{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:51:11Z","timestamp":1790419871936,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T00:00:00Z","timestamp":1676505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>It has been suggested that spinal manipulation may alter sensorimotor integration in the central nervous system and therefore may be used to treat central sensitization syndromes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the effectiveness of spinal manipulation in addition to pharmacological treatment in patients with fibromyalgia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A single\u2010center, randomized, and placebo\u2010controlled trial with three parallel arms<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Outpatient clinics at a tertiary health care facility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Female patients aged 18\u201055\u2009years receiving pharmacological treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Spinal manipulation, sham manipulation, and control groups. Patients in the spinal manipulation group received high\u2010velocity low\u2010amplitude manipulation treatment twice a week for 3\u2009weeks. Patients in the sham group received an application that was very similar to the active treatment but was not expected to have any real therapeutic effect. Patients in the control group continued to receive pharmacological therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The primary outcome, pain score (visual analog scale), and secondary outcomes, pressure pain threshold (PPT), Revised Fibromyalgia Impact Questionnaire (FIQR), Widespread Pain Index (WPI), and Fibromyalgia Severity Score (FSS) were measured before, 1 month, and 3 months after randomization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty patients with a mean age of 41.7\u2009years (SD\u00a0=\u00a08.0) were enrolled in the study. A mixed\u2010design repeated analysis of covariance was used to test the data. At 1 month after randomization, pain scores did not differ between groups. At 3 months after randomization, the spinal manipulation group had a significantly lower pain score (adjusted mean\u00a0=\u00a04.3 cm, SE: 0.4) than the control group (adjusted mean\u00a0=\u00a06.8 cm, SE: 0.4) and the sham manipulation group (adjusted mean\u00a0=\u00a05.7 cm, SE: 0.4). PPT did not differ between groups at any time point. FIQR, WPI, and FSS showed some improvement 1 or 3 months after randomization in favor of the spinal manipulation group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Spinal manipulation used in addition to pharmacological treatment in young\/middle\u2010aged female patients with fibromyalgia could be an effective treatment for pain, disease severity, and functionality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.12953","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T10:39:37Z","timestamp":1674643177000},"page":"342-351","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effectiveness of spinal manipulation in addition to pharmacological treatment in fibromyalgia: A blinded randomized trial"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7467-4073","authenticated-orcid":false,"given":"Bugra","family":"Ince","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Bezmialem Vakif University  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0042-4156","authenticated-orcid":false,"given":"Mert","family":"Kara","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Bezmialem Vakif University  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irem","family":"Erdem","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Bezmialem Vakif University  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4567-8133","authenticated-orcid":false,"given":"Ozan Volkan","family":"Yurdakul","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Bezmialem Vakif University  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0926-5879","authenticated-orcid":false,"given":"Tunay","family":"Erden","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Acibadem Fulya Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0902-6771","authenticated-orcid":false,"given":"Teoman","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Bezmialem Vakif University  Istanbul 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