Is high-frequency repetitive transcranial magnetic stimulation of the left primary motor cortex superior to the stimulation of the left dorsolateral prefrontal cortex in fibromyalgia syndrome?

Objective: To investigate effectiveness of two different high-frequency repetitive transcranial magnetic stimulation (rTMS) protocols on pain, fatigue, quality of life (QoL) and depression in female patients with fibromyalgia.Methods: Thirty patients were randomized into three groups. Fifteen sessions of 10Hz (90% resting motor threshold-RMT, 1200 pulses) rTMS were applied to left primary motor cortex and left dorsolateral prefrontal cortex (DLPFC) in Group M1 (n:10) and Group DLPFC (n:10), respectively. Group sham (n=10) received 15 sessions of sham rTMS over 3weeks. Visual Analogue Scale, Fibromyalgia Impact Questionnaire, Fatigue Severity Scale, Short-form 36, and Beck Depression Inventory were assessed at baseline and at the end of the treatments by a blinded-experienced assessor.Results: Significant improvements in pain, QoL, and depression scores were observed in three groups. However, improvements in depression, physical functioning, physical role functioning, and general health perceptions were greater in active rTMS groups than in sham group. Emotional role functioning was only improved in Group M1. The decrease in VAS scores was significantly greater in Group M1 when compared to sham group. Change in physical role functioning was significantly greater in Group DLPFC than in Group M1.Conclusions: Significant improvements in physical role functioning, physical functioning, depression, and general health perceptions were achieved in active rTMS groups. Further clinical studies on larger samples involving both sexes with longer follow-up durations are needed.