Effects of High-Frequency Neuronavigated Repetitive Transcranial Magnetic Stimulation in Fibromyalgia Syndrome

Abstract

Objective The primary aim of the study was to investigate the effect of 10-Hz repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex on pain in fibromyalgia. Secondary aims were to determine its effects on stiffness, fatigue, quality of life, depression/anxiety, and cognitive functions. Design Twenty participants were randomized into two groups. Group A received 10-Hz repetitive transcranial magnetic stimulation to left dorsolateral prefrontal cortex and group B received sham stimulation. Visual analog scale for pain, visual analog scale–stiffness, Fibromyalgia Impact Questionnaire, and Fatigue Severity Scale were assessed at the baseline, 2nd, and 6th weeks, whereas Hospital Anxiety Depression Scale and Addenbrooke’s cognitive examination were assessed at the baseline and 6th week. Results There was no significant difference in visual analog scale–pain and Fatigue Severity Scale within and between groups over time (P > 0.05). In group A, significant improvement was found in visual analog scale–stiffness and fibromyalgia impact questionnaire at the 2nd week in comparison to the baseline (P < 0.05). However, no significant difference was detected in comparison with group B. There was no significant change in Hospital Anxiety Depression Scale scores between and within groups. All cognitive measures were similar in terms of differences from baseline between the groups (P > 0.05). Conclusions High-frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex did not show any significant beneficial effect on pain, stiffness, fatigue, quality of life, mood, and cognitive state over sham stimulation.

High-frequency rTMS over the dorsolateral prefrontal cortex on chronic and provoked pain: A systematic review and meta-analysis

“…In one study, DLPFC-rTMS was able to reduce fibromyalgia stiffness but not pain intensity [6]. A recent study has also explored the efficacy of low-frequency rTMS in the management of fibromyalgia, demonstrating a significant pain reduction in the active group [69].…”

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].…”

“…Three of the articles [11,19,21] did not report a method for random sequence generation (Figure 2). 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].…”

“…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].…”