Exploring Relationships Between Multimodal Lifestyle Factors, Inflammatory Biomarkers, and Pain Processing in Women with Fibromyalgia: An Exploratory Pilot Study

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.