Repetitive Transcranial Magnetic Stimulation for Fibromyalgia

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Editor’s comment: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain.  Although participants in this study did not report any improvements in pain, the study did find that rTMS help reduce symptoms like depression and improved quality of life for people with fibromyalgia. 

rTMS in fibromyalgia: A randomized trial evaluating QoL and its brain metabolic substrate

By Laurent Boyer, MD, PhD, et al.

Abstract:

Objective: This double-blind, randomized, placebo-controlled study investigated the impact of repetitive transcranial magnetic stimulation (rTMS) on quality of life (QoL) of patients with fibromyalgia, and its possible brain metabolic substrate.


Methods: Thirty-eight patients were randomly assigned to receive high-frequency rTMS (n = 19) or sham stimulation (n = 19), applied to left primary motor cortex in 14 sessions over 10 weeks. Primary clinical outcomes were QoL changes at the end of week 11, measured using the Fibromyalgia Impact Questionnaire (FIQ). Secondary clinical outcomes were mental and physical QoL component measured using the 36-Item Short Form Health Survey (SF-36), but also pain, mood, and anxiety. Resting-state [18F]-fluorodeoxyglucose-PET metabolism was assessed at baseline, week 2, and week 11. Whole-brain voxel-based analysis was performed to study between-group metabolic changes over time.

Results: At week 11, patients of the active rTMS group had greater QoL improvement in the FIQ (p = 0.032) and in the mental component of the SF-36 (p = 0.019) than the sham stimulation group. No significant impact was found for other clinical outcomes. Compared with the sham stimulation group, patients of the active rTMS group presented an increase in right medial temporal metabolism between baseline and week 11 (p < 0.001), which was correlated with FIQ and mental component SF-36 concomitant changes (r = ?0.38, p = 0.043; r = 0.51, p = 0.009, respectively). QoL improvement involved mainly affective, emotional, and social dimensions.

Conclusion: Our study shows that rTMS improves QoL of patients with fibromyalgia. This improvement is associated with a concomitant increase in right limbic metabolism, arguing for a neural substrate to the impact of rTMS on emotional dimensions involved in QoL.

Classification of evidence: This study provides Class II evidence that rTMS compared with sham rTMS improves QoL in patients with fibromyalgia.

Source: Neurology, March 26, 2014 (epub ahead of print). By Laurent Boyer, MD, PhD, Alix Dousset, MD, Philippe Roussel, MD, Nathalie Dossetto, PhD, Serge Cammilleri, MD, PhD, Virginie Piano, MD, Stéphanie Khalfa, PhD, Olivier Mundler, MD, PhD, Anne Donnet, MD and Eric Guedj, MD, PhD. From EA 3279–Self-perceived Health Assessment Research Unit (L.B.), School of Medicine, La Timone University, Marseille; Centre d’Evaluation et de Traitement de la Douleur (A. Dousset, P.R., N.D., V.P., A. Donnet) and Service Central de Biophysique et Médecine Nucléaire (S.C., O.M., E.G.), APHM, Hôpital de la Timone, Marseille; CERIMED (S.C., O.M., E.G.) and Institut de Neurosciences de la Timone, CNRS UMR 7289 (S.K., E.G.), Aix-Marseille Université, Marseille, France.

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