Ten sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: A randomized, controlled pilot study

Abstract

Transcranial magnetic stimulation (TMS) of the prefrontal cortex can cause changes in acute pain perception. Several weeks of daily left prefrontal TMS has been shown to treat depression. We recruited 20 patients with fibromyalgia, defined by American College of Rheumatology criteria, and randomized them to receive 4000 pulses at 10Hz TMS (n=10), or sham TMS (n=10) treatment for 10 sessions over 2 weeks along with their standard medications, which were fixed and stable for at least 4 weeks before starting sessions. Subjects recorded daily pain, mood, and activity. Blinded raters assessed pain, mood, functional status, and tender points weekly with the Brief Pain Inventory, Hamilton Depression Rating Scale, and Fibromyalgia Impact Questionnaire. No statistically significant differences between groups were observed. Patients who received active TMS had a mean 29% (statistically significant) reduction in pain symptoms in comparison to their baseline pain. Sham TMS participants had a 4% nonsignificant change in daily pain from their baseline pain. At 2 weeks after treatment, there was a significant improvement in depression symptoms in the active group compared to baseline. Pain reduction preceded antidepressant effects. TMS was well tolerated, with few side effects. Further studies that address study limitations are needed to determine whether daily prefrontal TMS may be an effective, durable, and clinically useful treatment for fibromyalgia symptoms.

Prevalence, clinical features and potential therapies for fibromyalgia in primary headaches

“…The analgesic effects induced by neurostimulation of the motor cortex have shown efficacy in FM [85,86], while the effects induced by dorsolateral prewhile the effects induced by dorsolateral prefrontal cortex modulation are quite uncertain [87]. No data are available on the possible efficacy in patients sharing FM and chronic headache, although the positive effects on psychiatric symptoms of right and left dorsolateral prefrontal cortex neuromodulation may support its potential efficacy on factors favoring comorbidity [88,89].…”

“…The analgesic effects induced by neurostimulation of the motor cortex have shown efficacy in FM [85,86], while the effects induced by dorsolateral prewhile the effects induced by dorsolateral prefrontal cortex modulation are quite uncertain [87]. No data are available on the possible efficacy in patients sharing FM and chronic headache, although the positive effects on psychiatric symptoms of right and left dorsolateral prefrontal cortex neuromodulation may support its potential efficacy on factors favoring comorbidity [88,89].Occipital nerve stimulation is a neuromodulation technique currently under study to treat various migraine headache disorders [90]. In 12 patients sharing migraine and FM, the C2 area stimulation technique resulted in a global improvement of pain and associated symptoms [47].…”

The Irritable Bowel Syndrome: How Stress Can Affect the Amygdala Activity and the Brain-Gut Axis

“…Psychological mind-body interventions including psychotherapy, cognitive behavioral therapy, hypnotherapy, relaxation exercises or mindfulness mediation have been shown to improve symptoms of IBS patients (Kearney and Brown-Chang 2008;Ford 2009;Whorwell 2009). Repetitive transcranial magnetic stimulation of the PFC, based on the central role of the mPFC in cognitive theory of mind, can cause changes in acute pain perception and has been used in a model of central sensitization syndrome such as fibromyalgia (Mhalla, et al 2011;Short, et al 2011) but no data have been currently published in IBS patients. Modulation of the ANS by restoring the sympatho-vagal balance (DeBenedittis, et al 1994;Nishith, et al 2003;Gemignani, et al 2006) as well as modifying coping strategies vigilance state and globally the restoration of a functional brain-gut axis, are at the origin of the efficacy of these treatments.…”

Repetitive transcranial magnetic stimulation in neurology and psychiatry

“…В ис-следовании E. Short и соавт. [111] на 20 пациентах проде-монстрировано достоверное уменьшение болевого син-дрома после 10 сеансов высокочастотной стимуляции ле-вой DLPFC по сравнению с группой плацебо.…”