Central Sensitization, Sleep Disturbances and Premenstrual Syndrome: A Nursing Perspective in Fibromyalgia.

Background

Fibromyalgia (FM) is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and heightened central sensitivity. Women with FM frequently experience sleep disturbances and premenstrual syndrome (PMS), yet the interrelationship among central sensitization (CS), sleep quality, and PMS remains insufficiently understood.

Aim

To examine the associations among premenstrual syndrome (PMS) severity, central sensitization (CS), and sleep quality in women with fibromyalgia, and to test whether central sensitization mediates the association between PMS severity and sleep quality.

Methods

A cross-sectional study was conducted among 359 women with FM attending rheumatology outpatient clinics at Cairo University Hospitals, Egypt. Data were collected using Arabic versions of the Central Sensitization Inventory (CSI), Pittsburgh Sleep Quality Index (PSQI), and Premenstrual Syndrome Scale (PMSS). Analyses included descriptive statistics, Pearson correlations, and path analysis with mediation testing using SPSS v29 and AMOS.

Results

Participants reported poor sleep quality (PSQI mean = 8.16 ± 4.06), high PMS severity (PMSS mean = 122.54 ± 15.74), and moderate CS symptoms (CSI mean = 51.75 ± 10.43). PMS severity was positively associated with CS (r = 0.487, p < .001) and negatively associated with sleep quality (r = -0.543, p < .001). CS was also negatively associated with sleep quality (r = -0.467, p < .001). Path analysis indicated that CS partially mediated the association between PMS severity and sleep quality.

Conclusion

Central sensitization partially mediates the association between PMS severity and sleep quality in women with fibromyalgia, highlighting the interconnected role of menstrual symptoms, central pain processing, and sleep disturbances. IMPLICATIONS FOR NURSING PRACTICE Nurses should incorporate assessment of central sensitization, sleep quality and menstrual symptom patterns when caring for women with fibromyalgia. Nursing interventions such as pain neuroscience education, cognitive-behavioral strategies, relaxation techniques and sleep hygiene counseling may help attenuate central sensitization and improve sleep-related outcomes.