Background <p>Fibromyalgia (FM) is a chronic pain disorder that is marked by psychological distress. While previous research has predominantly focused on negative outcomes such as anxiety and depression, this study investigates the role of positive psychological constructs—hope, optimism, and emotional regulation—in relation to pain perception among individuals with FM.</p> Objectives <p>The study aims to find the relationship between hope, optimism, emotional regulation, and pain in patients with fibromyalgia.</p> Methods <p>A total of 270 patients with FM were included in the study. The present study used the Adult Hope Scale, Life Orientation Test—Revised, Emotional Regulation Questionnaire, and Fibromyalgia Impact Questionnaire Revised to measure hope, optimism, emotional regulation, and pain, respectively. Spearman’s correlations were used to explore the relationship between psychological variables and pain severity.</p> Results <p>Hope showed a moderate negative correlation with pain, <i>r</i> =  − .34, 95% CI [− .44, − .23], <i>p</i> &lt; .001, indicating that individuals with higher levels of hope experienced lower pain. The study found a weak negative correlation of optimism with pain, <i>r</i> =  − .12, 95% CI [− .15, − .09], <i>p</i> = .042.</p> Conclusion <p>These findings suggest that hope plays a pivotal role in modulating pain experiences in FM and should be considered in treatment planning. The study emphasizes the need for multidisciplinary care that integrates cognitive-behavioral techniques, emotion regulation training, and resilience-building exercises for symptom management and overall wellbeing of the patient with chronic pain. The study accounted for age and gender in the analysis; however, other confounding variables such as socioeconomic status, education, disease duration, and comorbidities like depression, anxiety, and social and relational factors were not measured. These factors may influence both psychological outcomes and pain perception.</p> Trial registration <p>The trial was registered in the clinical trial registry in India. CTRI Registration CTRI/2025/02/081217 (Registered on: 24/02/2025). The link of the trial registry is <a href="https://ctri.nic.in/">https://ctri.nic.in/</a></p> <p><Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> <p><b>Key Points</b></p> </entry> </row> <row> <entry align="left" colname="c1"> <p>• <i>Hope and optimism may both serve as psychological resources that help regulate the severity of pain</i>.</p> <p>• <i>Pain outcomes may not be shaped by emotional regulation alone</i>.</p> <p>• <i>Routine assessment of hope and optimism may add value to fibromyalgia management protocols</i>.</p> </entry> </row> </tbody> </tgroup> </Table></p>