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Effectiveness of Transcranial Direct Current Stimulation Combined With Exercising in People With Fibromyalgia: A Randomized Sham-Controlled Clinical Trial

  • Rubén Arroyo-Fernández
    Affiliations
    Physiotherapy Unit, Nª Sª del Prado Hospital, Talavera de la Reina

    Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo

    Research Group on Water and Health (GIAS), University of Castilla-La Mancha, Toledo
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  • Juan Avendaño-Coy
    Correspondence
    Corresponding author Juan Avendaño Coy, PhD, Faculty of Physiotherapy and Nursing, Castilla-La Mancha University, Avda Carlos III, s/n, 45071 Toledo, Spain.
    Affiliations
    Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo

    Toledo Physiotherapy Research Group (GIFTO), University of Castilla-La Mancha, Toledo
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  • Rafael Velasco-Velasco
    Affiliations
    Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo
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  • Rocío Palomo-Carrión
    Affiliations
    Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo

    Toledo Physiotherapy Research Group (GIFTO), University of Castilla-La Mancha, Toledo
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  • Author Footnotes
    ⁎ Elisabeth Bravo-Esteban and Asunción Ferri-Morales contributed equally to this work.
    Elisabeth Bravo-Esteban
    Footnotes
    ⁎ Elisabeth Bravo-Esteban and Asunción Ferri-Morales contributed equally to this work.
    Affiliations
    Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo

    Toledo Physiotherapy Research Group (GIFTO), University of Castilla-La Mancha, Toledo
    Search for articles by this author
  • Author Footnotes
    ⁎ Elisabeth Bravo-Esteban and Asunción Ferri-Morales contributed equally to this work.
    Asunción Ferri-Morales
    Footnotes
    ⁎ Elisabeth Bravo-Esteban and Asunción Ferri-Morales contributed equally to this work.
    Affiliations
    Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo

    Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
    Search for articles by this author
  • Author Footnotes
    ⁎ Elisabeth Bravo-Esteban and Asunción Ferri-Morales contributed equally to this work.
Published:March 21, 2022DOI:https://doi.org/10.1016/j.apmr.2022.02.020

      Abstract

      Objective

      To evaluate the effectiveness of transcranial direct current stimulation (tDCS) combined with exercising in people with fibromyalgia.

      Design

      Randomized, triple-blind, sham-controlled, clinical trial.

      Setting

      Primary health care center.

      Participants

      A total of 120 volunteer participants (N=120) between 18 and 65 years old and diagnosed with fibromyalgia. Four participants dropped out of the study for causes unrelated to the intervention.

      Intervention

      Participants were randomized into 3 groups (active tDCS+exercising, sham tDCS+exercising, no-intervention control). The intervention was delivered in 5 sessions over 2 weeks.

      Main Outcome Measures

      Pain intensity and referred pain area after suprathreshold pressure stimulation.

      Results

      Pain intensity further decreased in the active tDCS group vs control (mean, −14.43; 95% confidence interval, −25.27 to −3.58) at post intervention, unlike the sham tDCS group. Both tDCS groups did not achieve greater reductions in referred pain vs control. In the active tDCS group, health status (mean, −14.80; 95% confidence interval, −23.10 to −6.50) and pain catastrophizing (mean, −6.68, 95% confidence interval, −11.62 to −1.73) improved at post intervention, and so did health status (mean, −8.81; 95% confidence interval, −17.11 to −0.51), pain catastrophizing (mean, −7.00; 95% confidence interval, −12.13 to −1.87), and depression (mean, −3.52; 95% confidence interval, −6.86 to −0.19) after 1 month. In the sham tDCS group, improvements were recorded in health status (mean, −13.21; 95% confidence interval, −21.52 to −4.91) and depression (mean, −3.35; 95% confidence interval, −6.35 to −0.35) at post intervention and in health status (mean, −8.77; 95% confidence interval, −17.06 to −0.47), pain catastrophizing (mean, −5.68; 95% confidence interval, −10.80 to −0.55), and depression (mean, −3.98; 95% confidence interval, −7.31 to −0.64) after 1 month. No intergroup differences were observed between active and sham tDCS.

      Conclusions

      Active and sham tDCS improved health status, pain catastrophizing, and depression vs control, but pain intensity decreased only in the active tDCS group.

      Keywords

      List of abbreviations:

      FM (fibromyalgia), MDD (minimal detectable difference), tDCS (transcranial direct current stimulation), VAS (visual analog scale.)
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