Transcranial Magnetic Stimulation (TMS) and its cortical targets in the treatment of fibromyalgia: a systematic review

Abstract

Background: Fibromyalgia (FM) is a non-inflammatory disease with unknown etiology expressed by diffuse musculoskeletal pain, whose definition and management are subjects of controversies. Thus we aimed to review the literature on efficacy and main cortical targets of TMS for FM. Methods: A systematic review was carried out in PubMed databases, along with the terms DeCS/MeSH: “Fibromyalgia AND (Transcranial Magnetic Stimu-lation OR TMS)”. Randomized studies and clinical trials published in the last 10 years were selected. After exclusion, 11 articles remained. Results: The references found for TMS in the treatment of FM indicate average reduction in pain symptoms (29%). TMS showed significant improvement in pain measured by visual analog scale and was more advantageous in clinical and functional improvement, but less efficient in psychiatric conditions. In female patients, active use of repetitive high-frequency TMS was significantly better on pain, quality of life (QoL) and depression. Another study showed that 20 sessions produced significantly lasting pain inhibition and improved QoL when operated at 10 Hz. Moreover, the right dorsolateral prefrontal cortex or the left motor cortex can have antidepressant and pain-modulating effects. Evidence also points to an important improvement in physical and general fatigue, as well as greater chance of clinical improvement in pain intensity. Conclusions: Evidence on TMS for FM available so far is promising, with potential to represent a valuable and safe therapeutic option. However, more and larger studies are needed to elucidate mechanisms and effectiveness better