Sexual trauma relates to central sensitization severity in fibromyalgia: A community-based cohort study of women

Background Central sensitization (CS) is a core feature of fibromyalgia, but the relative contribution of pain distribution, sleep disturbance, cognitive symptoms, and trauma-related factors to its severity remains unclear. Objective To identify independent determinants of CS severity in fibromyalgia, focusing on sexual abuse as a primary exposure, and to explore indirect pathways using mediation analyses. Methods In this cross-sectional community-based study, 2099 women with fibromyalgia completed validated measures of central sensitization (CSI), pain distribution, sleep disturbance, cognitive symptoms, psychological factors, medication use, and lifetime adversity. We applied a theoretically driven hierarchical regression model, followed by mediation analyses with 10,000 bootstrap resamples. Results are reported as regression coefficients (β) with 95% confidence intervals (CI). Results The fully adjusted model explained 52.8% of CSI variance (adjusted R 2 = 0.523). Sexual abuse was independently associated with higher CSI scores (β = 1.26; 95% CI 0.13–2.39). Widespread Pain Index (WPI) (β = 0.14; 95% CI 0.03–0.25), cognitive symptoms (β = 1.81; 95% CI 1.24–2.38), and non-restorative sleep (β = 1.49; 95% CI 0.77-2.22) were also independent correlates. Non-restorative sleep showed an indirect association between WPI and CSI (effect = 0.105; 95% CI 0.068–0.144), whereas cognition did not (effect = 0.037; 95% CI −0.004–0.080). WPI did not mediate the sexual abuse–CSI association (indirect effect = 0.124; 95% CI −0.101–0.356). Conclusion CS-related symptom burden was associated with pain distribution, sleep, cognition, and trauma. Sexual abuse retained a small independent association not statistically explained by WPI. These cross-sectional findings support a multidimensional, trauma-informed framework but do not establish causality.