Sun P, Fang L, Zhang J, et al. Repetitive transcranial magnetic stimulation for fibromyalgia patients: A Systematic Review with Meta-Analysis. Pain Med. 2021 Sep 20. pii: 6372702. doi: 10.1093/pm/pnab276. (Systematic review)

OBJECTIVE: Fibromyalgia is a poorly understood pain syndrome. Repetitive transcranial magnetic stimulation is a noninvasive brain stimulation therapy and is commonly applied for the management of fibromyalgia. However, controversy regarding its efficacy remains. Therefore, a meta-analysis was conducted to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for fibromyalgia syndrome.

METHOD: 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), Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS) anxiety score, Pain Catastrophizing Scale (PCS), Fatigue Severity Scale (FSS), Short Form-36 general health survey mental score, and Fibromyalgia Impact Questionnaire (FIQ) were set as outcome measures.

RESULTS: Analysis of 14 studies and 433 participants indicated that rTMS exerted more favorable effects on the NPRS than sham rTMS after treatment (standardized mean difference = -0.49, 95% confidence interval = -0.86 to - 0.13, P = 0.008, I2 = 68%) and 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 included studies was an acceptable score of 8.5 based on the PEDro scale, suggesting the validity of our conclusions.

CONCLUSION: This study demonstrated that rTMS relieved pain and enhanced quality of life of patients with fibromyalgia; however, it did not improve anxiety, depression, and other symptoms based on current reports.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

It's very difficult to assess the clinical usefulness of this intervention.

Physician rater

Although the meta-analysis showed significant improvement in pain with this procedure, it is troubling that most studies showed no significant benefit. This suggests there is heterogeneity either in the participant population or in the treatment approach. Further studies may or may not show benefit!

Physician rater

The present meta-analysis suggests that the application of the noninvasive low frequency Repetitive Transcranial Magnetic Stimulation(rTMS) in the dorso lateral prefrontal cortex (DLPFC) region is effective for relieving the fibromyalgia pain and improving the quality of life alike. The technique standandardisation and the novel studies design are needed.
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