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Transcranial Magnetic Stimulation in the Treatment of Fibromyalgia
Fibromyalgia occurs in 0.5 to 5.0% of the general population with a female predominance of 10:1. According to the American College of Rheumatology, fibromyalgia can be diagnosed if the patient complains of pain of at least 3 months that is felt in at least 11 of 18 specific tender points in the soft tissues of both sides of the nape, shoulders, chest, lower back, shins, elbows and knees.
Given its common association with depression together with normal findings of the muscles and bones, researchers have shifted to the central nervous system in search of an explanation. Functional magnetic resonance imaging (fMRI) of fibromyalgia patients subjected to pressure stimuli showed similar brain activity to normal participants who are subjected to moderate pain. They also have lower levels of serotonin and dopamine, both of which are hypothesized to decrease pain perception.
No single treatment will take away all the symptoms of fibromyalgia. The first line of treatment may include physical therapy, exercise and relaxation techniques. Cognitive behavioral therapy may also be initiated to help patients deal with negative thoughts and recognize the triggers for their pain. There are currently only three drugs approved by the US Food and Drug Administration to treat fibromyalgia: Lyrica, an anti-seizure medication, Cymbalta and Savella, both of which are antidepressants.
It has only been recent that transcranial magnetic stimulation (TMS) is being explored as a treatment option. It is theorized that TMS treats fibromyalgia by changing the hemodynamic activity of certain brain centers involved in pain processing and modulation, particularly the thalamus and brainstem descending to the spinal cord.
A review of several small studies has demonstrated this method may be of clinical value. Sampson et al in 2006 showed that 4 patients with fibromyalgia and concurrent depression reported an improvement and even resolution of their pain after receiving repetitive TMS for 4 weeks to the prefrontal cortex. On follow-up, the duration of pain relief lasted between 15 to 27 weeks.
In a study published in the 2007 edition of the Brain Journal, Passard et al reported that participants who received 10 sessions of TMS of the motor cortex reported decreased pain starting from the 5th session up to 2 weeks after the last treatment. They also reported an improvement in fatigue, sleeping patterns and general activity a week after the last session. Minor and temporary side effects included headaches, nausea, dizziness and tinnitus.
It may also seem that longer treatment duration is proportional to the duration of pain relief. A study conducted by Mhalla et al published in July 2011 showed prolonged pain relief and improved quality of life in 20 participants after treatment duration of 25 weeks. However, further research must be done to establish the optimal treatment duration.
The future applications of TMS may be boundless. It may work synergistically with pain medications to provide adequate pain relief. It may also be used to identify the neurologic structures specific for pain relief, thus guiding the implantation of devices that provide constant electrical stimulation. As such, the future may not be bleak for patients dealing with the chronic pain of fibromyalgia.