Effects of Repetitive-Transcranial Magnetic Stimulation (rTMS) in Fibromyalgia Syndrome: An Umbrella and Mapping Review

Overview

Journal Brain Sci

Publisher MDPI

Date 2023 Jul 29

PMID 37508991

Authors

Ferran Cuenca-Martinez

Nuria Sempere-Rubio

Sara Molla-Casanova

Elena Munoz-Gomez

Josue Fernandez-Carnero

Alberto Sanchez-Sabater

Luis Suso-Marti

Affiliations

Soon will be listed here.

Abstract

Background: The main aim of this study was to assess the effects of repetitive-transcranial magnetic stimulation (rTMS) in patients with fibromyalgia (FMS).

Methods: We systematically searched PubMed, PEDro, EMBASE, and CINAHL. Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the guidelines advisory committee grading criteria. A total of 11 systematic reviews were included. The assessed variables were pain intensity, depressive symptoms, anxiety, and general health.

Results: Regarding pain intensity, it seems that high-frequency rTMS significantly reduces pain intensity at a 1-month follow-up when the primary motor cortex (M1) is stimulated. However, we cannot robustly conclude the same for low-frequency protocols. When we look at the combination of high and low-frequency rTMS, there seems to be a significant effect on pain intensity up to 1-week post-intervention, but after that point of follow-up, the results are controversial. Regarding depressive symptoms and anxiety, results showed that the effects of rTMS are almost non-existent. Finally, in regard to general health, results showed that rTMS caused significant post-intervention effects in a robust way. However, the results of the follow-ups are contradictory.

Conclusions: The results obtained showed that high-frequency rTMS applied on the M1 showed some effect on the variable of pain intensity with a limited quality of evidence. Overall, rTMS was shown to be effective in improving general health with moderate quality of evidence. Finally, rTMS was not shown to be effective in managing depressive symptoms and anxiety with a limited to moderate quality of evidence. PROSPERO number: This review was previously registered in PROSPERO (CRD42023391032).

Citing Articles

Efficacy of brain stimulation therapies across psychiatric, movement, and cognitive disorders: an umbrella review synthesizing meta-analyses of randomized controlled trials.

Zu Z, Chen F, Yang L, Wei W, Zhang M, Huang L EClinicalMedicine. 2025; 80:103046.

PMID: 39867967 PMC: 11760298. DOI: 10.1016/j.eclinm.2024.103046.

Repetitive Transcranial Magnetic Stimulation in Fibromyalgia: Exploring the Necessity of Neuronavigation for Targeting New Brain Regions.

Velickovic Z, Radunovic G J Pers Med. 2024; 14(6).

PMID: 38929883 PMC: 11204413. DOI: 10.3390/jpm14060662.

References

Conde-Anton A, Hernando-Garijo I, Jimenez-Del-Barrio S, Mingo-Gomez M, Medrano-de-la-Fuente R, Ceballos-Laita L . Effects of transcranial direct current stimulation and transcranial magnetic stimulation in patients with fibromyalgia. A systematic review. Neurologia (Engl Ed). 2023; 38(6):427-439. DOI: 10.1016/j.nrleng.2020.07.025. View

Torres A, Tennant B, Ribeiro-Lucas I, Vaux-Bjerke A, Piercy K, Bloodgood B . Umbrella and Systematic Review Methodology to Support the 2018 Physical Activity Guidelines Advisory Committee. J Phys Act Health. 2018; 15(11):805-810. DOI: 10.1123/jpah.2018-0372. View

Hazra S, Venkataraman S, Handa G, Yadav S, Wadhwa S, Singh U . A Cross-Sectional Study on Central Sensitization and Autonomic Changes in Fibromyalgia. Front Neurosci. 2020; 14:788. PMC: 7417433. DOI: 10.3389/fnins.2020.00788. View

Choo Y, Kwak S, Chang M . Effectiveness of Repetitive Transcranial Magnetic Stimulation on Managing Fibromyalgia: A Systematic Meta-Analysis. Pain Med. 2022; 23(7):1272-1282. DOI: 10.1093/pm/pnab354. View

George M, Post R . Daily left prefrontal repetitive transcranial magnetic stimulation for acute treatment of medication-resistant depression. Am J Psychiatry. 2011; 168(4):356-64. DOI: 10.1176/appi.ajp.2010.10060864. View

Zhu P, Xie J, Liu H, Wen Y, Shao Y, Bao X . Efficacy of High-Frequency Repetitive Transcranial Magnetic Stimulation at 10 Hz in Fibromyalgia: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2022; 104(1):151-159. DOI: 10.1016/j.apmr.2022.05.006. View

Kim H, Jung J, Park S, Joo Y, Lee S, Lee S . Effects of Repetitive Transcranial Magnetic Stimulation on the Primary Motor Cortex of Individuals with Fibromyalgia: A Systematic Review and Meta-Analysis. Brain Sci. 2022; 12(5). PMC: 9139594. DOI: 10.3390/brainsci12050570. View

Stone P . Popping the (PICO) question in research and evidence-based practice. Appl Nurs Res. 2002; 15(3):197-8. DOI: 10.1053/apnr.2002.34181. View

Frot M, Magnin M, Mauguiere F, Garcia-Larrea L . Cortical representation of pain in primary sensory-motor areas (S1/M1)--a study using intracortical recordings in humans. Hum Brain Mapp. 2012; 34(10):2655-68. PMC: 6869910. DOI: 10.1002/hbm.22097. View

10.

Moher D, Pham B, Jones A, Cook D, Jadad A, Moher M . Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?. Lancet. 1998; 352(9128):609-13. DOI: 10.1016/S0140-6736(98)01085-X. View

11.

Gan Z, Gangadharan V, Liu S, Korber C, Tan L, Li H . Layer-specific pain relief pathways originating from primary motor cortex. Science. 2022; 378(6626):1336-1343. DOI: 10.1126/science.add4391. View

12.

Garcia-Larrea L, Peyron R, Mertens P, Gregoire M, Lavenne F, LE Bars D . Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain. 1999; 83(2):259-73. DOI: 10.1016/s0304-3959(99)00114-1. View

13.

McHugh M . Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012; 22(3):276-82. PMC: 3900052. View

14.

Flodin P, Martinsen S, Lofgren M, Bileviciute-Ljungar I, Kosek E, Fransson P . Fibromyalgia is associated with decreased connectivity between pain- and sensorimotor brain areas. Brain Connect. 2014; 4(8):587-94. PMC: 4202907. DOI: 10.1089/brain.2014.0274. View

15.

Richard J, Hurley R, Taber K . Fibromyalgia: Centralized Pain Processing and Neuroimaging. J Neuropsychiatry Clin Neurosci. 2019; 31(3):A6-187. DOI: 10.1176/appi.neuropsych.19050107. View

16.

Peyron R, Schneider F, Faillenot I, Convers P, Barral F, Garcia-Larrea L . An fMRI study of cortical representation of mechanical allodynia in patients with neuropathic pain. Neurology. 2004; 63(10):1838-46. DOI: 10.1212/01.wnl.0000144177.61125.85. View

17.

Giovagnoli A, Franceschetti S, Reati F, Parente A, Maccagnano C, Villani F . Theory of mind in frontal and temporal lobe epilepsy: cognitive and neural aspects. Epilepsia. 2011; 52(11):1995-2002. DOI: 10.1111/j.1528-1167.2011.03215.x. View

18.

Miake-Lye I, Hempel S, Shanman R, Shekelle P . What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Syst Rev. 2016; 5:28. PMC: 4750281. DOI: 10.1186/s13643-016-0204-x. View

19.

Saltychev M, Laimi K . Effectiveness of repetitive transcranial magnetic stimulation in patients with fibromyalgia: a meta-analysis. Int J Rehabil Res. 2016; 40(1):11-18. DOI: 10.1097/MRR.0000000000000207. View

20.

Yunus M . Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Pract Res Clin Rheumatol. 2007; 21(3):481-97. DOI: 10.1016/j.berh.2007.03.006. View