Fibromyalgia and repetitive transcranial magnetic stimulation (rTMS)

We provide in our centre brain neruomodulation with rTMS in order to treat patients with fibromyalgia. Fibromyalgia is a very common chronic painful musculoskeletal condition affecting about 1-3% of the population world wide. Main clinical features are widespread muscular pain and tenderness, commonly associated with fatigue, sleep disturbances, memory and attention deficits and mood disorders (anxiety and depression). Diagnosis is made according to the American College of Rheumatology criteria (Wolfe et al. 2010 and 2016). A rheumatologist should provide the diagnosis.
The aetiology of the disorder is unknown and there is no a definite cure. Pharmacological interventions (anticonvulsants, antidepressants, AINS and opioid-like substances) have limited efficacy and often side effects. Psychotherapies and physiotherapy have partial success.
Several experimental studies on fibromyalgia suggested the key role of chemical, structural and physiological changes of the central nervous system for pain maintenance. An increased neuronal excitability is installed in brain areas processing physical, emotional and cognitive attributes of pain, probably mediated by glutamate activity on the NMDA receptors.
Repetitive transcranial magnetic stimulation (rTMS) is a safe and non-invasive procedure that uses a magnetic field to modulate the activity of cortical brain areas and their networks and to reduce glutamate activity.
Contraindications for TMS are epilepsy or history of seizure, pacemakers and other implantable medical devices, serious head injury, pregnancy. rTMS treatment can be easily performed on outpatients.
Even if there are only weak recommendations provided by meta-analytic studies and further clinical research is needed, several studies demonstrated the effectiveness of rTMS excitatory modulation on the fronto-dorso-lateral cortex over several weeks. There is expected a minimum 30% of pain improvement and a similar significant chance of fatigue reduction and improvement in sleep and quality of life.

REFERENCES

Fitzgibbon BM et al. Evidence for the improvement of fatigue in fibromyalgia: a 4-week left dorsolateral prefrontal cortex repetitive magnetic stimulation randomized-controlled trial. Eur J Pain 2018 (epub ahead of print).

Hou WH et al. The effects of add-on non-invasive brain stimulation in fibromyalgia : a meta-analysis and meta-regression of randomized controlled trial. Rheumatology (Oxford)2016.55(8):1507-17.

Boyer L. et al. rTMS in fibromyalgia: a randomized trial evaluating QoL and its brain metabolic substrate. Neurology 2014.82(14):1231-8.

Lee SJ et al. The effect of repetitive transcranial magnetic stimulation on fibromyalgia: a randomized sham-controlled trial with 1-mo follow-up. Am J Phys Med Rehabil 2012.91(12): 1077-85.

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