higher perceived stress was strongly associated with greater fibromyalgia impact (r = 0.68, p < 0.001, n = 20), central sensitization (r = 0.67, p < 0.001, n = 20), and current pain intensity (r = 0.64, p = 0.002, n = 20). A more pro-inflammatory diet was positively associated with IL-6 (r = 0.46, p = 0.04, n = 20) and IL-10 (r = 0.47, p = 0.10, n = 13), while higher TNF-α concentrations were associated with lower pressure pain thresholds (overall; r = −0.55, p = 0.021, n = 19; tibialis: r = −0.57, p = 0.010, n = 19). Following adjustment for age and disease duration, associations between stress and fibromyalgia impact, central sensitization, and current and worst pain intensity, together with associations between pro-inflammatory diet and IL-6 and IL-10, and between BMI and IL-10 showed similar directions and effect estimates. However, following FDR adjustment as a sensitivity analysis, no associations retained statistical significance. Conclusions: This study suggests that different modifiable lifestyle factors may be associated with distinct aspects of pain and inflammatory processes in women with fibromyalgia. Perceived stress showed the most consistent associations with pain-related outcomes, while dietary inflammatory potential showed preliminary associations with inflammatory biomarkers that need further investigation.
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BibTeX
@article{elma2026exploring,
title = {{Exploring Relationships Between Multimodal Lifestyle Factors, Inflammatory Biomarkers, and Pain Processing in Women with Fibromyalgia: An Exploratory Pilot Study}},
author = {Ömer Elma and Christopher Long and Amber Brown and Jamie Dresse and Karen Yendole and Carol Clark and Jonathan Williams and Rebecca A. Neal and Nils Runge and Emma Mosley and Sevilay Tümkaya Yılmaz and Sumanto Haldar},
journal = {Nutrients},
year = {2026},
month = oct,
doi = {10.3390/nu18213507},
url = {https://www.mdpi.com/2072-6643/18/21/3507},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Exploring Relationships Between Multimodal Lifestyle Factors, Inflammatory Biomarkers, and Pain Processing in Women with Fibromyalgia: An Exploratory Pilot Study
AU - Ömer Elma
AU - Christopher Long
AU - Amber Brown
AU - Jamie Dresse
AU - Karen Yendole
AU - Carol Clark
AU - Jonathan Williams
AU - Rebecca A. Neal
AU - Nils Runge
AU - Emma Mosley
AU - Sevilay Tümkaya Yılmaz
AU - Sumanto Haldar
PY - 2026
DA - 2026/10/25
JO - Nutrients
DO - 10.3390/nu18213507
UR - https://www.mdpi.com/2072-6643/18/21/3507
AB - Background: Fibromyalgia is a chronic pain condition characterised by altered pain processing, widespread pain, and symptoms including sleep disturbance, fatigue, and psychological distress. Emerging evidence suggests that modifiable multimodal lifestyle factors may influence inflammation and pain mechanisms; however, the relationships between multimodal lifestyle factors, systemic inflammatory biomarkers, and pain processing remain poorly understood. In this study we aimed to investigate the associations between lifestyle factors, inflammatory biomarkers, and experimental and clinical pain outcomes in women with fibromyalgia. Methods: Women with fibromyalgia were invited to participate in this exploratory cross-sectional study. Lifestyle factors included diet, perceived stress, sleep, physical activity, heart rate variability, and BMI. Plasma IL-6, IL-10, and TNF-α were measured. Pain outcomes included quantitative sensory testing and patient-reported outcome measures. Spearman’s rank correlations and multiple linear regression analyses adjusted for age and disease duration were performed. Bootstrap 95% confidence intervals were calculated for all estimates, and False Discovery Rate (FDR) corrections using the Benjamini–Hochberg procedure were applied as a sensitivity analysis. Results: Twenty patients were included. Correlation analyses demonstrated that higher perceived stress was strongly associated with greater fibromyalgia impact (r = 0.68, p < 0.001, n = 20), central sensitization (r = 0.67, p < 0.001, n = 20), and current pain intensity (r = 0.64, p = 0.002, n = 20). A more pro-inflammatory diet was positively associated with IL-6 (r = 0.46, p = 0.04, n = 20) and IL-10 (r = 0.47, p = 0.10, n = 13), while higher TNF-α concentrations were associated with lower pressure pain thresholds (overall; r = −0.55, p = 0.021, n = 19; tibialis: r = −0.57, p = 0.010, n = 19). Following adjustment for age and disease duration, associations between stress and fibromyalgia impact, central sensitization, and current and worst pain intensity, together with associations between pro-inflammatory diet and IL-6 and IL-10, and between BMI and IL-10 showed similar directions and effect estimates. However, following FDR adjustment as a sensitivity analysis, no associations retained statistical significance. Conclusions: This study suggests that different modifiable lifestyle factors may be associated with distinct aspects of pain and inflammatory processes in women with fibromyalgia. Perceived stress showed the most consistent associations with pain-related outcomes, while dietary inflammatory potential showed preliminary associations with inflammatory biomarkers that need further investigation.
SN - 2072-6643
ER -