Abstract
ObjectivesFibromyalgia Syndrome (FMS), is a chronic pain disorder with poorly understood pathophysiology. In recent years, repetitive transcranial magnetic stimulation (rTMS) has been recommended for pain relief in various chronic pain disorders. The objective of the present research was to study the effect of low frequency rTMS over the right dorsolateral prefrontal cortex (DLPFC) on pain status in FMS.MethodsNinety diagnosed cases of FMS were randomized into Sham-rTMS and Real-rTMS groups. Real rTMS (1 Hz/1200 pulses/8 trains/90% resting motor threshold) was delivered over the right DLPFC for 5 consecutive days/week for 4 weeks. Pain was assessed by subjective and objective methods along with oxidative stress markers. Patients were followed up for 6 months (post-rTMS;15 days, 3 months and 6 months).ResultsIn Real-rTMS group, average pain ratings and associated symptoms showed significant improvement post rTMS. The beneficial effects of rTMS lasted up to 6 months in the follow-up phase. In Sham-rTMS group, no significant change in pain ratings was observed.ConclusionRight DLPFC rTMS can significantly reduce pain and associated symptoms of FMS probably through targeting spinal pain circuits and top-down pain modulation .Trial registration: Ref No: CTRI/2013/12/004228.
Highlights
Fibromyalgia affects nearly 2.10% of the world’s population [1]
To further substantiate the literature suggesting the role of oxidative stress markers in Fibromyalgia Syndrome (FMS) [11, 12], we assessed the levels of thiobarbituric acid reactive substances (TBARS) and F2-isoprostane in our FMS patients before and after repetitive transcranial magnetic stimulation (rTMS) therapy
Primary outcome A decrease in Numerical Pain Rating Scale (NPRS) ratings due to rTMS treatment was observed in the Real-rTMS group immediately postrTMS (p = 0·001) which was sustained through 6 months (Fig. 1)
Summary
Fibromyalgia affects nearly 2.10% of the world’s population [1]. The etiopathogenesis of FMS is largely unknown, tender points all over the body suggest a peripheral pathology, but a considerable amount of data points towards the sensitization of central pain processing pathways [2], dysfunctional pain inhibition [3] and abnormal cortical excitability [4]. Transcranial magnetic stimulation is a non-invasive brain stimulation technique which is being used to manage psychiatric cases, several movement disorders and chronic pain conditions including fibromyalgia [6,7,8]. A previous study by our group observed beneficial effects of low frequency rTMS and established the role of DLPFC modulation in chronic tension type headache [10]. We hypothesized that TMS of the right DLPFC using low-frequency rTMS could relieve pain and associated symptoms of fibromyalgia. The objectives (primary and secondary) of the study were to investigate the effect of rTMS on FMS pain and related symptoms and explore the mechanism of analgesia by recording the nociceptive flexion reflex (NFR); an objective marker of pain. To further substantiate the literature suggesting the role of oxidative stress markers in FMS [11, 12], we assessed the levels of thiobarbituric acid reactive substances (TBARS) and F2-isoprostane in our FMS patients before and after rTMS therapy
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