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

Abstract

This article aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in fibromyalgia. The PubMed, Medline, Cochrane Library, and Web of Science databases were searched for articles published through 14 August 2021. We enrolled only randomized controlled trials. The Cochrane Collaboration risk of bias tool was used for quality assessment. Outcomes were analyzed as standardized mean differences (SMDs) with 95% CIs. The beta coefficient and p value were adopted for meta-regression. We included 18 studies comprising 643 participants. A significant reduction in disease influence, as measured by the Fibromyalgia Impact Questionnaire, was observed (SMD, −0.700, 95% CI, −1.173 to −0.228), and the reduction was larger in older patients (β = −0.1327, p = 0.008). The effect persisted at least two weeks after the final treatment session (SMD, −0.784, 95% CI, −1.136 to −0.432). Reductions in pain, depression, and anxiety were discovered, which persisted for at least two weeks after the last intervention. The effects on pain and depression remained significant up to one and a half months after the final session. No serious adverse events were reported by the included articles. In conclusion, our systematic review and meta-analysis revealed that rTMS is safe and effective for managing multiple domains of fibromyalgia-related symptoms and older patients may have a stronger treatment effect. Larger randomized controlled trials with sufficient male populations are warranted to confirm our findings, detect rare adverse events, and determine the optimal stimulation parameters.

Analgesic Effects of Repetitive Transcranial Magnetic Stimulation in Patients With Advanced Non-Small-Cell Lung Cancer: A Randomized, Sham-Controlled, Pilot Study

“…DLPFC directly promotes or inhibits pain through coordination with these brain regions or through modulating the activity of pain descending inhibition pathways ( 31 ). Therefore, DLPFC-rTMS was able to reduce pain sensation, as supported by several recent studies, like spinal cord injury ( 12 ), migraine ( 13 ) and fibromyalgia ( 14 ). In this study, we hypothesized that DLPFC-rTMS may also be effective in the treatment of cancer pain and thus conducted this trial.…”

“…Usually, low frequency (< 1Hz) stimulation has an inhibitory effect on the brain, while high frequency (> 5Hz) stimulation excite neurons ( 11 ). It has been reported that rTMS relieves various types of pain, such as neuropathic pain after spinal cord injury, stroke or postoperative of trigeminal nerve ( 12 ), migraine ( 13 ), fibromyalgia ( 14 ) and chronic musculoskeletal pain ( 15 ). Even less clinical study has been done on the application of rTMS in patients with cancer pain.…”

Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex beyond Motor Rehabilitation: A Review of the Current Evidence

“…Fibromyalgia syndrome (FMS) is a severe widespread pain associated with sleep disorders and cognitive dysfunction [ 54 ]. Two recent meta-analyses concluded that high-frequency rTMS over the left M1 effectively relieved pain and improved the quality of life in patients with FMS [ 56 , 57 ]. The improvement in FMS symptomology was associated with changes in resting-state connectivity and metabolism in sensory, affective, and cognitive brain processing areas, as shown in fMRI [ 58 ] and PET scans [ 59 ].…”

“…In two recent meta-analyses, fatigue severity scales (FSS) did not show significant improvement following rTMS in fibromyalgia syndrome (FMS) patients [ 56 , 57 ]. However, neither of these studies conducted a subgroup analysis on the effect of targeting M1 and only included FSS as an outcome measure for fatigue, which was used in a single M1-rTMS study.…”

“…Among them, only two studies reported a significant antidepressant efficacy following M1-rTMS in patients with chronic spinal cord injury and failed back surgery syndrome [ 43 ]. While in patients with fibromyalgia syndrome (FMS), two recent meta-analyses showed conflicting results regarding the effect of rTMS on anxiety and depression [ 56 , 57 ]. However, neither of these studies conducted a subgroup analysis for the effect of targeting M1 on anxiety and depression.…”