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.