Pain hypervigilance is associated with daily-activity pain beyond resting pain in women with fibromyalgia: a cross-sectional observational study.

OBJECTIVE: Pain during activities of daily living (ADL) may reflect functional interference more directly than pain at rest. We examined whether pain hypervigilance is associated with ADL pain beyond resting pain in women with fibromyalgia, while also exploring the contribution of objective cognitive efficiency and an ADL-rest pain difference score (ADL pain minus resting pain). METHODS: In this cross-sectional observational study, 124 women with fibromyalgia completed 0-10 numerical rating scales for resting pain and pain during activities of daily living (ADL pain), the 9-item Pain Vigilance and Awareness Questionnaire, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and a neurocognitive battery summarized as an Objective Cognitive Efficiency Index (OCI). ADL pain was analyzed using ordinary least squares regression adjusted for resting pain, hypervigilance, OCI, age, and body mass index with HC3-robust standard errors. An ADL-rest pain difference score (ADL pain minus resting pain) was examined as a secondary outcome. Complementary analyses included penalized regression with nested cross-validation, partial-correlation network estimation, and sensitivity models additionally adjusting for affective symptoms and fibromyalgia impact. RESULTS: Resting pain (B = 0.254, p = .009) and hypervigilance (B = 0.054, p = .005) were independently associated with higher ADL pain in the adjusted model (R2 = 0.221). OCI showed a weak negative association that did not reach conventional significance (B =  - 0.240, p = .052). The ADL-rest pain difference score model explained little variance (R2 = 0.011), and no predictor reached statistical significance. Out-of-sample prediction was limited (ADL pain CV-R2 =  - 0.124; ADL-rest pain difference score CV-R2 =  - 0.393). CONCLUSION: Pain hypervigilance was associated with daily-activity pain beyond resting pain, supporting its relevance as a modest correlate of functional pain interference in fibromyalgia. Objective cognitive efficiency showed only a weak association, and the ADL-rest pain difference score outcome added little explanatory value. These findings support baseline-adjusted modeling of ADL pain over simple difference score approaches, while highlighting the need for longitudinal and interventional studies. Key Points • Pain hypervigilance is associated with higher pain during daily activities beyond resting pain in fibromyalgia. • Daily-activity pain may better reflect functional pain interference than resting pain alone. • Objective cognitive efficiency shows a weak, non-conclusive association with activity-related pain. • ADL-rest pain difference scores provide limited explanatory value compared to adjusted models.