Introduction: Fibromyalgia (FM) is a multifactorial syndrome involving chronic pain and psychological distress. Psychological traits such as anxiety, depression, and catastrophising are linked to symptom severity. Genetic variability may contribute to these dimensions through mechanisms related to pain modulation and stress response. Objectives: To examine associations between selected genetic polymorphisms and psychological variables in women with FM. Methods: A cross‐sectional study was conducted in 67 women diagnosed with FM. Pain intensity, FM impact and psychological variables—anxiety, depression and catastrophising—were assessed using validated questionnaires. Saliva samples were collected and 10 SNPs were genotyped ( COMT rs4680, DRD3 rs6280, OPRM1 rs1799971, BDNF rs6265, MAOA rs1137070, FKBP5 rs1360780, IL6 rs1800796, TNF rs1800629, IL10 rs1800896, IFITM3 rs12252). Correlations were assessed using Pearson or Spearman coefficients, and associations were examined using ANOVA or Kruskal–Wallis with Tukey or Mann–Whitney post hoc tests. Results: Pain intensity correlated with depression ( r = 0.476, p < 0.001), catastrophising ( r = 0.414, p < 0.001), and anxiety ( r = 0.314, p = 0.009). Catastrophising was related to depression ( r = 0.615, p < 0.001), anxiety ( r = 0.453, p < 0.001), and kinesiophobia ( r = 0.445, p < 0.001). BDNF rs6265 was associated with catastrophising ( p = 0.044), OPRM1 rs1799971 with anxiety ( p = 0.030), and MAOA rs1137070 with depression ( p = 0.020). Conclusions: Psychological variables in FM are interrelated and linked to pain perception. BDNF , OPRM1 and MAOA polymorphisms are associated with indices of psychological vulnerability, underscoring the importance of integrating genetic and psychological perspectives to understand variability in FM. Significance Statement: Genetic variability influences psychological vulnerability in fibromyalgia. Specific variants were associated with key psychological traits: BDNF rs6265 with pain catastrophising, OPRM1 rs1799971 with anxiety, and MAOA rs1137070 with depressive symptoms. These findings reveal an interplay between genetic and psychological factors that may guide more personalised strategies for managing fibromyalgia.

Background and Objectives: Osteoarthritis (OA) of the knee and hip is a major cause of pain and functional impairment. This study evaluated the effects of non-immersive virtual reality (NIVR) combined with conventional physical therapy (CPT) on pain intensity, mechanical hyperalgesia, and perceived recovery in older adults with OA. Materials and Methods: Sixty older adults with mild-to-moderate knee or hip OA were randomly assigned to a NIVR group (NIVR-G; n = 30) or a CPT group (CPT-G; n = 30). Both groups completed 30 sessions over 10 weeks (3 sessions/week). The NIVR-G performed 20 minutes of exergames integrated into CPT. Pain intensity was assessed using the Visual Analog Scale (VAS), and mechanical hyperalgesia was evaluated through pressure pain thresholds (PPTs). Secondary outcomes included the Global Rating of Change (GRoC) and the minimal clinically important difference (MCID) for the VAS. This study is a secondary analysis of a randomized controlled trial registered at ClinicalTrials.gov (ID: NCT05839262). Results: The NIVR-G demonstrated significant reductions in pain intensity after 30 sessions (p < 0.05, d = 1.50), with greater improvements compared to the CPT-G (p < 0.05, d = 1.17). The MCID for the VAS was established at 9.2 mm, with a higher proportion of responders in the NIVR-G (p < 0.05). The NIVR-G also reported superior recovery perception on the GRoC scale (p < 0.05). No significant changes in PPTs were observed in either group. However, the improvements in the NIVR-G diminished four weeks post-intervention. Conclusions: NIVR exergames combined with CPT significantly reduced pain intensity, improved perceived recovery, and resulted in a higher proportion of responders compared to CPT alone. These findings support the use of NIVR as an effective adjunct to CPT in older adults with OA; however, further research is needed to optimize its long-term benefits.

Background. Manual therapy (MT) is a treatment recommended by clinical practice guidelines in the management of patients with neck pain. However, the mechanisms through which MT works remain unknown. The aim of the present study is to investigate if MT is mediated by mechanisms related to conditioned pain modulation (CPM), comparing the effects of painful with a pain-free MT treatment. Methods. A two-arm, parallel, randomized controlled clinical trial with concealed allocation and blinding of the outcome assessor was conducted in university students with chronic or recurrent nonspecific neck pain (NSNP). Participants received either a painful or pain-free MT session. Psychophysical variables including pressure pain thresholds, CPM, temporal summation of pain and cold pain intensity were assessed before and immediately after treatment. In addition, changes in neck pain intensity over the following 7 days and self-perceived improvement immediately and 7 days after treatment were assessed. Results: No significant differences were found between groups in any of the psychophysical variables or in patients’ self-perceived improvement. Only a significantly greater decrease in neck pain intensity immediately after treatment was found in the pain-free MT group compared to the painful MT group. Conclusion: The results suggest that the immediate and short-term effects of MT on NSNP are not mediated by CPM-related mechanisms.

Objective: The aim of this study is to assess whether pain-inducing manual pressure (PIMP) leads to effects on pressure pain threshold (PPT) mediated by conditioned pain modulation (CPM) and whether these effects are influenced by the intensity and repetition of the stimulus. Additionally, the influence of psychological factors and physical activity on the response to PIMP was explored. Methods: A total of 72 pain-free students were randomly assigned to three crossover trials. Trial 1 compared the effects of PIMP with the cold pressor task and pain-inducing electrostimulation. Trial 2 compared the effects of manual pressure that elicited moderate pain, mild pain, and no pain. Trial 3 compared a single PIMP stimulation with four stimuli applied at the same site or at different sites. Results: PIMP produced a lower increase in PPT than cold pressor task and no difference with electrostimulation. Manual pressure that caused moderate pain led to a greater increase in PPT compared to mild pain and pain-free application. Repetition of PIMP stimulus, whether at the same or different sites, did not significantly increase PPT compared to a single stimulation. No association with psychological factors or physical activity was found. Conclusions: PIMP produces an increase in PPT, suggesting the involvement of CPM-related mechanisms.

Background: Plantar fasciitis (PF) is the leading cause of chronic heel pain in adults, impairing mobility and quality of life. Radial extracorporeal shockwave therapy (rESWT) is widely used in physiotherapy for its practicality and cost-effectiveness. However, heterogeneity in study designs and protocols limits conclusions regarding its efficacy compared with other electrophysical modalities (EPMs). This systematic review and meta-analysis aimed to synthesize the immediate effects of rESWT, alone or combined with conventional physiotherapy, versus other EPMs, focusing on pain and functional outcomes. Methods: A systematic search of PubMed, CINAHL, Scopus, Web of Science, and PEDro was conducted up to April 2025 to identify randomized controlled trials (RCTs) comparing rESWT, alone or combined with non-electrophysical interventions, versus other EPMs in adults with PF. Pain intensity and functional disability were the primary outcomes. Meta-analyses were performed using random-effects models, with sensitivity analyses conducted according to outcome type and comparator. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: Fourteen RCTs (n = 797) were included, of which 12 contributed to the meta-analysis. Radial extracorporeal shockwave therapy did not demonstrate superiority over other EPMs for pain reduction (standardized mean difference [SMD] = −0.03; 95% confidence interval [CI]: −0.39 to 0.33) or functional improvement (SMD = −0.11; 95% CI: −0.47 to 0.25). Low-level laser therapy showed small but statistically significant advantages over rESWT for functional outcomes. Overall risk of bias (RoB) was high across most studies. Conclusions: Radial extracorporeal shockwave therapy, alone or combined with physical therapy, does not appear superior to other EPMs for PF. The high heterogeneity and overall elevated RoB limit the certainty of these findings, highlighting the need for high-quality trials to guide clinical recommendations. Level of Evidence: Level I: Systematic Review