{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:09:47Z","timestamp":1791950987471,"version":"4.3.4"},"reference-count":53,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["EJIHPE"],"abstract":"<jats:p>Background: The biopsychosocial model positions fibromyalgia (FM) as the result of altered pain modulation shaped by trauma, psychological vulnerability, and structural stressors. The Sense of Coherence (SOC) may be a key resilience factor explaining differences in symptom severity after similar hardships. Objectives: To evaluate whether SOC mediates and\/or moderates associations between trauma-related adversity and symptom burden in FM and whether comorbidities, medication use, healthcare factors, or treatment engagement modify these relationships. Methods: In this cross-sectional study, 2099 women with FM completed an online survey assessing adversity, psychosocial factors, core symptoms, healthcare support, treatment engagement, and medication use. A theory-driven SOC composite followed Antonovsky\u2019s model (comprehensibility, manageability, meaningfulness) using the proxy SOC composite derived from a theory-driven framework that underwent internal construct validation, including discriminant validity analyses and latent structure evaluation, but it was not benchmarked against a gold-standard SOC questionnaire. Linear regression evaluated adversity\u2013symptom associations, SOC mediation, and moderation by SOC and medication classes. Results: Higher adversity predicted lower SOC (e.g., cumulative abuse: B = \u22120.25), and lower SOC predicted higher symptom burden (e.g., Fibromyalgia Impact Questionnaire (FIQ): B = \u22126.77), producing significant indirect effects (cognitive symptoms: 0.22; FIQ: 1.69). SOC also moderated the effects of adversity on fatigue and global impact, weakening associations at higher SOC. Comorbidities showed modest influence: hypertension had minor indirect effects (ab = 0.27), scheduled consultation produced small interactions (cognition \u03b2 = \u22120.38 to \u22120.46; fatigue \u03b2 = ~0.05\u20130.06), and stroke showed the only clinically meaningful moderation (\u03b2 \u2248 4.9\u20135.2), all far smaller than SOC effects. Conclusions: SOC functions as a central psychosocial pathway and resilience-related factor in the association between trauma and FM symptoms. Targeting SOC-related processes may help reduce symptom burden and improve outcomes.<\/jats:p>","DOI":"10.3390\/ejihpe16030045","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T13:07:06Z","timestamp":1774271226000},"page":"45","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sense of Coherence in the Trauma\u2013Fibromyalgia Relationship: Mediation and Moderation Findings from a 2099-Participant Cohort"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5083-4658","authenticated-orcid":false,"given":"Wolnei","family":"Caumo","sequence":"first","affiliation":[{"name":"Post-Graduate Program in Medical Science, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"},{"name":"Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"},{"name":"Pain and Palliative Care Service, Hospital de Cl\u00ednicas de Porto Alegre (HCPA), Porto Alegre 90035-003, Brazil"},{"name":"Surgery Department, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graziele Borges","family":"Bueno","sequence":"additional","affiliation":[{"name":"Post-Graduate Program in Medical Science, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"},{"name":"Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7571-9129","authenticated-orcid":false,"given":"Giordano Mayer De","family":"Freitas","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Teixeira","family":"Lopes","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5170-8283","authenticated-orcid":false,"given":"Mariana Lentino","family":"Coelho","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9495-5257","authenticated-orcid":false,"given":"Julia","family":"Gomes","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7864-0254","authenticated-orcid":false,"given":"Caroline Leffa","family":"Venturini","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0188-9656","authenticated-orcid":false,"given":"Maria Eduarda","family":"Louzada","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1388-978X","authenticated-orcid":false,"given":"Sara Machado","family":"Peres","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3081-115X","authenticated-orcid":false,"given":"Iraci L. 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