A form of brain-stimulation therapy called repetitive transcranial magnetic stimulation (rTMS) may help relieve some of the non-pain symptoms of fibromyalgia, including emotional distress, and improve overall quality of life for patients living with the disease, according to a new study published in the journal Neurology.
Fibromyalgia is a chronic disorder that causes long-term pain and tenderness in the joints, muscles, and tendons throughout the body, as well as severe fatigue. People with fibromyalgia may also experience a number of other symptoms, including sleep disturbances, irritable bowel syndrome, restless leg syndrome, numbness or tingling in the arms and legs, and depression, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD).
Fibromyalgia affects an estimated five million American adults, and 80 to 90 percent of those diagnosed with the disease are women, according to the NIAMSD.
Currently, prescription and nonprescription drugs and pain killers are the primary treatments for fibromyalgia. Researchers hope the results of this study will lead to a new way of relieving some of the more stubborn symptoms of the disease.
In a press release, study author Dr. Eric Guedj said, “rTMS is a way to alter the excitability of the brain. A treatment such as this may provide a safe and noninvasive complement to pain pills in some people.”
Previous studies have found brain-function abnormalities in some fibromyalgia patients, said Guedj, in an interview with Healthline. These brain areas are reachable by rTMS, but these studies did not test rTMS as a potential treatment.
“Other colleagues have reported the interest of rTMS in fibromyalgia—two clinical trials to my knowledge,” Guedj said. “Our study is the first to combine an rTMS clinical trial to a functional brain exploration in order to better understand the mechanisms of action of this therapeutic in fibromyalgia.”
Pain vs. Non-Pain Symptoms
“Previous neuroimaging studies in patients with fibromyalgia have suggested an alteration of brain processes involved in the regulation of pain and emotion,” Guedj said. “The objective of our study was to demonstrate that it is possible to modulate brain areas, using rTMS, in order to correct functional brain abnormalities and improve patients’ symptoms.”
To do this, Guedj and his colleagues performed a randomized, double-blind, placebo-controlled trial in which 38 adults who had suffered from fibromyalgia for more than six months were assigned to receive either rTMS or sham stimulation using a similar-looking device.
During the 10-week study, which consisted of 14 sessions of rTMS or sham stimulation, researchers assessed quality of life, depression, anxiety, and pain at three points: at the start, after two weeks, and after 11 weeks. Changes in quality of life were measured using a questionnaire, and brain metabolic changes were measured using PET neuroimaging.
Researchers found that after 11 weeks, high-frequency rTMS over the brain's left primary motor cortex had a positive impact on fibromyalgia patients' quality of life, without having any effect on pain.
Results from the questionnaire showed that patients receiving rTMS had an average score of 60 on the quality-of-life scale at the beginning of the study. Scores ranged from zero to 100, with lower scores indicating a better quality of life. After 11 weeks, the average score of participants receiving actual rTMS treatment had dropped by about 10 points. Those receiving the sham stimulation had an initial average score of 64, and after 11 weeks their average score increased by two points.
“This study shows that rTMS improves the quality of life of patients with fibromyalgia, with probably a clinical interest for hyperalgesic and [drug resistant] patients,” Guedj said.
Improvements in quality of life were measured in terms of mood and feelings; emotions such as joy, sadness, anger, and anxiety; and social areas, such as work performance, social interactions and activities; and engagement in hobbies or other interests.
The Psychological Side of Fibromyalgia
The results of this study shed light on the emotional and social aspects of fibromyalgia. According to the Anxiety and Depression Association of America (ADAA), about 20 percent of people living with symptoms of pain due to fibromyalgia also suffer from anxiety or depression.
These secondary symptoms—particularly those that are manifested as sleep disturbances and memory or cognitive impairment—often do not get the attention they deserve and are not treated as effectively as the symptoms of pain commonly associated with the disease, Guedj said.
To treat all of the symptoms of fibromyalgia, the ADAA suggests seeing one doctor for treatment of the disease's physical symptoms and another doctor or therapist for any other social or emotional symptoms.
Living with Fibromyalgia
In addition to working with your doctor or therapist, the NIAMSD recommends incorporating the following healthy practices into your daily routine to help relieve symptoms and improve quality of life:
- Practice proper sleep hygiene by going to bed at the same time each night and waking up at the same time each morning, avoiding caffeine in the afternoon and evening, and reserving the bed for sleep and sex only.
- Exercise regularly, even when pain and fatigue make physical exertion difficult.
- Stick to a healthy diet.
- Make work and life changes, such as working fewer hours or finding a less demanding job, to suit your specific symptoms and needs.