Abstract
Objective A recent review showed that rTMS and tDCS are associated with initial efficacy for the treatment of chronic pain in fibromyalgia (FM). Based on these initial positive findings, there has been an interest in testing modified methods of rTMS and tDCS for the treatment of FM. Our aim was to review efficacy of modified rTMS and tDCS in recent studies published after this initial review. Methods We screened electronic databases including Medline/Pubmed, Cochrane Controlled Trials Register, Embase, Google Scholar and Scopus Elsevier, entering keywords “fibromyalgia” with “HD-tDCS”, “HD-direct current stimulation”, “low-intensity rTMS”, “low-intensity magnetic stimulation”, “multi coil rTMS”, and “multi coil magnetic stimulation”. Results We found 4 studies using the following methods: (1) HD-tDCS, (2) low-intensity rTMS and (1) multi-coil rTMS in the treatment of pain in FM. They were double-blinded and sham-controlled trials. These studies used different parameters of stimulation such as number and duration of sessions, and cortical target area (low-intensity rTMS: twice- daily 40 min for seven days in the auditory cortex vs. eight consecutive weekly 20-min sessions over the entire cortex; Multi-coil rTMS: 20 daily 20 min session in the prefontal cortex; HD-tDCS: single, 20-min sessions for both cathodal and anodal stimulation of M1). These studies showed a significant improvement in pain in FM patients and also quality of life as indexed by Fibromyalgia Inventory Questionnaire in some of them. For the studies with multiple sessions, there was a long-lasting effect that varied between multi-coil rTMS and low-intensity rTMS. No serious adverse events were reported. Conclusion These results show that the modified NIBS techniques HD-tDCS, low-intensity rTMS and multi-coil rTMS can have a significant effect on pain symptoms in FM. It is not clear whether these methods are more efficacious or safer than standard TMS and tDCS. Development of modified rTMS and tDCS is discussed.
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