Effectiveness of High-Frequency Transcranial Magnetic Stimulation and Physical Exercise in Women With Fibromyalgia: A Randomized Controlled Trial

Abstract

Objective: Fibromyalgia (FM) is characterized by chronic widespread pain and both physical and emotional alterations, which in turn may affect the individual’s quality of life. Thus, interventions aimed at treating such symptoms, without increasing fatigue, are needed. The aim of this study was to explore the effect of high-frequency transcranial magnetic stimulation (HF-TMS) and physical exercise (PE) on pain, impact of FM, physical conditioning, and emotional status in people with FM. Methods: Forty-nine women with FM were randomly allocated to a PE group (PEG, n = 16), who underwent an 8-week (two 60-minute sessions/week) low intensity PE program; TMS group (TMSG, n = 17), receiving a 2-week (five 20-minute sessions/week) HF-TMS intervention and a control group (CG, n = 16). Pain (ie, perceived pain and average pressure pain threshold (PPT), perceived impact of FM (ie, overall impact, symptoms, and perceived physical function), physical conditioning (ie, endurance and functional capacity, fatigue, gait velocity, and power) and emotional status (ie, anxiety, depression, stress, and satisfaction) were assessed at baseline (T1) and after the intervention (T1, at 2 weeks for TMSG and at 8 weeks for PEG and CG). Results: TMSG showed to significantly improve all studied variables after the intervention except for satisfaction, whereas PEG improved average PPT, perceived overall impact of FM and total score, endurance and functional capacity, velocity and power, anxiety, depression, and stress. In contrast, the CG showed no improvements in any variable. Conclusions: Both PE and HF-TMS are effective in improving pain, impact of FM, physical conditioning, and emotional status in people with FM, while HF-TMS achieved larger improvements in emotional status than PE.

Efficacy of Repetitive Transcranial Magnetic Stimulation in Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…The initial search returned 455 articles. Eighteen RCTs [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] with 643 participants entered qualitative synthesis (Figure 1). Two studies [11,18] included two intervention arms; therefore, the control groups for this research were divided for separate comparisons, creating 20 comparisons in total.…”

“…The number of participants ranged from 15 to 86, and the mean age ranged from 40.4 to 53.9 years. Three studies [12,13,17] recruited fibromyalgia patients diagnosed with the 2016 ACR criteria. One article enrolled participants with fibromyalgia diagnosed with the 2011 ACR criteria [18].…”

“…Nine articles [11,13,15,16,19,21,[25][26][27] did not state whether the allocation was concealed. The participants or research team were not blinded in four investigations [12,21,23,25], and blinding was not mentioned in detail in one report [11]. In two studies, outcome assessment blinding was not explained [11,23].…”

“…The FIQ/FIQR score was mentioned for 13 comparisons derived from 11 articles [11][12][13][14][15][17][18][19][20]24,25]. For 11 comparisons, the FIQ/FIQR scores reported after treatment were significantly lower in the rTMS group (SMD, −0.700, 95% CI, −1.173 to −0.228, I 2 = 62.8%; Figure 3).…”

“…Randomized controlled trials (RCTs) have reported that rTMS can alleviate fibromyalgiarelated symptoms with few adverse events [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Although the mechanism of action of rTMS in fibromyalgia is not fully understood yet, it is believed to modulate the brain areas associated with affective-emotional components of pain, as well as activating the endogenous opioid analgesic system through mediating the motor cortex [28].…”