Treating fibromyalgia with electrical neuromodulation: A systematic review and meta-analysis

Cheng, Ying‐Chih; Hsiao, Chia-Ying; Su, Min‐I; Chiu, Chih-Chiang; Huang, Yu‐Chen; Huang, Wei‐Lieh

doi:10.1016/j.clinph.2023.01.011

Cited by 17 publications

(5 citation statements)

References 52 publications

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“…In detail, anode tDCS electrode positions adjacent to DLPFC (and not to M1) revealed a significant effect on mood; TMS showed non-significant effect on depression and anxiety. In addition, age seemed to have a significant influence on the tDCS effects on depression, with older subjects showing lower levels of improvement (43). In addition, another review assessing the effectiveness of 10-Hz repetitive TMS in FM suggested that DLPFC appears to be more effective for analgesia at high frequencies and for mood disturbances at low frequencies (44).…”

Section: Non-pharmacological Therapymentioning

confidence: 99%

“…Settings and modalities of treatment should be modulated on patient's needs and major symptoms (31)(32)(33)(34)(35)(36)(37)(38)(39). • Among electrophysical agents, evidences about the effectiveness of TMS and tDCS (applicated adjacent to DLPFC or to M1) are growing; their mechanisms of action worth to be investigated more (40)(41)(42)(43)(44)(45)(46)(47). • Acupuncture seems to improve pain and other symptoms in FM patients.…”

Section: Take Home Messagesmentioning

confidence: 99%

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Fibromyalgia: one year in review 2024

Di Carlo,

Bianchi,

Salaffi

et al. 2024

Clinical and Experimental Rheumatology

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Fibromyalgia (FM) remains a condition with a pathogenesis that is not completely understood, affecting a significant portion of the global population. This article summarises the main advances in FM during the last year. Even in 2023, research on FM was notably active. From a clinimetric perspective, studies have been conducted to evaluate the possibilities of interchanging the primary indices of disease severity, primarily for studies with substantial case numbers. Regarding FM pathogenesis, ongoing research focuses on small fiber neuropathy: some studies have documented its association with central sensitisation, while others have revealed distinct sensory profiles in patients with FM and small fiber neuropathy compared to those solely with small fiber neuropathy. Dorsal root ganglia seem to play a crucial role in the pathogenesis of FM as they host satellite glial cells, which are targeted by pain-driving immunoglobulin G. These antibodies have been identified in a subset of patients exhibiting high symptom severity. An important study conducted on animal models confirmed the role of neuroinflammation at the level of dorsal root ganglia, in this case mediated by polymorphonuclear neutrophils. Mounting evidence underscores the link between COVID-19 and the persistence of FM symptoms after recovery. In identifying potential biomarkers aiding FM diagnosis, research has also concentrated on studying the expression of specific circulating microRNAs. Recent discoveries have unveiled novel therapeutic strategies for FM, especially focused in non-pharmacological interventions. This includes a focus on non-invasive brain stimulation and exercise programs, all directed towards relieving symptoms and improving functionality in individuals affected by the condition.

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Section: Non-pharmacological Therapymentioning

confidence: 99%

Section: Take Home Messagesmentioning

confidence: 99%

Fibromyalgia: one year in review 2024

Di Carlo,

Bianchi,

Salaffi

et al. 2024

Clinical and Experimental Rheumatology

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“…However, European regulatory authorities rejected the indication of these three drugs due to small effect sizes in various studies and associated adverse effects. 7 – 9 In contrast, numerous non-pharmacological interventions, such as physical exercise 10 and electrical neuromodulation 11 among others, have shown significant positive effects, including psychological, neuroendocrine, and immunological changes, in pain-related conditions, including FM. 12 Among these treatments, modern forms of cognitive behavioral therapy, including mindfulness- and acceptance-based interventions, have shown evidence of effectiveness in patients with FM.…”

Section: Introductionmentioning

confidence: 99%

Study protocol for a three-arm randomized controlled trial investigating the effectiveness, cost-utility, and physiological effects of a fully self-guided digital Acceptance and Commitment Therapy for Spanish patients with fibromyalgia

Gallego,

Serrat,

Royuela-Colomer

et al. 2024

DIGITAL HEALTH

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Objective Fibromyalgia (FM) is a prevalent pain syndrome with significant healthcare and societal costs. The aim of the SMART-FM-SP study is to determine the effectiveness, cost-utility, and physiological effects in patients with FM of a digital intervention (STANZA®) currently marketed in the United States, which delivers smartphone-based, fully self-guided Acceptance and Commitment Therapy (Digital ACT) for treating FM-related symptoms. Methods A single-site, parallel-group, superiority, randomized controlled trial (RCT) will be conducted, including a total of 360 adults diagnosed with FM. Individuals will be randomly allocated (1:1:1) to treatment as usual (TAU), to TAU plus 12 weeks of treatment with Digital ACT, or to TAU plus 12 weeks of treatment with digital symptom tracking (i.e. FibroST). Participants will be assessed at baseline, post-treatment, and 6-month follow-up. An intention-to-treat analysis using linear mixed models will be computed to analyze the effects of Digital ACT on functional impairment (primary outcome), as measured by the Fibromyalgia Impact Questionnaire Revised at 6 months from the inception of the treatment. Secondary outcomes include impression of change, symptoms of distress, pain catastrophising, quality of life, cost-utility, and selected biomarkers (cortisol and cortisone, immune-inflammatory markers, and FKBP5 gene polymorphisms). The role of ACT-related processes of change will be tested with path analyses. Conclusions This study is the first RCT that tests Digital ACT for Spanish patients with FM. Results will be important not only for patients and clinicians, but also for policy makers by examining the cost-utility of the app in a public healthcare context.

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“…The most recent systematic review of this topic included studies published until June 2022 and included studies without control and placebo groups as well [17]. One novel aspect of the current systematic review compared to recent reviews and meta-analyses [11,17,18] is that we only included randomized controlled trials that applied tDCS (no other electrical stimulation and no combined intervention) in a parallel-group design with a sham control group. This was to examine the sole and specific effects of active tDCS in reducing pain in FM patients and to prevent potential carry-over effects that might occur in studies with a cross-over design.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Transcranial Direct Current Stimulation on Pain Level and Disability of Patients with Fibromyalgia: A Systematic Review of Randomized Controlled Trials with Parallel-Group Design

Azarkolah,

Noorbala,

Ansari

et al. 2023

Brain Sciences

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Transcranial direct current stimulation (tDCS) has been increasingly applied in fibromyalgia (FM) to reduce pain and fatigue. While results are promising, observed effects are variable, and there are questions about optimal stimulation parameters such as target region (e.g., motor vs. prefrontal cortices). This systematic review aimed to provide the latest update on published randomized controlled trials with a parallel-group design to examine the specific effects of active tDCS in reducing pain and disability in FM patients. Using the PRISMA approach, a literature search identified 14 randomized controlled trials investigating the effects of tDCS on pain and fatigue in patients with FM. Assessment of biases shows an overall low-to-moderate risk of bias. tDCS was found effective in all included studies conducted in patients with FM, except one study, in which the improving effects of tDCS were due to placebo. We recommended tDCS over the motor and prefrontal cortices as “effective” and “probably effective” respectively, and also safe for reducing pain perception and fatigue in patients with FM, according to evidence-based guidelines. Stimulation polarity was anodal in all studies, and one single-session study also examined cathodal polarity. The stimulation intensity ranged from 1-mA (7.14% of studies) to 1.5-mA (7.14% of studies) and 2-mA (85.7% of studies). In all of the included studies, a significant improvement in at least one outcome variable (pain or fatigue reduction) was observed. Moreover, 92.8% (13 of 14) applied multi-session tDCS protocols in FM treatment and reported significant improvement in their outcome variables. While tDCS is therapeutically effective for FM, titration studies that systematically evaluate different stimulation intensities, durations, and electrode placement are needed.

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Treating fibromyalgia with electrical neuromodulation: A systematic review and meta-analysis

Cited by 17 publications

References 52 publications

Fibromyalgia: one year in review 2024

Fibromyalgia: one year in review 2024

Study protocol for a three-arm randomized controlled trial investigating the effectiveness, cost-utility, and physiological effects of a fully self-guided digital Acceptance and Commitment Therapy for Spanish patients with fibromyalgia

Efficacy of Transcranial Direct Current Stimulation on Pain Level and Disability of Patients with Fibromyalgia: A Systematic Review of Randomized Controlled Trials with Parallel-Group Design

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