Trauma and psychological impact in fibromyalgia and other central sensitization syndromes: the role of anxiety and pain acceptance

Recent literature suggests an association between traumatic experiences and central sensitization syndromes (CSS), particularly fibromyalgia (FM). However, few studies have explored the specific variables involved in the relationship between post-traumatic stress disorder (PTSD) and the severity of central sensitization. This study aimed to compare the frequency and characteristics of trauma, PTSD, and clinical symptoms among FM patients, other CSS patients, and healthy controls, and to identify potential mediators between intensity of post-traumatic stress symptoms and central sensitization severity.A cross-sectional study was conducted with 82 women with FM, 41 women with other CSS, and 43 healthy controls. The assessment protocol included a semi-structured interview, self-report measures of PTSD, central sensitization, pain and pain attitudes, sleep quality, fatigue, anxiety, depression, and disability; and objective measures to assess pressure pain thresholds via a digital algometry and sleep quality via actigraphy. Participants wore the actigraphs for one week. Statistical analyses included descriptive statistics, group comparisons using chi-square tests and one-way ANOVA with post-hoc tests, effect size estimations, correlation analyses, and a multiple mediation model.FM patients reported higher trauma frequency and severity, and a higher prevalence of PTSD and intensity of post-traumatic stress symptoms than the CSS and healthy participants. The FM group also exhibited greater impairment across all clinical variables assessed, followed by the CSS group and healthy individuals. Within FM patients, those with PTSD showed more severe clinical profile than those without PTSD, highlighting the correlations between the intensity of post-traumatic stress symptoms and several clinical symptoms. In this subgroup of FM and PTSD, anxiety and pain acceptance are significant mediators in the relationship between post-traumatic stress symptoms and central sensitization.The findings highlight the importance of assessing and addressing PTSD in patients with CSS, particularly FM. Individuals with FM/CSS may require a tailored treatment approach that emphasizes addressing emotions such as anxiety and increasing acceptance. Trauma resolution may have a relevant impact on FM/CSS and contribute substantially to improving the quality of life in this complex patient population.