Repetitive Transcranial Magnetic Stimulation Does Not Improve Pain in Fibromyalgia

Man hooked up to TMS
Patient in transcranial magnetic stimulation (TMS) experiment
Researchers compared the effects of repetitive transcranial magnetic stimulation (rTMS) with a combination of multicomponent therapy and rTMS on pain in patients with fibromyalgia.

Repetitive transcranial magnetic stimulation (rTMS) in addition to multicomponent therapy (MT) does not reduce pain in patients with fibromyalgia, according to research results published in Arthritis Care & Research.

The study included data from patients with fibromyalgia who had a pain visual analog scale (pVAS) ≥40 mm (n=39). Patients were randomly assigned to receive either active or sham rTMS (high frequency, primary motor cortex M1) plus 12 weeks of MT (3 sessions/week, including aerobic training, pool-based exercises, and relaxation). The rTMS sessions began 2 weeks before MT, which was maintained until the end of the program (week 14).

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Researchers assessed patient data at baseline, at week 14, and at 6 months (week 40) after completing the program. The primary outcome was pain reduction, which was assessed by the weekly mean daily self-reported level of pain. Secondary outcomes included cardiorespiratory fitness (by graded maximal exercise test), cardiac autonomic adaptations, and fibromyalgia impact (by fibromyalgia impact, depression, sleep efficiency, and pain catastrophizing scales).

After performing repeated measures of analysis of variance (ANOVA), the researchers found that there was no significant difference in weekly mean daily pain reduction among patients who received rTMS vs those who did not.

In both groups, 2-way ANOVAs revealed that pVAS (P <.05), fibromyalgia impact (P <.001), depression (P <.001), and pain catastrophizing (P <.05) improved significantly at week 14 compared with baseline. These improvements remained consistent through week 40 and did not significantly differ between groups.

Researchers did not find any significant changes in sleep or cardiac autonomic adaptations.

Study limitations included that the placebo effect of rTMS could not be excluded, and the study may be underpowered.

“The updated meta-analysis strengthens the experimental results suggesting that rTMS is not effective in improving either pain or [quality of life] in [patients with] severe [fibromyalgia],” the researchers wrote.


Guinot M, Maindet C, Hodaj H, et al. Effects of repetitive transcranial magnetic stimulation and multicomponent therapy in patients with fibromyalgia: a randomized controlled trial. [published online November 30, 2019]. Arthritis Care Res. doi:10.1002/acr.24118