Repetitive Transcranial Magnetic Stimulation as a Modality of Treatment in Patients with Fibromyalgia

Abstract Background Fibromyalgia is a common musculoskeletal condition affecting around 1–3% of the general population worldwide. It is defined as a complex chronic disorder characterized by widespread musculoskeletal pain and tenderness, often accompanied by additional features including fatigue, sleep disturbance and cognitive dysfunction and is associated with co-occurring health issues including mood disorders. Aim of the Work The aim of this study is to evaluate the role of repetitive transcranial magnetic stimulation (rTMS) in treatment of fibromyalgia. Patients and Methods The study was conducted on 30 primary fibromyalgia patients according to American college of rheumatology criteria (ACR) 2010 criteria 20 of which were subjective to repetitive transcranial magnetic stimulation (rTMS) and 10 subjected to Sham stimulation (placebo) as a control group. Results As regards the quality of life assessment after rTMS sessions, there was a highly statistically significant difference in feel good and work missed scores by FIQ being lower in cases group compared to control group with p-values 0.008 and 0.003 respectively. Also there was a statistically significant difference as regards physical impairment, anxiety and depression scores by FIQ being lower in cases group compared to control with p-values 0.013, 0.022 and 0.037 respectively. On comparing the control and cases groups regarding anxiety and depression using HADS questionnaire after rTMS sessions, there was a statistically significant difference in depression score as it was lower in cases group compared to control group with p- value 0.024. Regarding fatigue assessment after rTMS sessions, there was a highly statistically significant difference between both groups as regards energy/fatigue, general health and health change scores being higher in cases group compared to control group with p-values 0.004, 0.005 and 0.009 respectively. Also, there was a statistically significant difference regarding emotional well-being score which was higher in cases group compared to control group with p-value 0.012. Upon correlating age and BMI with the studied parameters among the cases group, our results showed a positive correlation between age and pain score by FIQ (r 0.049, p 0.028), But, there was no correlation between BMI and other studied parameters. Conclusion rTMS was more effective than sham stimulation in improving quality of life, anxiety and depression when patients were assessed approximately 3 weeks after therapy. But, it was not effective concerning pain improvement.