Efficacy of High Frequency [10 Hz] Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex in Patients with Fibromyalgia Syndrome: A Randomized, Double Blind, Sham-Controlled Trial

Objectives: Repetitive transcranial magnetic stimulation [rTMS] of the cerebral cortex has been tested as a treatment tool for various neurological and psychiatric diseases and other painful disorders. Our objectives were to determine whether high-frequency rTMS applied to the primary motor cortex could decrease pain intensity and influence the quality of life in patients with fibromyalgia syndrome [FMS]. Design: Fifty two patients with FMS were randomized to real [n = 27] or sham [n = 25] treatment groups. Ten consecutive sessions of rTMS were given to each of the patients. All patients were evaluated with the Structured Clinical Interview from the Diagnostic and Statistical Manual of Mental Disorders before treatment. The level of pain and the mood status were assessed with a visual analog scale and the Montgomery Asberg Rating Scale, respectively. The Turkish version of the World Health Quality of Life-BREF instrument was used to evaluate the quality of life. Results: The decrease of pain scale scores was found to be significantly greater among the real rTMS group than among those in the sham group [p<0.001]. Also the life quality physical subscale score improvement was significantly greater among those in the real rTMS therapy group than among those in the sham treatment group [p<0.001]. A strong relationship was found betweeen the decrease of pain levels in the real rTMS treated patients and the life quality physical subscale score improvement [R-2=0.419 and p<0.001]. Conclusions: These findings suggest that high-frequency rTMS application to the primary motor cortex could have an analgesic effect. Therefore, rTMS may be an alternative therapeutic option in FMS.