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Velickovic Z, Radunovic G. Repetitive Transcranial Magnetic Stimulation in Fibromyalgia: Exploring the Necessity of Neuronavigation for Targeting New Brain Regions. J Pers Med 2024; 14:662. [PMID: 38929883 PMCID: PMC11204413 DOI: 10.3390/jpm14060662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Fibromyalgia and osteoarthritis are among the most prevalent rheumatic conditions worldwide. Nonpharmacological interventions have gained scientific endorsements as the preferred initial treatments before resorting to pharmacological modalities. Repetitive transcranial magnetic stimulation (rTMS) is among the most widely researched neuromodulation techniques, though it has not yet been officially recommended for fibromyalgia. This review aims to summarize the current evidence supporting rTMS for treating various fibromyalgia symptoms. Recent findings: High-frequency rTMS directed at the primary motor cortex (M1) has the strongest support in the literature for reducing pain intensity, with new research examining its long-term effectiveness. Nonetheless, some individuals may not respond to M1-targeted rTMS, and symptoms beyond pain can be prominent. Ongoing research aims to improve the efficacy of rTMS by exploring new brain targets, using innovative stimulation parameters, incorporating neuronavigation, and better identifying patients likely to benefit from this treatment. Summary: Noninvasive brain stimulation with rTMS over M1 is a well-tolerated treatment that can improve chronic pain and overall quality of life in fibromyalgia patients. However, the data are highly heterogeneous, with a limited level of evidence, posing a significant challenge to the inclusion of rTMS in official treatment guidelines. Research is ongoing to enhance its effectiveness, with future perspectives exploring its impact by targeting additional areas of the brain such as the medial prefrontal cortex, anterior cingulate cortex, and inferior parietal lobe, as well as selecting the right patients who could benefit from this treatment.
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Affiliation(s)
| | - Goran Radunovic
- Institute of Rheumatology, Resavska 69, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, Dr Subotića 1, 11000 Belgrade, Serbia
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Herrero Babiloni A, Provost C, Charlebois-Plante C, De Koninck BP, Apinis-Deshaies A, Lavigne GJ, Martel MO, De Beaumont L. One session of repetitive transcranial magnetic stimulation induces mild and transient analgesic effects among female individuals with painful temporomandibular disorders. J Oral Rehabil 2024; 51:827-839. [PMID: 38225806 DOI: 10.1111/joor.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/11/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE Temporomandibular disorders (TMD) are characterised by chronic pain and dysfunction in the jaw joint and masticatory muscles. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential non-invasive treatment for chronic pain; however, its effectiveness in individuals with TMD has not been thoroughly investigated. This study aimed to evaluate the immediate and sustained (over seven consecutive days) effects of a single session of active rTMS compared to sham stimulation on pain intensity and pain unpleasantness in individuals with TMD. METHODS A randomised, double-blind, sham-controlled trial enrolled 41 female participants with chronic TMD. Pain intensity and pain unpleasantness were assessed immediately pre- and post-intervention, as well as twice daily for 21 days using electronic diaries. Secondary outcomes included pain interference, sleep quality, positive and negative affect and pain catastrophizing. Adverse effects were monitored. Repeated measures ANOVA and multilevel modelling regression analyses were employed for data analysis. RESULT Active rTMS demonstrated a significant immediate mild reduction in pain intensity and pain unpleasantness compared to sham stimulation. However, these effects were not sustained over the 7-day post-intervention period. No significant differences were observed between interventions for pain interference, sleep quality and negative affect. A minority of participants reported minor and transient side effects, including headaches and fatigue. CONCLUSION A single session of active rTMS was safe and led to immediate mild analgesic effects in individuals with TMD compared to sham stimulation. However, no significant differences were observed between interventions over the 7-day post-intervention period. Based on this study, rTMS stimulation appears to be a promising safe approach to be tested in TMD patients with longer stimulation protocols.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Catherine Provost
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Camille Charlebois-Plante
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Beatrice P De Koninck
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Amelie Apinis-Deshaies
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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Cuenca-Martínez F, Sempere-Rubio N, Mollà-Casanova S, Muñoz-Gómez E, Fernández-Carnero J, Sánchez-Sabater A, Suso-Martí L. Effects of Repetitive-Transcranial Magnetic Stimulation (rTMS) in Fibromyalgia Syndrome: An Umbrella and Mapping Review. Brain Sci 2023; 13:1059. [PMID: 37508991 PMCID: PMC10377383 DOI: 10.3390/brainsci13071059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The main aim of this study was to assess the effects of repetitive-transcranial magnetic stimulation (rTMS) in patients with fibromyalgia (FMS). METHODS We systematically searched PubMed, PEDro, EMBASE, and CINAHL. Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the guidelines advisory committee grading criteria. A total of 11 systematic reviews were included. The assessed variables were pain intensity, depressive symptoms, anxiety, and general health. RESULTS Regarding pain intensity, it seems that high-frequency rTMS significantly reduces pain intensity at a 1-month follow-up when the primary motor cortex (M1) is stimulated. However, we cannot robustly conclude the same for low-frequency protocols. When we look at the combination of high and low-frequency rTMS, there seems to be a significant effect on pain intensity up to 1-week post-intervention, but after that point of follow-up, the results are controversial. Regarding depressive symptoms and anxiety, results showed that the effects of rTMS are almost non-existent. Finally, in regard to general health, results showed that rTMS caused significant post-intervention effects in a robust way. However, the results of the follow-ups are contradictory. CONCLUSIONS The results obtained showed that high-frequency rTMS applied on the M1 showed some effect on the variable of pain intensity with a limited quality of evidence. Overall, rTMS was shown to be effective in improving general health with moderate quality of evidence. Finally, rTMS was not shown to be effective in managing depressive symptoms and anxiety with a limited to moderate quality of evidence. PROSPERO number: This review was previously registered in PROSPERO (CRD42023391032).
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Affiliation(s)
| | | | | | - Elena Muñoz-Gómez
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Josué Fernández-Carnero
- Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, 28922 Madrid, Spain
- Grupo de Investigación en Neurociencia Cognitiva, Dolor y Rehabilitación en Ciencias de la Salud (NECODOR), Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | | | - Luis Suso-Martí
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Song S, Kim G, Kim H. A Systematic Review and Meta-Analysis of Exercise Beneficial for Locomotion in Community-Dwelling Elderly People with Sarcopenia. J Funct Morphol Kinesiol 2023; 8:92. [PMID: 37489305 PMCID: PMC10366781 DOI: 10.3390/jfmk8030092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/26/2023] Open
Abstract
Sarcopenia, in addition to aging and reduced physical activity, is a progressive skeletal muscle disorder that causes the loss of muscle mass and strength. The most prominent functional change is mobility, which contributes to a decrease in the quality of life. Therefore, we aimed to perform qualitative and quantitative analyses by synthesizing randomized controlled trials (RCTs) that evaluated exercises that affected locomotion in patients with sarcopenia. The RCTs were retrieved in April 2023 from three international electronic databases (Embase, MEDLINE, and PubMed). RCTs published after 2013 were compared with a control group that did not include exercise. Qualitative and quantitative analyses were performed on the identified studies using RevMan 5.4 and risk of bias assessment provided by Cochrane. RCTs involving 594 patients with sarcopenia were included in this study. The analysis model was synthesized as a random effects model, and the standard mean difference (SMD) was used as the effect measure. Exercise interventions were found to not change muscle mass in individuals with sarcopenia (SMD = 0.04; 95% CI: -0.15 to 0.22). However, they had positive effects on lower extremity muscle strength (SMD = 0.34; 95% CI: 0.02 to 0.66) and walking speed (SMD = 0.42; 95% CI: 0.11 to 0.72). For community-dwelling elderly people with sarcopenia, exercise intervention did not lead to an increase in reduced muscle mass, but it brought positive improvements in lower extremity strength and gait speed to improve locomotion.
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Affiliation(s)
- Seunghyeok Song
- Korea Pediatric Integrative Manual Therapy Association, 302 Gwanggyojungang-ro, Yongin 16943, Republic of Korea
| | - Gushik Kim
- Gyeonggi Branch, Korea Physical Therapy Association, 1030 Gyeongsu-daero, Suwon 16203, Republic of Korea
| | - Hyunjoong Kim
- Neuromusculoskeletal Science Laboratory, 306 Jangsin-ro, Gwangju 62287, Republic of Korea
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