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In fibromyalgia, stress and cold exposure are commonly associated with worsening pain and fatigue. Stress can lead to increased levels of pain perception due to its effects on the body's pain processing pathways. Psychological stress may also cause a flare-up of fibromyalgia symptoms by affecting sleep quality, increasing muscle tension, and exacerbating fatigue. Cold exposure can trigger symptoms as well, as many individuals with fibromyalgia report heightened sensitivity to cold temperatures, which can lead to increased muscle stiffness and pain.

On the other hand, high caffeine intake may not have a direct correlation with worsening symptoms in all patients with fibromyalgia; responses to caffeine can vary widely among individuals. Complete rest and relaxation, while appealing, can sometimes lead to deconditioning and increased fatigue, rather than alleviating symptoms. High-impact physical exercise, while beneficial in moderation for many, can sometimes overwhelm those with fibromyalgia and potentially worsen pain if performed excessively. Thus, the effects of stress and cold exposure are significant factors in significantly impacting the overall state of individuals suffering from fibromyalgia.