Pressure Point Thresholds and ME/CFS Comorbidity as Indicators of Patient's Response to Manual Physiotherapy in Fibromyalgia.

Observed Findings

• Patients with lower baseline pain sensitivity (higher algometer thresholds) showed better treatment response to the manual therapy protocol.
• Patients with fibromyalgia alone responded better to the therapy than patients with both fibromyalgia and comorbid ME/CFS.
• The intervention appeared to improve FM hyperalgesia/allodynia and quality of life measures in responders.
• Baseline pressure point thresholds inversely correlated with treatment outcome.
• ME/CFS comorbidity emerged as an unexpected negative predictor of physiotherapy response in post-stratification analysis.

Inferred Conclusions

• Baseline pain sensitivity (measured by PPT) and ME/CFS comorbidity status may serve as predictive indicators of whether a patient will respond to mechanical trigger-based manual physiotherapy.
• Current drug-based treatments for FM have limitations, and physiotherapy could be a useful adjunctive or alternative approach—but only for specific patient subgroups.
• Differential treatment responses between FM and FM+ME/CFS cohorts suggest distinct or at least divergent pathophysiological mechanisms between these conditions.
• Gene expression profiling may reveal molecular mechanisms underlying differential treatment responsiveness.

Remaining Questions