Motor cortex repetitive transcranial magnetic stimulation in fibromyalgia: a multicentre randomised controlled trial
Valquíria A. Silva, Abrahão Fontes Baptista, Alessandra de Souza Fonseca, Adriana Munhoz Carneiro, André R. Brunoni, Paulo Eduardo Mestrinelli Carrilho, Catarina Cöuras Lins, Gabriel Taricani Kubota, Ana Mércia Fernandes, Jorge Dornellys da Silva Lapa, Lucas M. dos Santos, Ivo Sasso, Kátia Monte‐Silva, Frédérique Poindessous‐Jazat, Nobuhiko Mori, Kenji Miki, Adriana Baltar, Clarice Tanaka, Manoel Jacobsen Teixeira, Koichi Hosomi, Didier Bouhassira, Nadine Attal, Daniel Ciampi de Andrade
Abstract
BACKGROUND: Despite affecting 2-4% of the population worldwide, fibromyalgia often remains refractory to treatment. Here we report the first international randomised double-blind, sham-controlled trial developed to assess the efficacy of repetitive transcranial magnetic stimulation (rTMS) as an add-on therapy for fibromyalgia. METHODS: , or sham stimulation. This included 10 induction sessions over 2 weeks, followed by weekly maintenance (6 weeks), and fortnightly extended maintenance (8 weeks). Primary outcome was ≥50% pain reduction at week 8 compared with baseline. Secondary outcomes included pain interference, mood, global impression of change, and Fibromyalgia Impact Questionnaire (FIQ) scores at weeks 8 and 16. RESULTS: We randomised 101 women (mean age 48 [range 25-83] yr) into active (n=52) or sham (n=49) arms. Bayesian analysis revealed a 99.4% probability of ≥50% pain reduction at week 8 in the active group vs sham (odds ratio [OR] 3.04; 95% credible interval [95% CrI] 1.26-8.06), with a number needed to treat of 4.54. Frequentist analysis confirmed that relative pain reduction was higher in the active than in the sham group (40.4% vs 18.4%, P=0.028). At week 16, this probability reduced to 34.2% (OR 0.815; 95% CrI 0.313-2.1), but the likelihood of FIQ score reduction was 79.1%. The intervention appeared safe. CONCLUSIONS: Add-on M1-repetitive transcranial magnetic stimulation reduced pain intensity up to 8 weeks in women with fibromyalgia. Although analgesic effects waned, functional improvements remained during extended maintenance at week 16.