Deep TMS Augmentation Treatment for Fibromyalgia: A Safety and Feasibility Study

Journal: Brain Stimulation 10:450 (2017)

Authors: B Cohen, J.N Ablin, Y Braw, Y Bloch, H Maoz, Y Levkovitz, K Lapidus, U Nitzan


Fibromyalgia (FM) is a prevalent chronic pain syndrome,with limited therapeutic options. Repetitive Transcranial MagneticStimulation (rTMS) is emerging as a potential new treatment modalityfor FM. Deep TMS (dTMS) is a novel modification of standard rTMS,capable of delivering stimulation to a greater depth.


This preliminarystudy is thefirst to explore the efficacy of dTMS as an augmentationtreatment in FM.


Eleven FM patients completed a 20-day treatment protocol, in order to examine left dorsal-lateral prefrontal cortex (DLPFC) excitation via dTMS using the h-coil. Clinical and psychophysical measurements of pain were evaluated each week, and 2 weeks after study completion. The primary outcome measures were the changes in pain measures from baseline to visit 20: Short Form-McGill Pain Questionnaire (SF-Mcgill) and Brief Pain Inventory (BPI). Secondary outcomes were FM clinical measures such as the Fibromyalgia Pain Questionnaire (FIQ).


Patients demonstrated a significant reduction in pain symptoms(p=.024) and improved functioning (p=.022) at visit 20. A significantdecrease in FM symptoms that are not directly linked to pain (sleep disturbances, cognitive impairments and tiredness) was found only at follow-up (p=.044). Depressive symptoms were not reduced, indicating that painreduction among our subjects could not be attributed to the antidepressant effect of dTMS. Treatment was well tolerated andno significant sideeffects were reported.


dTMS was safe and tolerable as augmentation treatment forFM patients. It reduced pain intensity in FM, improved function, and mayhave induced changes in neuroplasticity. Further double-blindedcontrolled studies, with a larger sample, are required to confirm and moreaccurately assess the therapeutic utility of dTMS in FM.

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