Analgesic effects of repetitive transcranial magnetic stimulation on modified 2010 criteria‐diagnosed fibromyalgia: Pilot study

Abstract

Aim Fibromyalgia is often comorbid with depression, and less than half those patients achieve satisfactory improvement after adequate pharmacological intervention. The investigation of repetitive transcranial magnetic stimulation (rTMS) at left dorsolateral prefrontal cortex for modified‐2010 American College of Rheumatology (ACR) fibromyalgia and major depressive disorder (MDD) is still in its infancy. Methods In this double‐blind, randomized, sham‐control study, subjects diagnosed with ACR‐2010 fibromyalgia and DSM‐IV‐TR MDD were recruited and received either active or sham interventions for 2 weeks. Hamilton Depression Rating Scale (HDRS) and the 10‐cm visual analogue pain scale were evaluated at baseline, week 1, and week 2. Multivariable generalized estimating equations analysis was performed for the association between depression and pain scores at each checkpoint. Results Twenty subjects were recruited. There was a significant difference over the 2 weeks between the rTMS and sham stimulation groups (P = 0.029), but subgroup analyses were further performed due to significant interaction of group and HDRS on pain outcomes (P = 0.020). The active group had significant improvement in pain at week 2 compared with week 1 (P = 0.021), but the control group did not have any improvement in pain (P = 0.585). Of the mild–moderate depression patients, the pain score in the active group was significantly lower than in the sham group at week 1 (P = 0.001) and at week 2 (P < 0.001). For the severe depression group, there was significantly lower pain over the 2 weeks in the active group (P = 0.045) but the sham group had significantly relapsing pain at week 2 (P < 0.001). Conclusion Left prefrontal rTMS has an analgesic effect in modified‐ACR 2010‐defined fibromyalgia and MDD patients. Further investigation is required, however, in order to determine how to regulate the different rTMS treatment protocols according to individual baseline depression severity in patients with MDD and fibromyalgia.

Differential Neuroplastic Changes in Fibromyalgia and Depression Indexed by Up-Regulation of Motor Cortex Inhibition and Disinhibition of the Descending Pain System: An Exploratory Study

“…A similar effect was found when the invasive chronic motor cortex stimulation decreased the thalamic hyperactivity in patients with thalamic pain (Tsubokawa et al, 1993). Aligned with this assumption, we found extensive literature showing that the transcranial stimulation (i.e., tDCS and TMS) might improve the disrupted neurochemical processes in chronic pain (Cheng et al, 2010).…”

“…Besides, it can help to personalize the therapeutic approach. Despite the absence of a FDA-approved neuromodulation protocol targeted to patients with comorbidity MDD and FM, the effectiveness of neuromodulatory techniques (i.e., tDCS and TMS) has been supported by consistent evidence to treat both FM and depression (Kauffmann et al, 2004; Antal et al, 2010; Brunoni et al, 2011; Marie, 2014; Fagerlund et al, 2015; Castillo-Saavedra et al, 2016; Cheng et al, 2018; Karina do Monte-Silva et al, 2019). Considering that these two disorders are frequently overlapped, it poses a considerable challenge to decide if it would be better to stimulate the M1 or the dorsal lateral prefrontal cortex for the treatment of pain accompanied by depression.…”

Effect of Repetitive Transcranial Magnetic Stimulation on Pain Management: A Systematic Narrative Review

“…Notably, the decrease in VAS scores was significantly prominent in patients who received M1 rTMS stimulation, whereas improvement in physical function was significant in patients who received DLPFC rTMS stimulation. A similar RCT was performed in the same year by Cheng et al (61) that included 20 patients with FM who also had major depressive disorder (MDD). This study showed that pain was significantly improved in patients who received 10-Hz rTMS over the left DLPFC (nine patients) over 2 weeks as compared with that in patients who received sham stimulations (11 patients).…”

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.…”

“…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].…”