{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T21:09:13Z","timestamp":1788210553538,"version":"build-2803163510"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Roma La Sapienza"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Intern Emerg Med"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Most fibromyalgia (FM) patients are women, with a female-to-male ratio of 3:1. While sex differences in pain perception and description have been reported, the impact of sex and gender on FM severity remains controversial. Additionally, sex-related differential item functioning (DIF) in FM assessment tools has not yet been explored. The primary aim of this study was to analyze sex- and gender-related differences in FM severity using data from a web-based FM registry. The secondary aim was to assess sex-related DIF in three commonly used questionnaires: the Polysymptomatic Distress Scale (PDS), the modified Fibromyalgia Assessment Status (ModFAS), and the revised Fibromyalgia Impact Questionnaire (FIQR). Data from 331 male and 331 female patients, matched for age and body mass index (BMI) and fulfilling ACR 2010\/2011 criteria, were retrospectively collected from the Italian Fibromyalgia Registry. Multivariate analyses were conducted on the overall and sex-stratified populations. Sex-related DIF was assessed using a hybrid Ordinal Logistic Regression\/Item Response Theory method. Female sex was significantly associated with greater physical impairment, despite no differences in overall disease severity. In stratified analyses, married status influenced disease impact and burden in women, whereas BMI was associated with higher disability in men. Significant sex-related DIF was detected in one item of the Symptom Severity Scale of the PDS. Women with FM experience greater physical impairment than men, despite similar disease severity. Sociodemographic factors influence FM differently across sexes. Despite minor DIF, the three FM-specific questionnaires appear valid for use in both male and female patients.<\/jats:p>","DOI":"10.1007\/s11739-026-04277-2","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T14:50:50Z","timestamp":1772203850000},"page":"1193-1202","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The impact of sex and gender on Fibromyalgia Syndrome: data from the Italian Fibromyalgia Registry"],"prefix":"10.1007","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1428-9725","authenticated-orcid":false,"given":"Cristina","family":"Iannuccelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7777-6058","authenticated-orcid":false,"given":"Martina","family":"Favretti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Dolcini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9815-2621","authenticated-orcid":false,"given":"Sonia","family":"Farah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0906-4647","authenticated-orcid":false,"given":"Marco","family":"Di Carlo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Tramontano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Ferrari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9328-3075","authenticated-orcid":false,"given":"Fabiola","family":"Atzeni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1762-0770","authenticated-orcid":false,"given":"Greta","family":"Pellegrino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8673-5133","authenticated-orcid":false,"given":"Piercarlo Sarzi","family":"Puttini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3794-6831","authenticated-orcid":false,"given":"Fausto","family":"Salaffi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-2065","authenticated-orcid":false,"given":"Manuela","family":"Di Franco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"issue":"7","key":"4277_CR1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12071543","volume":"12","author":"LN Jurado-Priego","year":"2024","unstructured":"Jurado-Priego LN, Cueto-Ure\u00f1a C, Ram\u00edrez-Exp\u00f3sito MJ, Mart\u00ednez-Martos JM (2024) Fibromyalgia: a review of the pathophysiological mechanisms and multidisciplinary treatment strategies. Biomedicines 12(7):1543. https:\/\/doi.org\/10.3390\/biomedicines12071543","journal-title":"Biomedicines"},{"issue":"1","key":"4277_CR2","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1097\/BOR.0000000000000464","volume":"30","author":"A Lichtenstein","year":"2018","unstructured":"Lichtenstein A, Tiosano S, Amital H (2018) The complexities of fibromyalgia and its comorbidities. Curr Opin Rheumatol 30(1):94\u2013100. https:\/\/doi.org\/10.1097\/BOR.0000000000000464","journal-title":"Curr Opin Rheumatol"},{"issue":"8","key":"4277_CR3","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-013-0356-5","volume":"17","author":"LP Queiroz","year":"2013","unstructured":"Queiroz LP (2013) Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep 17(8):356. https:\/\/doi.org\/10.1007\/s11916-013-0356-5","journal-title":"Curr Pain Headache Rep"},{"issue":"5","key":"4277_CR4","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1002\/jnr.24945","volume":"101","author":"C Reale","year":"2023","unstructured":"Reale C, Invernizzi F, Panteghini C, Garavaglia B (2023) Genetics, sex, and gender. J Neurosci Res 101(5):553\u2013562. https:\/\/doi.org\/10.1002\/jnr.24945","journal-title":"J Neurosci Res"},{"key":"4277_CR5","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinsp.2023.100209","volume":"78","author":"BVM Santiago","year":"2023","unstructured":"Santiago BVM et al (2023) Prevalence of chronic pain in Brazil: a systematic review and meta-analysis. Clinics 78:100209. https:\/\/doi.org\/10.1016\/j.clinsp.2023.100209","journal-title":"Clinics"},{"issue":"4","key":"4277_CR6","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1111\/ejn.13125","volume":"43","author":"G Galli","year":"2016","unstructured":"Galli G et al (2016) Individual and sex-related differences in pain and relief responsiveness are associated with differences in resting-state functional networks in healthy volunteers. Eur J Neurosci 43(4):486\u2013493. https:\/\/doi.org\/10.1111\/ejn.13125","journal-title":"Eur J Neurosci"},{"issue":"1","key":"4277_CR7","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1007\/s40122-021-00244-1","volume":"10","author":"R Casale","year":"2021","unstructured":"Casale R et al (2021) Pain in women: a perspective review on a relevant clinical issue that deserves prioritization. Pain Ther 10(1):287\u2013314. https:\/\/doi.org\/10.1007\/s40122-021-00244-1","journal-title":"Pain Ther"},{"issue":"7","key":"4277_CR8","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1038\/s41583-020-0310-6","volume":"21","author":"JS Mogil","year":"2020","unstructured":"Mogil JS (2020) Qualitative sex differences in pain processing: emerging evidence of a biased literature. Nat Rev Neurosci 21(7):353\u2013365. https:\/\/doi.org\/10.1038\/s41583-020-0310-6","journal-title":"Nat Rev Neurosci"},{"issue":"3","key":"4277_CR9","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1016\/j.pain.2011.11.026","volume":"153","author":"M Racine","year":"2012","unstructured":"Racine M, Tousignant-Laflamme Y, Kloda LA, Dion D, Dupuis G, Choini\u00e8re M (2012) A systematic literature review of 10 years of research on sex\/gender and pain perception - part 2: do biopsychosocial factors alter pain sensitivity differently in women and men? Pain 153(3):619\u2013635. https:\/\/doi.org\/10.1016\/j.pain.2011.11.026","journal-title":"Pain"},{"issue":"10289","key":"4277_CR10","doi-asserted-by":"publisher","first-page":"2082","DOI":"10.1016\/S0140-6736(21)00393-7","volume":"397","author":"SP Cohen","year":"2021","unstructured":"Cohen SP, Vase L, Hooten WM (2021) Chronic pain: an update on burden, best practices, and new advances. Lancet 397(10289):2082\u20132097. https:\/\/doi.org\/10.1016\/S0140-6736(21)00393-7","journal-title":"Lancet"},{"issue":"9","key":"4277_CR11","doi-asserted-by":"publisher","first-page":"1836","DOI":"10.1097\/j.pain.0000000000000577","volume":"157","author":"AM Taylor","year":"2016","unstructured":"Taylor AM et al (2016) Assessment of physical function and participation in chronic pain clinical trials: IMMPACT\/OMERACT recommendations. Pain 157(9):1836\u20131850. https:\/\/doi.org\/10.1097\/j.pain.0000000000000577","journal-title":"Pain"},{"key":"4277_CR12","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1007\/s40471-019-00194-5","volume":"6","author":"RN Jones","year":"2019","unstructured":"Jones RN (2019) Differential item functioning and its relevance to epidemiology. Curr Epidemiol Rep 6:174\u2013183. https:\/\/doi.org\/10.1007\/s40471-019-00194-5","journal-title":"Curr Epidemiol Rep"},{"issue":"2","key":"4277_CR13","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11020223","volume":"11","author":"I Ruschak","year":"2023","unstructured":"Ruschak I, Montes\u00f3-Curto P, Rossell\u00f3 L, Aguilar Mart\u00edn C, S\u00e1nchez-Montes\u00f3 L, Toussaint L (2023) Fibromyalgia syndrome pain in men and women: a scoping review. Healthcare 11(2):223. https:\/\/doi.org\/10.3390\/healthcare11020223","journal-title":"Healthcare"},{"issue":"6","key":"4277_CR14","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.3899\/jrheum.100594","volume":"38","author":"F Wolfe","year":"2011","unstructured":"Wolfe F et al (2011) Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol 38(6):1113\u20131122. https:\/\/doi.org\/10.3899\/jrheum.100594","journal-title":"J Rheumatol"},{"issue":"2","key":"4277_CR15","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1136\/annrheumdis-2016-209724","volume":"76","author":"GJ Macfarlane","year":"2016","unstructured":"Macfarlane GJ et al (2016) EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 76(2):318\u2013328. https:\/\/doi.org\/10.1136\/annrheumdis-2016-209724","journal-title":"Ann Rheum Dis"},{"issue":"2","key":"4277_CR16","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1093\/rheumatology\/keaa355","volume":"60","author":"F Salaffi","year":"2021","unstructured":"Salaffi F et al (2021) Definition of fibromyalgia severity: findings from a cross-sectional survey of 2339 Italian patients. Rheumatol Oxf Engl 60(2):728\u2013736. https:\/\/doi.org\/10.1093\/rheumatology\/keaa355","journal-title":"Rheumatol Oxf Engl"},{"issue":"10","key":"4277_CR17","doi-asserted-by":"publisher","first-page":"3042","DOI":"10.1093\/rheumatology\/keaa061","volume":"59","author":"F Salaffi","year":"2020","unstructured":"Salaffi F et al (2020) Diagnosis of fibromyalgia: comparison of the 2011\/2016 ACR and AAPT criteria and validation of the modified Fibromyalgia Assessment Status. Rheumatol Oxf Engl 59(10):3042\u20133049. https:\/\/doi.org\/10.1093\/rheumatology\/keaa061","journal-title":"Rheumatol Oxf Engl"},{"issue":"6 Suppl 79","key":"4277_CR18","first-page":"S41","volume":"31","author":"F Salaffi","year":"2013","unstructured":"Salaffi F, Franchignoni F, Giordano A, Ciapetti A, Sarzi-Puttini P, Ottonello M (2013) (2013) Psychometric characteristics of the Italian version of the revised Fibromyalgia Impact Questionnaire using classical test theory and Rasch analysis. Clin Exp Rheumatol 31(6 Suppl 79):S41-49","journal-title":"Clin Exp Rheumatol"},{"key":"4277_CR19","doi-asserted-by":"publisher","first-page":"289","DOI":"10.2307\/2346101","volume":"57","author":"Y Benjamini","year":"1995","unstructured":"Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B 57:289\u2013300. https:\/\/doi.org\/10.2307\/2346101","journal-title":"J R Stat Soc Ser B"},{"issue":"10","key":"4277_CR20","doi-asserted-by":"publisher","first-page":"1682","DOI":"10.1002\/acr.22034","volume":"65","author":"JV Luciano","year":"2013","unstructured":"Luciano JV, Aguado J, Serrano-Blanco A, Calandre EP, Rodriguez-Lopez CM (2013) Dimensionality, reliability, and validity of the revised fibromyalgia impact questionnaire in two Spanish samples. Arthritis Care Res 65(10):1682\u20131689. https:\/\/doi.org\/10.1002\/acr.22034","journal-title":"Arthritis Care Res"},{"issue":"1","key":"4277_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705519909540118","volume":"6","author":"L Hu","year":"1999","unstructured":"Hu L, Peter M, Bentler (1999) Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model Multidiscip J 6(1):1\u201355. https:\/\/doi.org\/10.1080\/10705519909540118","journal-title":"Struct Equ Model Multidiscip J"},{"issue":"8","key":"4277_CR22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v039.i08","volume":"39","author":"SW Choi","year":"2011","unstructured":"Choi SW, Gibbons LE, Crane PK (2011) lordif: an R package for detecting differential item functioning using iterative hybrid ordinal logistic regression\/item response theory and monte carlo simulations. J Stat Softw 39(8):1\u201330. https:\/\/doi.org\/10.18637\/jss.v039.i08","journal-title":"J Stat Softw"},{"issue":"11 Suppl 3","key":"4277_CR23","doi-asserted-by":"publisher","first-page":"S115","DOI":"10.1097\/01.mlr.0000245183.28384.ed","volume":"44","author":"PK Crane","year":"2006","unstructured":"Crane PK, Gibbons LE, Jolley L, van Belle G (2006) Differential item functioning analysis with ordinal logistic regression techniques. DIFdetect and difwithpar. Med Care 44(11 Suppl 3):S115-123. https:\/\/doi.org\/10.1097\/01.mlr.0000245183.28384.ed","journal-title":"Med Care"},{"key":"4277_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2023.111415","volume":"172","author":"RA Marrie","year":"2023","unstructured":"Marrie RA et al (2023) Assessment of differential item functioning of the PHQ-9, HADS-D and PROMIS-depression scales in persons with and without multiple sclerosis. J Psychosom Res 172:111415. https:\/\/doi.org\/10.1016\/j.jpsychores.2023.111415","journal-title":"J Psychosom Res"},{"key":"4277_CR25","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.4735","author":"M Di Carlo","year":"2024","unstructured":"Di Carlo M et al (2024) Geographical disparities in fibromyalgia severity: an Italian study. Eur J Pain. https:\/\/doi.org\/10.1002\/ejp.4735","journal-title":"Eur J Pain"},{"key":"4277_CR26","doi-asserted-by":"publisher","first-page":"67","DOI":"10.2147\/OARRR.S358255","volume":"14","author":"A Moshrif","year":"2022","unstructured":"Moshrif A, Shoaeir MZ, Abbas AS, Abdel-Aziz TM, Gouda W (2022) Evaluating gender differences in Egyptian fibromyalgia patients using the 1990, 2011, and 2016 ACR Criteria. Open Access Rheumatol Res Rev 14:67\u201374. https:\/\/doi.org\/10.2147\/OARRR.S358255","journal-title":"Open Access Rheumatol Res Rev"},{"issue":"9","key":"4277_CR27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203755","volume":"13","author":"F Wolfe","year":"2018","unstructured":"Wolfe F, Walitt B, Perrot S, Rasker JJ, H\u00e4user W (2018) Fibromyalgia diagnosis and biased assessment: sex, prevalence and bias. PLoS ONE 13(9):e0203755. https:\/\/doi.org\/10.1371\/journal.pone.0203755","journal-title":"PLoS ONE"},{"issue":"2","key":"4277_CR28","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1007\/s40744-021-00303-1","volume":"8","author":"J Jiao","year":"2021","unstructured":"Jiao J, Cheng Z, Wang W, Zhao Y, Jiang Q (2021) Demographic characteristics and clinical features of fibromyalgia in China: a cross-sectional study. Rheumatol Ther 8(2):817\u2013831. https:\/\/doi.org\/10.1007\/s40744-021-00303-1","journal-title":"Rheumatol Ther"},{"issue":"6","key":"4277_CR29","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.55563\/clinexprheumatol\/4mlktj","volume":"41","author":"M Favretti","year":"2023","unstructured":"Favretti M et al (2023) Gender differences in the revised Fibromyalgia Impact Questionnaire: a pilot study. Clin Exp Rheumatol 41(6):1310\u20131316. https:\/\/doi.org\/10.55563\/clinexprheumatol\/4mlktj","journal-title":"Clin Exp Rheumatol"},{"issue":"7","key":"4277_CR30","doi-asserted-by":"publisher","first-page":"2171","DOI":"10.1007\/s10067-022-06133-y","volume":"41","author":"C Iannuccelli","year":"2022","unstructured":"Iannuccelli C et al (2022) Gender influence on clinical manifestations, depressive symptoms and brain-derived neurotrophic factor (BDNF) serum levels in patients affected by fibromyalgia. Clin Rheumatol 41(7):2171\u20132178. https:\/\/doi.org\/10.1007\/s10067-022-06133-y","journal-title":"Clin Rheumatol"},{"issue":"6","key":"4277_CR31","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.55563\/clinexprheumatol\/64963d","volume":"40","author":"F Atzeni","year":"2022","unstructured":"Atzeni F et al (2022) Sociodemographic factors in fibromyalgia: results from the Italian Fibromyalgia Registry. Clin Exp Rheumatol 40(6):1183\u20131188. https:\/\/doi.org\/10.55563\/clinexprheumatol\/64963d","journal-title":"Clin Exp Rheumatol"},{"issue":"1","key":"4277_CR32","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1053\/sarh.2000.8363","volume":"30","author":"D Buskila","year":"2000","unstructured":"Buskila D, Neumann L, Alhoashle A, Abu-Shakra M (2000) Fibromyalgia syndrome in men. Semin Arthritis Rheum 30(1):47\u201351. https:\/\/doi.org\/10.1053\/sarh.2000.8363","journal-title":"Semin Arthritis Rheum"},{"issue":"12","key":"4277_CR33","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1111\/j.1526-4637.2012.01523.x","volume":"13","author":"AM Castro-S\u00e1nchez","year":"2012","unstructured":"Castro-S\u00e1nchez AM, Matar\u00e1n-Pe\u00f1arrocha GA, L\u00f3pez-Rodr\u00edguez MM, Lara-Palomo IC, Arendt-Nielsen L, Fern\u00e1ndez-de-las-Pe\u00f1as C (2012) Gender differences in pain severity, disability, depression, and widespread pressure pain sensitivity in patients with fibromyalgia syndrome without comorbid conditions. Pain Med 13(12):1639\u20131647. https:\/\/doi.org\/10.1111\/j.1526-4637.2012.01523.x","journal-title":"Pain Med"},{"issue":"2","key":"4277_CR34","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1002\/art.1780330203","volume":"33","author":"F Wolfe","year":"1990","unstructured":"Wolfe F et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33(2):160\u2013172. https:\/\/doi.org\/10.1002\/art.1780330203","journal-title":"Arthritis Rheum"},{"key":"4277_CR35","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.2147\/PRBM.S446798","volume":"17","author":"C Galvez-S\u00e1nchez","year":"2024","unstructured":"Galvez-S\u00e1nchez C, Duschek S, Reyes Del Paso G (2024) A comparative analysis of cognitive deficits in rheumatoid arthritis and fibromyalgia: impact of symptoms severity and its clinical implications. Psychol Res Behav Manag 17:1399\u20131415. https:\/\/doi.org\/10.2147\/PRBM.S446798","journal-title":"Psychol Res Behav Manag"},{"issue":"4","key":"4277_CR36","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1111\/j.1547-5069.2007.00187.x","volume":"39","author":"DN Rutledge","year":"2007","unstructured":"Rutledge DN, Jones K, Jones CJ (2007) Predicting high physical function in people with fibromyalgia. J Nurs Scholarsh 39(4):319\u2013324. https:\/\/doi.org\/10.1111\/j.1547-5069.2007.00187.x","journal-title":"J Nurs Scholarsh"},{"issue":"2","key":"4277_CR37","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3109\/09638280903026572","volume":"32","author":"D C\u00f4t\u00e9","year":"2010","unstructured":"C\u00f4t\u00e9 D, Coutu M-F (2010) A critical review of gender issues in understanding prolonged disability related to musculoskeletal pain: how are they relevant to rehabilitation? Disabil Rehabil 32(2):87\u2013102. https:\/\/doi.org\/10.3109\/09638280903026572","journal-title":"Disabil Rehabil"},{"issue":"1","key":"4277_CR38","doi-asserted-by":"publisher","DOI":"10.1093\/rap\/rkab015","volume":"5","author":"F Atzeni","year":"2021","unstructured":"Atzeni F et al (2021) The association between body mass index and fibromyalgia severity: data from a cross-sectional survey of 2339 patients. Rheumatol Adv Pract 5(1):rkab015. https:\/\/doi.org\/10.1093\/rap\/rkab015","journal-title":"Rheumatol Adv Pract"},{"issue":"8","key":"4277_CR39","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1080\/13548506.2018.1444183","volume":"23","author":"ER Huang","year":"2018","unstructured":"Huang ER, Jones KD, Bennett RM, Hall GCN, Lyons KS (2018) The role of spousal relationships in fibromyalgia patients\u2019 quality of life. Psychol Health Med 23(8):987\u2013995. https:\/\/doi.org\/10.1080\/13548506.2018.1444183","journal-title":"Psychol Health Med"},{"issue":"2","key":"4277_CR40","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.mayocp.2013.09.021","volume":"89","author":"J Jiao","year":"2014","unstructured":"Jiao J, Vincent A, Cha SS, Luedtke CA, Oh TH (2014) Relation of age with symptom severity and quality of life in patients with fibromyalgia. Mayo Clin Proc 89(2):199\u2013206. https:\/\/doi.org\/10.1016\/j.mayocp.2013.09.021","journal-title":"Mayo Clin Proc"},{"key":"4277_CR41","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.sjpain.2017.05.010","volume":"16","author":"MH Prenevost","year":"2017","unstructured":"Prenevost MH, Reme SE (2017) Couples coping with chronic pain: How do intercouple interactions relate to pain coping? Scand J Pain 16:150\u2013157. https:\/\/doi.org\/10.1016\/j.sjpain.2017.05.010","journal-title":"Scand J Pain"},{"issue":"11","key":"4277_CR42","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1016\/j.jpain.2011.04.004","volume":"12","author":"LEM Leong","year":"2011","unstructured":"Leong LEM, Cano A, Johansen AB (2011) Sequential and base rate analysis of emotional validation and invalidation in chronic pain couples: patient gender matters. J Pain 12(11):1140\u20131148. https:\/\/doi.org\/10.1016\/j.jpain.2011.04.004","journal-title":"J Pain"},{"issue":"1","key":"4277_CR43","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.pain.2012.10.004","volume":"154","author":"SS Taylor","year":"2013","unstructured":"Taylor SS, Davis MC, Zautra AJ (2013) Relationship status and quality moderate daily pain-related changes in physical disability, affect, and cognitions in women with chronic pain. Pain 154(1):147\u2013153. https:\/\/doi.org\/10.1016\/j.pain.2012.10.004","journal-title":"Pain"},{"key":"4277_CR44","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.mce.2014.11.029","volume":"402","author":"BF Palmer","year":"2015","unstructured":"Palmer BF, Clegg DJ (2015) The sexual dimorphism of obesity. Mol Cell Endocrinol 402:113\u2013119. https:\/\/doi.org\/10.1016\/j.mce.2014.11.029","journal-title":"Mol Cell Endocrinol"},{"key":"4277_CR45","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2023.04.006","volume":"176","author":"L Smith","year":"2023","unstructured":"Smith L et al (2023) Sex differences in the association between dynapenic abdominal obesity and onset of disability in activities of daily living among adults aged \u226550 years: a prospective analysis of the Irish Longitudinal Study on Ageing. Maturitas 176:107763. https:\/\/doi.org\/10.1016\/j.maturitas.2023.04.006","journal-title":"Maturitas"},{"issue":"7","key":"4277_CR46","doi-asserted-by":"publisher","first-page":"412","DOI":"10.4082\/kjfm.2011.32.7.412","volume":"32","author":"YM Na","year":"2011","unstructured":"Na YM et al (2011) Obesity, obesity related disease, and disability. Korean J Fam Med 32(7):412\u2013422. https:\/\/doi.org\/10.4082\/kjfm.2011.32.7.412","journal-title":"Korean J Fam Med"}],"container-title":["Internal and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-026-04277-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11739-026-04277-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-026-04277-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T11:07:00Z","timestamp":1781262420000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11739-026-04277-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":46,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["4277"],"URL":"https:\/\/doi.org\/10.1007\/s11739-026-04277-2","relation":{},"ISSN":["1828-0447","1970-9366"],"issn-type":[{"value":"1828-0447","type":"print"},{"value":"1970-9366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]},"assertion":[{"value":"18 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The Ethics Committee of the Universit\u00e0 Politecnica delle Marche (Comitato Unico Regionale\u2014ASUR Marche, No. 1970\/AV2) and the review boards of all participating centers approved this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights statement"}},{"value":"Informed consent were obtained from the patients to utilize their medical records for the purpose of this article.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}