Table 5. Literature review summary of fibromyalgia treatment or investigation by rTMS.
Note all studies used a figure-of-8 TMS coil. ABP, abductor pollicis brevis; BDI, Beck depression inventory; BPI, brief pain inventory; CGI, clinical global impression; D, diagnostic; FIQ, fibromyalgia impact questionnaire; GAF, global assessment of function; HAD, hospital anxiety and depression scale; HF, high-frequency; HRSD, Hamilton rating scale for depression; ICF, intracortical facilitation; LF, low-frequency; MADRS, Montgomery Asberg depression rating scale; MC, motor cortex; MEP, motor evoked potential; MPQ, McGill pain questionnaire; NR, not reported; NSAID, non-steroidal anti-inflammatory drug; PCS, pain catastrophizing RDLPC, right dorsolateral prefrontal cortex; rTMS, repetitive transcranial magnetic stimulation; SICI, short intracortical inhibition; T, therapeutic
| Author (Year) | # of Subjects (Age Range) | Drug therapy details | rTMS Protocol [Therapeutic or Diagnostic] | Coil Position | MRI Navigation | Sham Method | Adverse Events details | Fibromyalgia Outcome Measure | #of Responders (% total) comments |
|---|---|---|---|---|---|---|---|---|---|
| Sampson SM, et al. (2006) | 4 (36–51) | Yes Maintained medication with no change in dose (analgesic, anticonvulsant) |
[LF] 18–20 days of (2 trains (1 Hz × 13.3 mins w/60s ITI)) =1600 pulses/day @ 110% MT [T] |
RDLPC defined as area 5cm anterior to MC for activation of ABP | No | Coil tilted 45° from the skull | NR | HRSD MADRS CGI GAF Self-rating scale |
4(100%) |
| Passard A, et al (2007) | 15 (44–60) | Yes Maintained medication with no change in dose (analgesics, antidepressants, NSAIDS) |
[HF] 10 days of (25 trains (10 Hz × 8s w/52s ITI)) =2000 pulses/day @ 80% RMT [T] |
Motor cortex as defined by maximal contralateral MEP amplitude | No | Sham Coil | Headache (n = 4) Nausea (n = 1) |
BPI MPQ FIQ manual tender point survey HDRS BDI HAD |
NR Active rTMS improved pain associated with fibromyalgia. |
| Carretero B, et al. (2009) | 14 (41–53) | Yes Maintained medication with no change in dose (analgesic, antidepressant) |
[LF] 20 days of (20 trains (1 Hz × 1 min w/45s ITI)) =1200 pulses/day @ 110% MT [T] |
RDLPC defined as area 5cm anterior to MC for activation of ABP | No | Coil tilted 45° from the skull | Headache (n = 6) Neck Pain (n = 6) Aggravation of depression (n = 1) |
HDRS CGI Likert pain scale FibroFatigue scale |
NR Active rTMS improved pain associated with fibromyalgia. |
| Mhalla A, et al. (2011) | 20 (40–62) | Yes Maintained medication with no change in dose (analgesics, antidepressants) |
[HF] 14 days of (15 trains (10 Hz × 10s w/50s ITI)) =1500 pulses/day @ 80% RMT [T] |
Motor cortex as definedby maximal contralateral MEP amplitude | No | Sham Coil | Headache (n = 6) Dizziness (n = 1) |
BPI MPQ FIQ HAD BDI PCS ICF SICI MEP RMT |
NR Active rTMS improved pain and quality of life associated with fibromyalgia. SICI and ICF were significantly higher after rTMS. |