Repetitive Transcranial Magnetic Stimulation for Patients with Fibromyalgia: A Systematic Review with Meta-Analysis.

Abstract

Fibromyalgia is a poorly understood pain syndrome. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation therapy and is commonly applied for the management of fibromyalgia. However, controversy about its efficacy remains. Therefore, a meta-analysis was conducted to evaluate the effectiveness of rTMS for fibromyalgia syndrome. Four medical databases and one physiotherapy database were screened for randomized controlled trials. A systematic review and meta-analysis was performed. Numerical Pain Rating Scale (NPRS) score, Beck Depression Inventory (BDI) score, Hospital Anxiety and Depression Scale (HADS) anxiety score, Pain Catastrophizing Scale (PCS) score, Fatigue Severity Scale (FSS) score, Short Form-36 General Health Survey mental score, and Fibromyalgia Impact Questionnaire (FIQ) score were set as outcome measures. Analysis of 14 studies and 433 participants indicated that rTMS exerted more favorable effects than did sham rTMS after treatment on the NPRS (standardized mean difference = -0.49, 95% confidence interval = -0.86 to -0.13, P = 0.008, I2 = 68%) and the FIQ (standardized mean difference = -0.50, 95% confidence interval = -0.75 to -0.25, P = 0.0001, I2 = 28%). However, the BDI, FSS, PCS, mood index, and HADS scores showed no significant difference compared with sham rTMS after treatment. The mean methodological quality of the included studies was an acceptable score of 8.5 based on the PEDro scale, suggesting the validity of our conclusions. This study demonstrated that rTMS relieved pain and enhanced the quality of life of patients with fibromyalgia; however, on the basis of current reports, it did not improve anxiety, depression, or other symptoms.