Efficacy of High-Frequency Repetitive Transcranial Magnetic Stimulation at 10 Hz in Fibromyalgia: A Systematic Review and Meta-analysis

  • Author Footnotes
    ⁎ PingAn Zhu and Ju-Ying Xie contributed equally to this work and should be considered as cofirst authors.
    Ping-an Zhu
    ⁎ PingAn Zhu and Ju-Ying Xie contributed equally to this work and should be considered as cofirst authors.
    Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China

    School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
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  • Author Footnotes
    ⁎ PingAn Zhu and Ju-Ying Xie contributed equally to this work and should be considered as cofirst authors.
    Ju-Ying Xie
    ⁎ PingAn Zhu and Ju-Ying Xie contributed equally to this work and should be considered as cofirst authors.
    Department of Rehabilitation Medicine, Affiliated Hospital of Xiangnan University, Chenzhou, China
    Search for articles by this author
  • Howe Liu
    Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, TX
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  • Youliang Wen
    School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
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  • Yin-Jin Shao
    Department of Rehabilitation Medicine, Ganzhou People's Hospital, Ganzhou, China
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  • Xiao Bao
    Corresponding author Xiao Bao, PhD, Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan 512025, China.
    Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
    Search for articles by this author
  • Author Footnotes
    ⁎ PingAn Zhu and Ju-Ying Xie contributed equally to this work and should be considered as cofirst authors.



      The purpose of this review was to systematically assess the effectiveness of 10-Hz repetitive transcranial magnetic stimulation (rTMS) in fibromyalgia.

      Data Sources

      We searched PubMed, Cochrane Library, Embase, Web of Science, and Ovid databases as of November 6, 2021.

      Study Selection

      The inclusion criteria for this review were randomized controlled trials of 10-Hz rTMS for fibromyalgia, exploring the effects of 10-Hz rTMS on pain, depression, and quality of life in patients with fibromyalgia.

      Data Extraction

      Data extraction was performed independently by 2 evaluators according to predefined criteria, and the quality of the included literature was assessed using the Cochrane Bias Risk Assessment Tool. The measurement outcomes include visual analog scale, Hamilton Depression Rating Scale, and Fibromyalgia Impact Questionnaire, and so on.

      Data Synthesis

      A total of 488 articles were screened, and the final 7 selected high-quality articles with 217 patients met our inclusion criteria. Analysis of the results showed that high-frequency transcranial magnetic stimulation at 10 Hz was significantly associated with reduced pain compared with sham stimulation in controls (standardized mean difference [SMD]=−0.72; 95% confidence interval [CI], −1.12 to −0.33; P<.001; I2=46%) and was able to improve quality of life (SMD=−0.70; 95% CI, −1.00 to −0.40; P<.001; I2=15%) but not improve depression (SMD=−0.23; 95% CI, −0.50 to 0.05; P=.11; I2=33%). In addition, a subgroup analysis of pain conducted based on stimulation at the primary motor cortex and dorsolateral prefrontal cortex showed no significant difference (SMD=−0.72; 95% CI, −1.12 to −0.33; P=.10; I2=62%).


      Overall, 10-Hz rTMS has a significant effect on analgesia and improved quality of life in patients with FMS but did not improve depression.


      List of abbreviations:

      BDI (Beck Depression Inventory), BPI (Brief Pain Inventory), CI (confidence interval), DLPFC (dorsolateral prefrontal cortex), FIQ (Fibromyalgia Impact Questionnaire), FMS (fibromyalgia syndrome), HADS (Hospital Anxiety and Depression Scale), HDRS (Hamilton Depression Rating Scale), M1 (primary motor cortex), rTMS (repetitive transcranial magnetic stimulation), SMD (standardized mean difference), VAS (visual analog scale)
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