Is the Transcranial Magnetic Stimulation an Adjunctive Treatment in Fibromyalgia Patients?

Abstract

ÖzetAmaç: Medikal tedaviye dirençli fibromiyalji hastalarında motor korteks alana uygulanan düşük frekanslı tekrarlayıcı transkraniyal manyetik stimülasyonun (tTMS) etkinliğini araştırmak. Gereç ve Yöntemler: Toplam 25 hasta randomize olarak aktif ve plasebo gruplarına ayrılarak çalışmaya alındı. Aktif tTMS grubu için stimülasyon sol primer motor korteks üzerinden motor eşik değerin %90'ı hesaplanarak 1 Hz ve 20 dakika uygulandı. Her seansta 1200 uyarı olmak üzere, iki hafta boyunca toplam 10 seans tedavi uygulandı. Plasebo grup için, parabolik koil 90° açı ile motor kortekse yerleştirildi ve aynı şekilde toplam 10 seans stimülasyon uygulandı. Sonuçlar, ağrı için vizüel analog skalası (VAS), Fibromiyalji Etkinlik Anketi (FIQ) ve Beck Depresyon Skalası (BDS) ile değerlendirildi. Bulgular: Her iki grupta da tedavi sonunda, 1 ve 3. ay sonunda ağrı derecesinde, FIQ ve BDS'de anlamlı iyileşme gözlendi. Ancak, aktif tTMS grubunda iyileşme plasebo gruba göre daha iyiydi. Tedavi sonu FIQ skorlarında aktif grupta, plasebo gruba göre istatistiksel olarak anlamlı iyileşme gözlendi. Diğer değerlendirmelerde gruplar arasında istatistiksel farklılık saptanmadı. Sonuç: Primer motor korteks üzerine düşük doz tTMS uygulamasının uzun süreli takiplerde fibromiyalji hastalarında plaseboya göre anlamlı iyileşme göstermediği görülmüştür. Anahtar Kelimeler: Fibromiyalji, transkraniyal manyetik stimülasyon, ağrı AbstractObjective: To investigate the effectiveness of low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) to the motor cortex area in fibromyalgia patients who are resistant to medical treatment. Material and Methods: A total of 25 patients were randomly assigned to the study, who were in the active rTMS (n=13) or sham stimulation (n=12) group. For the rTMS group, the main stimulation parameters were 90% of motor threshold for 60 seconds at 1 Hz and a 45-second interval between each train. Ten sessions of low-frequency rTMS, which had a total of 1200 pulses at each session, were applied to the left primary motor cortex area daily over a period of 2 weeks. For the sham group, the same parabolic coil was placed at 90° angles to the motor cortex area, and the patients received 10 sessions of sham stimulation. The outcome parameters were pain intensity, which was measured by visual analog scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), and the Beck Depression Inventory (BDI). Results: A significant improvement in pain intensity, FIQ, and BDI scores was seen at the 10 th day and first and third months in both groups. Although the mean of parameters of the rTMS groups was better than the sham group, the difference did not reach statistical significance, except FIQ scores at the 10 th day in the real rTMS group. Conclusion: Patients with fibromyalgia who enroll in real TMS did not present significant differences in long-term follow-ups with respect to those who enrolled in the sham TMS group.

Non-invasive brain stimulation techniques for chronic pain

“…We included 38 new studies in this review. Of these, 12 studies (355 participants) investigated only rTMS (Boyer 2014; Dall'Agnol 2014; de Oliveira 2014; Jetté 2013; Malavera 2013; Medeiros 2016; Nardone 2017; Nurmikko 2016; Tekin 2014; Umezaki 2016; Yagci 2014; Yilmaz 2014), 22 studies (772 participants) investigated tDCS (Ahn 2017; Ayache 2016; Bae 2014; Brietzke 2016; Chang 2017; Donnell 2015; Fagerlund 2015; Hagenacker 2014; Harvey 2017; Hazime 2017; Jales Junior 2015; Khedr 2017; Kim 2013; Lagueux 2017; Luedtke 2015; Mendonca 2016; Ngernyam 2015; Oliveira 2015; Sakrajai 2014; Souto 2014; Thibaut 2017; Volz 2016) one study (36 participants) investigated tDCS and rTMS (Attal 2016), two studies (16 participants) investigated tRNS (Curatolo 2017; Palm 2016) and one study investigated RINCE (Deering 2017, 46 participants). Overall this updated review included 94 studies (2983 participants), with 42 trials of rTMS (1101 participants), 36 trials of tDCS (1073 participants), 11 studies of CES (572 participants), one study (36 participants) of both rTMS and tDCS, two studies of RINCE (137 participants) and two studies of tRNS (36 participants).…”

“…Where we were unable to obtain this information we placed these records in Studies awaiting classification. One report previously placed in Studies awaiting classification was identified as a full paper and included in this review (Yagci 2014).…”

“…There was a mixture of parallel and cross‐over study designs. For rTMS there were 22 parallel studies (Ahmed 2011; Avery 2013; Boyer 2014; Carretero 2009; Dall'Agnol 2014; Defrin 2007; de Oliveira 2014; Fregni 2011; Khedr 2005; Lee 2012; Malavera 2013; Medeiros 2016; Mhalla 2011; Nardone 2017Passard 2007; Picarelli 2010; Short 2011; Tekin 2014; Tzabazis 2013; Umezaki 2016; Yagci 2014; Yilmaz 2014), and 20 cross‐over studies (André‐Obadia 2006; André‐Obadia 2008; André‐Obadia 2011; Borckardt 2009; Fregni 2005; Hirayama 2006; Hosomi 2013; Irlbacher 2006; Jetté 2013; Kang 2009; Lefaucheur 2001a; Lefaucheur 2001b; Lefaucheur 2004; Lefaucheur 2006; Lefaucheur 2008; Nurmikko 2016; Onesti 2013; Pleger 2004; Rollnik 2002; Saitoh 2007). For CES there were eight parallel studies (Gabis 2003; Gabis 2009; Katsnelson 2004; Lichtbroun 2001; Rintala 2010; Tan 2006; Tan 2011; Taylor 2013), and three cross‐over studies (Capel 2003; Cork 2004; Tan 2000), of which we considered two as parallel studies, with only the opening phase of the study considered in this review because subsequent phases were unblinded (Capel 2003; Cork 2004).…”

“…One study included a mix of participants with central and facial neuropathic pain (Lefaucheur 2001a), six rTMS studies included only participants with central neuropathic pain (Defrin 2007; de Oliveira 2014; Jetté 2013; Kang 2009; Nardone 2017, Yilmaz 2014 ), one included only participants with peripheral neuropathic pain (Borckardt 2009), and one study included participants with burning mouth syndrome (Umezaki 2016). Sixteen studies included non‐neuropathic chronic pain including fibromyalgia (Boyer 2014; Carretero 2009; Lee 2012; Mhalla 2011; Passard 2007; Short 2011; Tekin 2014; Tzabazis 2013; Yagci 2014), chronic widespread pain (Avery 2013), chronic pancreatitis pain (Fregni 2005; Fregni 2011), chronic myofascial pain (Dall'Agnol 2014; Medeiros 2016) and complex regional pain syndrome type I (CRPSI) (Picarelli 2010; Pleger 2004). Two studies included only phantom limb pain (Ahmed 2011; Malavera 2013).…”

“…Finally one study included a mix of peripheral neuropathic and non‐neuropathic chronic pain (Rollnik 2002), including one participant with phantom limb pain and one with osteomyelitis. The majority (21) of rTMS studies specified chronic pain that was refractory to current medical management (André‐Obadia 2006; André‐Obadia 2008, André‐Obadia 2011; Defrin 2007; Hirayama 2006; Hosomi 2013; Kang 2009; Khedr 2005; Lefaucheur 2001a; Lefaucheur 2001b; Lefaucheur 2004; Lefaucheur 2006; Lefaucheur 2008; Nardone 2017; Nurmikko 2016; Onesti 2013; Picarelli 2010; Rollnik 2002; Saitoh 2007; Yagci 2014; Yilmaz 2014). This inclusion criterion was varyingly described as intractable, resistant to medical intervention or resistant to drug management.…”