Advertisement

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

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

      Abstract

      Objective

      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%).

      Conclusions

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

      Keywords

      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)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Clauw DJ.
        Fibromyalgia: a clinical review.
        JAMA. 2014; 311: 1547-1555
        • Neumann L
        • Buskila D.
        Epidemiology of fibromyalgia.
        Curr Pain Headache Rep. 2003; 7: 362-368
        • Reid P
        • Pridmore S.
        Improvement in chronic pain with transcranial magnetic stimulation.
        Aust N Z J Psychiatry. 2001; 35: 252
        • Sumpton JE
        • Moulin DE
        Fibromyalgia.
        Handb Clin Neurol. 2014; 119: 513-527
        • Bennett RM
        • Jones J
        • Turk DC
        • Russell IJ
        • Matallana L.
        An internet survey of 2,596 people with fibromyalgia.
        BMC Musculoskelet Disord. 2007; 8: 27
        • Williams DA
        • Kratz AL.
        Patient-reported outcomes and fibromyalgia.
        Rheum Dis Clin North Am. 2016; 42: 317-332
        • Lacasse A
        • Bourgault P
        • Choinière M.
        Fibromyalgia-related costs and loss of productivity: a substantial societal burden.
        BMC Musculoskelet Disord. 2016; 17: 168
        • Bair MJ
        • Fibromyalgia Krebs EE.
        Ann Intern Med. 2020; 172: ITC33-ITC48
        • Short EB
        • Borckardt JJ
        • Anderson BS
        • et al.
        Ten sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: a randomized, controlled pilot study.
        Pain. 2011; 152: 2477-2484
        • Muir 3rd, WW
        • Woolf CJ
        Mechanisms of pain and their therapeutic implications.
        J Am Vet Med Assoc. 2001; 219: 1346-1356
        • Akkuş S
        • Naziroğlu M
        • Eriş S
        • Yalman K
        • Yilmaz N
        • Yener M.
        Levels of lipid peroxidation, nitric oxide, and antioxidant vitamins in plasma of patients with fibromyalgia.
        Cell Biochem Funct. 2009; 27: 181-185
        • Cordero MD.
        [Oxidative stress in fibromyalgia: pathophysiology and clinical implications].
        Reumatol Clin. 2011; 7 ([Spanish]): 281-283
        • Häuser W
        • Petzke F
        • Sommer C.
        Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome.
        J Pain. 2010; 11: 505-521
        • Arnold LM.
        Duloxetine and other antidepressants in the treatment of patients with fibromyalgia.
        Pain Med. 2007; 8: S63-S74
        • Tzellos TG
        • Toulis KA
        • Goulis DG
        • et al.
        Gabapentin and pregabalin in the treatment of fibromyalgia: a systematic review and a meta-analysis.
        J Clin Pharm Ther. 2010; 35: 639-656
        • Arnold LM
        • Clauw DJ
        • Wohlreich MM
        • et al.
        Efficacy of duloxetine in patients with fibromyalgia: pooled analysis of 4 placebo-controlled clinical trials.
        Prim Care Companion J Clin Psychiatry. 2009; 11: 237-244
        • Geisser ME
        • Palmer RH
        • Gendreau RM
        • Wang Y
        • Clauw DJ.
        A pooled analysis of two randomized, double-blind, placebo-controlled trials of milnacipran monotherapy in the treatment of fibromyalgia.
        Pain Pract. 2011; 11: 120-131
        • Russell JI
        • Holman AJ
        • Swick TJ
        • Alvarez-Horine S
        • Wang GY
        • Guinta D.
        Sodium oxybate reduces pain, fatigue, and sleep disturbance and improves functionality in fibromyalgia: results from a 14-week, randomized, double-blind, placebo-controlled study.
        Pain. 2011; 152: 1007-1017
        • Page MJ
        • McKenzie JE
        • Bossuyt PM
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Mist SD
        • Firestone KA
        • Jones KD.
        Complementary and alternative exercise for fibromyalgia: a meta-analysis.
        J Pain Res. 2013; 6: 247-260
        • Hou WH
        • Wang TY
        • Kang JH.
        The effects of add-on non-invasive brain stimulation in fibromyalgia: a meta-analysis and meta-regression of randomized controlled trials.
        Rheumatology (Oxford). 2016; 55: 1507-1517
        • O'Connell NE
        • Marston L
        • Spencer S
        • DeSouza LH
        • Wand BM.
        Non-invasive brain stimulation techniques for chronic pain.
        Cochrane Database Syst Rev. 2018; 4CD008208
        • Knijnik LM
        • Dussán-Sarria JA
        • Rozisky JR
        • et al.
        Repetitive transcranial magnetic stimulation for fibromyalgia: systematic review and meta-analysis.
        Pain Pract. 2016; 16: 294-304
        • Ansari AH
        • Pal A
        • Ramamurthy A
        • Kabat M
        • Jain S
        • Kumar S.
        Fibromyalgia pain and depression: an update on the role of repetitive transcranial magnetic stimulation.
        ACS Chem Neurosci. 2021; 12: 256-270
        • Simonetta-Moreau M.
        Non-invasive brain stimulation (NIBS) and motor recovery after stroke.
        Ann Phys Rehabil Med. 2014; 57: 530-542
        • Klomjai W
        • Katz R
        • Lackmy-Vallée A.
        Basic principles of transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS).
        Ann Phys Rehabil Med. 2015; 58: 208-213
        • Lefaucheur JP
        • Aleman A
        • Baeken C
        • et al.
        Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018).
        Clin Neurophysiol. 2020; 131: 474-528
        • Tanwar S
        • Mattoo B
        • Kumar U
        • Bhatia R.
        Repetitive transcranial magnetic stimulation of the prefrontal cortex for fibromyalgia syndrome: a randomised controlled trial with 6-months follow up.
        Adv Rheumatol. 2020; 60: 34
        • Tekin A
        • Ozdil E
        • Guleken MD
        • et al.
        Efficacy of high frequency repetitive transcranial magnetic stimulation of the primary motor cortex in patients with fibromyalgia syndrome: a randomized, double blind, sham-controlled trial.
        J Musculoskelet Pain. 2014; 22: 20-26
        • Passard A
        • Attal N
        • Benadhira R
        • et al.
        Effects of unilateral repetitive transcranial magnetic stimulation of the motor cortex on chronic widespread pain in fibromyalgia.
        Brain. 2007; 130: 2661-2670
        • Altas EU
        • Askin A
        • Beşiroğlu L
        • Tosun A.
        Is high-frequency repetitive transcranial magnetic stimulation of the left primary motor cortex superior to the stimulation of the left dorsolateral prefrontal cortex in fibromyalgia syndrome?.
        Somatosens Mot Res. 2019; 36: 56-62
        • Bilir I
        • Askin A
        • Sengul I
        • Tosun A.
        Effects of high-frequency neuronavigated repetitive transcranial magnetic stimulation in fibromyalgia syndrome: a double-blinded, randomized controlled study.
        Am J Phys Med Rehabil. 2021; 100: 138-146
        • Fitzgibbon BM
        • Hoy KE
        • Knox LA
        • et al.
        Evidence for the improvement of fatigue in fibromyalgia: a 4-week left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation randomized-controlled trial.
        Eur J Pain. 2018; 22: 1255-1267
        • Mhalla A
        • Baudic S
        • De Andrade DC
        • et al.
        Long-term maintenance of the analgesic effects of transcranial magnetic stimulation in fibromyalgia.
        Pain. 2011; 152: 1478-1485
        • Guedj E
        • Dousset A
        • Boyer L
        • et al.
        Transcranial magnetic stimulation in fibromyalgia: a randomized trial evaluating quality of life and its brain metabolic substrate.
        Eur J Nucl Med Mol Imaging. 2013; 40: S217
        • Bestmann S
        • Baudewig J
        • Siebner HR
        • Rothwell JC
        • Frahm J.
        Functional MRI of the immediate impact of transcranial magnetic stimulation on cortical and subcortical motor circuits.
        Eur J Neurosci. 2004; 19: 1950-1962
        • Lefaucheur JP
        • Drouot X
        • Ménard-Lefaucheur I
        • Keravel Y
        • Nguyen JP.
        Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain.
        Neurology. 2006; 67: 1568-1574
        • Giannoni-Luza S
        • Pacheco-Barrios K
        • Cardenas-Rojas A
        • et al.
        Noninvasive motor cortex stimulation effects on quantitative sensory testing in healthy and chronic pain subjects: a systematic review and meta-analysis.
        Pain. 2020; 161: 1955-1975
        • Seminowicz DA
        • Moayedi M.
        The dorsolateral prefrontal cortex in acute and chronic pain.
        J Pain. 2017; 18: 1027-1035
        • Jensen KB
        • Kosek E
        • Petzke F
        • et al.
        Evidence of dysfunctional pain inhibition in fibromyalgia reflected in rACC during provoked pain.
        Pain. 2009; 144: 95-100
        • Lorenz J
        • Cross DJ
        • Minoshima S
        • Morrow TJ
        • Paulson PE
        • Casey KL.
        A unique representation of heat allodynia in the human brain.
        Neuron. 2002; 35: 383-393
        • Lorenz J
        • Minoshima S
        • Casey KL.
        Keeping pain out of mind: the role of the dorsolateral prefrontal cortex in pain modulation.
        Brain. 2003; 126: 1079-1091
        • Sevel LS
        • Letzen JE
        • Staud R
        • Robinson ME.
        Interhemispheric dorsolateral prefrontal cortex connectivity is associated with individual differences in pain sensitivity in healthy controls.
        Brain Connect. 2016; 6: 357-364
        • Russo JF
        • Sheth SA.
        Deep brain stimulation of the dorsal anterior cingulate cortex for the treatment of chronic neuropathic pain.
        Neurosurg Focus. 2015; 38: E11
        • Chai SC
        • Kung JC
        • Shyu BC.
        Roles of the anterior cingulate cortex and medial thalamus in short-term and long-term aversive information processing.
        Mol Pain. 2010; 6: 42
        • Hodaj H
        • Payen JF
        • Lefaucheur JP.
        Therapeutic impact of motor cortex rTMS in patients with chronic neuropathic pain even in the absence of an analgesic response. A case report.
        Neurophysiol Clin. 2018; 48: 303-308
        • Ochsner KN
        • Bunge SA
        • Gross JJ
        • Gabrieli JD.
        Rethinking feelings: an FMRI study of the cognitive regulation of emotion.
        J Cogn Neurosci. 2002; 14: 1215-1229
        • Ochsner KN
        • Ray RD
        • Cooper JC
        • et al.
        For better or for worse: neural systems supporting the cognitive down- and up-regulation of negative emotion.
        Neuroimage. 2004; 23: 483-499
        • Eippert F
        • Veit R
        • Weiskopf N
        • Erb M
        • Birbaumer N
        • Anders S.
        Regulation of emotional responses elicited by threat-related stimuli.
        Hum Brain Mapp. 2007; 28: 409-423
        • Koenigs M
        • Grafman J.
        The functional neuroanatomy of depression: distinct roles for ventromedial and dorsolateral prefrontal cortex.
        Behav Brain Res. 2009; 201: 239-243
        • Chen J
        • Zhou C
        • Wu B
        • et al.
        Left versus right repetitive transcranial magnetic stimulation in treating major depression: A meta-analysis of randomised controlled trials.
        Psychiatry Res. 2013; 210: 1260-1264
        • Berlim MT
        • Van den Eynde F
        • Jeff Daskalakis Z
        Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation (rTMS) for treating primary major depression: a meta-analysis of randomized, double-blind and sham-controlled trials.
        Neuropsychopharmacology. 2013; 38: 543-551
        • Boyer L
        • Dousset A
        • Roussel P
        • et al.
        rTMS in fibromyalgia: a randomized trial evaluating QoL and its brain metabolic substrate.
        Neurology. 2014; 82: 1231-1238
        • Schneibel R
        • Brakemeier EL
        • Wilbertz G
        • Dykierek P
        • Zobel I
        • Schramm E.
        Sensitivity to detect change and the correlation of clinical factors with the Hamilton Depression Rating Scale and the Beck Depression Inventory in depressed inpatients.
        Psychiatry Res. 2012; 198: 62-67