Background & Aims

Most of the patients go to the hospital due to pain and its related symptoms. Fibromyalgia is an idiopathic, chronic, nonarticular pain syndrome defined by widespread musculoskeletal pain and generalized tender points without a well-defined underlying organic etiology. The treatment as well as diagnosis of the fibromyalgia patients are enigma as there is no laboratory diagnosis as well as treatment is available except symptomatic treatment. The pathophysiology of the disease is probably due to aberrant central pain processing mechanisms in the central nervous system. Transcranial magnetic stimulation (TMS) was devised as a new neurostimulation technique in neuroscience. Currently, repeated Transcranial Magnetic Stimulation (rTMS) is used for an increasing variety of applications specially for psychiatric patients. I used the rTMS in right dorsolateral prefrontal cortex area for stimulation in fibromyalgia patients and assessed its effects on pain and its associated symptoms for 6 month

Methods

The fibromyalgia patients were recruited from the pain clinic. They were randomly divided into two groups sham stimulation group and real rTMS groups. Either rTMS or sham stimulation were given for five days a week for four week for total twenty sessions to both the groups. Pain and associated symptoms were assesses one week before the session, during each week of session and then at the end of each week and then monthly for 6 months. the data were compared before and after the rTMS/sham stimulation in two groups and intra-group also. The patients and controls were evaluated using various psychiatric tests including The Coping Strategies Questionnaire (CSQ), Spielberger State- Trait Anxiety Inventory – six item short forms (STAI-SSF), Pain Belief Questionnaire (PBQ), World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, and Visual analogue scale (VAS) pre and post stimulation period upto follow up of six months.

Results

On comparing the questionnaire response and pain rating on VAS in the rTMS verses sham stimulation group, pain rating on the VAS score due to rTMS treatment was observed in the rTMS group during rTMS week 4 which was sustained during the post-rTMS week 2 through 26 indicating
long-term beneficial effects of rTMS (3.5 ± 1.03, 3.4 ±1.16, 3.2 ±1.09 and 3.2 ± 1.16, respectively from 7.1 0.53; p<0.001). However, in FM-Sham group, the VAS scores remained unaltered throughout the period of follow up as compared to its basal value indicating persistent pain. Similarly the anxiety state showed significant improvement in this group. Statistically significant improvement was also observed in psychological domain of the WHOQOL-BREF. The catastrophizing coping strategy score was also lower in rTMS group. Total pain score: The cumulative scores for sensory, affective-motivational, evaluative and miscellaneous components of pain did not vary significantly amongst rTMS week 4 and post-rTMS

Conclusions

FM syndrome has a psychological dimension with poor quality of life. They utilize catastrophizing, as the principal cognitive pain coping strategy. A significant relief from chronic pain was obtained following rTMS treatment for 4 weeks. The associated symptoms namely; anxiety and depression were reduced thereby improving the quality of life. The FM patients were able to cope better with
daily activities after rTMS treatment. Consequently, the relief from pain made them
optimistic about their chronic pain as a treatable entity including organic and
psychological components of it. This beneficial effect of rTMS was maintained till the
end of the study period (week 26 of follow up). The rTMS we used on right dorsolateral prefrontal cortex for four weeks significantly reduced pain and associated symptoms in fibromyalgia patients. We conducted follow up studies upto week 26.

References

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 Jan 20;12(2):256-270. doi: 10.1021/acschemneuro.0c00785.

Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low back pain
patients: relationship to patient characteristics and current adjustment. Pain. 1983; 17 (1): 33-44.

Rodero B, Casanueva B, García-Campayo J, Roca M, Magallón R, del Hoyo YL.
Stages of chronicity in fibromyalgia and pain catastrophising: a cross-sectional study. BMC Musculoskelet Disord. 2010; 11: 251. doi: 10.1186/1471-2474-11-251.

Sampson SM, Rome JD, Rummans TA. Slow-frequency rTMS reduces fibromyalgia
pain. Pain Med. 2006; 7 (2): 115-118.

?lgen U. On “Effectiveness of High-Frequency Transcranial Magnetic Stimulation and Physical Exercise in Women With Fibromyalgia: A Randomized Controlled Trial.” Izquierdo-Alventosa R, Inglés M, Cortés-Amador S, Gimeno-Mallench L, Sempere-Rubio N, Serra-Añó P. Phys Ther. 2021;101:pzab159. https://doi.org/10.1093/ptj/pzab159. Phys Ther. 2022 Aug 4;102(8):pzac071. doi: 10.1093/ptj/pzac071. PMID: 35713526.

Pacheco-Barrios K, Pimenta DC, Pessotto AV, Fregni F. Motor Cortex Inhibition and Facilitation Correlates with Fibromyalgia Compensatory Mechanisms and Pain: A Cross-Sectional Study. Biomedicines. 2023 May 26;11(6):1543. doi: 10.3390/biomedicines11061543. PMID: 37371638; PMCID: PMC10294994.

Zhang JH, Liang J, Yang ZW. Non-invasive brain stimulation for fibromyalgia: current trends and future perspectives. Front Neurosci. 2023 Oct 19;17:1288765. doi: 10.3389/fnins.2023.1288765. PMID: 37928733; PMCID: PMC10620708.

Tiwari VK, Kumar A, Nanda S, Chaudhary S, Sharma R, Kumar U, Kumaran SS, Bhatia R. Effect of neuronavigated repetitive Transcranial Magnetic Stimulation on pain, cognition and cortical excitability in fibromyalgia syndrome. Neurol Sci. 2024 Jan 25. doi: 10.1007/s10072-024-07317-x. Epub ahead of print. PMID: 38270728.

Attal N, Poindessous-Jazat F, De Chauvigny E, Quesada C, Mhalla A, Ayache SS, Fermanian C, Nizard J, Peyron R, Lefaucheur JP, Bouhassira D. Repetitive transcranial magnetic stimulation for neuropathic pain: a randomized multicentre sham-controlled trial. Brain. 2021 Dec 16;144(11):3328-3339. doi: 10.1093/brain/awab208. PMID: 34196698.

Presenting Author

Abdul Haque Ansari

Poster Authors

Abdul Haque Ansari

PhD

Nepalgunj Medical College

Lead Author

E-mail

Topics

  • Assessment and Diagnosis