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Effect of neuronavigated repetitive Transcranial Magnetic Stimulation on pain, cognition and cortical excitability in fibromyalgia syndrome

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Abstract  

Background

Fibromyalgia syndrome is a widespread chronic pain condition identified by body-wide pain, fatigue, cognitive fogginess, and sleep issues. In the past decade, repetitive transcranial magnetic stimulation has emerged as a potential management tool.. In the present study, we enquired whether repetitive transcranial magnetic stimulation could modify pain, corticomotor excitability, cognition, and sleep.

Methods

Study is a randomized, sham-controlled, double-blind, clinical trial; wherein after randomizing thirty-four fibromyalgia patients into active or sham therapy (n = 17 each), each participant received repetitive transcranial magnetic stimulation therapy. In active therapy was given at 1 Hz for 20 sessions were delivered on dorsolateral prefrontal cortex (1200 pulses, 150 pulses per train for 8 trains); while in sham therapy coil was placed at right angle to the scalp with same frequency. Functional magnetic resonance imaging was used to identify the therapeutic site. Pain intensity, corticomotor excitability, cognition, and sleep were examined before and after therapy.

Results

Baseline demographic and clinical parameters for both active and sham groups were comparable. In comparison to sham, active repetitive transcranial magnetic stimulation showed significant difference in pain intensity (P < 0.001, effect size = 0.29, large effect) after intervention. Other parameters of pain perception, cognition, and sleep quality also showed a significant improvement after the therapy in active therapy group only, as compared to sham.

Conclusions

Findings suggest that repetitive transcranial magnetic stimulation intervention is effective in managing pain alongside cognition and sleep disturbances in patients of fibromyalgia. It may prove to be an important tool in relieving fibromyalgia-associated morbidity.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and additional information can be provided if requested.

Abbreviations

FMS:

Fibromyalgia Syndromes

rTMS:

Repetitive Transcranial Magnetic Stimulation

fMRI:

Functional Magnetic Resonance Imaging

BOLD:

Blood Oxygen Level Dependent

NeNa:

Neuronavigation

MNI:

Montreal Imaging Institute

ACR:

American College of Rheumatology

MMSE:

Mini-Mental State Examination

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Acknowledgements

We would like to acknowledge Department of Physiology, All India Institute of Medical Sciences, New Delhi – 110029; for providing me various resources for my thesis work. A sincere acknowledgement to Department of NMR, All India Institute of Medical Sciences, New Delhi – 110029; for neuroimaging techniques and analysis of its data .

Funding

No funding was provided that could have influenced the outcome of the study.

Author information

Authors and Affiliations

  1. Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India, 110029

    Vikas Kumar Tiwari, Aasheesh Kumar, Srishti Nanda & Renu Bhatia

  2. Department of Nuclear Magnetic Resonance and MRI Facility, New Delhi, India

    Shefali Chaudhary & Senthil S. Kumaran

  3. Stress and Cognition Electroimaging Laboratory, Department of Physiology, New Delhi, India

    Ratna Sharma

  4. Department of Rheumatology, All India Institute of Medical Sciences (AIIMS), New Delhi, India, 110029

    Uma Kumar

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  1. Vikas Kumar Tiwari
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Contributions

The manuscript is a collective work of all the authors. The research concept was thesis work of MD student, VKT, involved in protocol writing, patient recruitment, execution of all tests, result analysis and preparation of the manuscript; SN was involved in performing tests, manuscript writing; SC did analysis of fMRI data; AK helped in data analysis and preparation of manuscript; RS contributed in execution of the cognitive evaluation of patients; UK contributed in diagnosis and referring the patients to our test lab, manuscript writing; SK for performing fMRI and related data analysis; RB was chief guide with original idea, over all planning, preparation of protocol, execution of the study and manuscript writing.

Corresponding author

Correspondence to Renu Bhatia.

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Ethics approval and consent to participate

Study was approved on 06 September 2017 by Institute Ethics Committee, All India Institute of Medical Sciences, New Delhi, India (Ref. No. IEC-450/01.09.2017). All the participants had given written consent to participate in the study and they were allowed to quite at any time during the study.

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Tiwari, V.K., Kumar, A., Nanda, S. et al. Effect of neuronavigated repetitive Transcranial Magnetic Stimulation on pain, cognition and cortical excitability in fibromyalgia syndrome. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07317-x

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