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Short-term Effects of a Manual Therapy Protocol on Pain, Physical Function, Quality of Sleep, Depressive Symptoms, and Pressure Sensitivity in Women and Men With Fibromyalgia Syndrome: A Randomized Controlled Trial

Castro-Sánchez, Adelaida M. PT, PhD*; Aguilar-Ferrándiz, María E. PT; Matarán-Peñarrocha, Guillermo A. PT, PhD; Sánchez-Joya, María del Mar PT*; Arroyo-Morales, Manuel PhD, MD; Fernández-de-las-Peñas, César PT, MSc, PhD§,∥

The Clinical Journal of Pain: July 2014 - Volume 30 - Issue 7 - p 589–597
doi: 10.1097/AJP.0000000000000008
Original Articles

Objective: To investigate the therapeutic effects of a manual therapy protocol for improving pain, function, pressure pain thresholds (PPT), quality of sleep, and depressive symptoms in women and men with fibromyalgia syndrome (FMS).

Materials and Methods: Eighty-nine patients were randomly assigned to experimental or control group. The experimental group (24 female, 21 male) received 5 sessions of manual therapy and the control group (24 female, 21 male) did not receive any intervention. PPT, pain, impact of FMS symptoms, quality of sleep, and depressive symptoms were assessed in both groups at baseline and after 48 hours of the last intervention in the experimental group.

Results: The analysis of covariance found significant Group×Time×Sex interactions for McGill PPI and Center for Epidemiologic Studies Depressive Symptoms Scale (P<0.01) was also found: men exhibited a larger effect size for depressive symptoms than women, whereas women exhibited a greater effect size than men in the McGill PPI. A significant Group×Time×Sex interaction for PPT over suboccipital, upper trapezius, supraspinatus, second rib, gluteal region, and tibialis anterior muscle was also found: men included in the experimental group experienced significant greater improvements in PPT as compared with women with FMS in the experimental group.

Conclusions: Manual therapy protocol was effective for improving pain intensity, widespread pressure pain sensitivity, impact of FMS symptoms, sleep quality, and depressive symptoms. In addition, sex differences were observed in response to treatment: women and men get similar improvements in quality of sleep and tender point count, whereas women showed a greater reduction in pain and impact of FMS symptoms than men, but men reported higher decreases in depressive symptoms and pressure hypersensitivity than women.

Departments of *Nursing, Physical Therapy and Medicine, Facultad de Ciencias de la Salud

Physical Therapy, Universidad de Granada

Servicio Andaluz de Salud, Granada

§Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine

Esthesiology Laboratory, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

The authors declare no conflict of interest.

Reprints: Adelaida M. Castro-Sánchez, PT, PhD, Department of Nursing, Physical Therapy and Medicine, Facultad de Ciencias de la Salud, Universidad de Almería, Carretera de Sacramento s/n, Almería 04120, Spain (e-mail:

Received February 6, 2013

Accepted August 2, 2013

© 2014 by Lippincott Williams & Wilkins