Effects of fMRI-Guided Neural Navigation Based rTMS Therapy on Pain Status in Fibromyalgia Patients

SOURCE: Indian Journal of Physiology and Pharmacology. Conference: 64th Annual National Conference of Association of Physiologists and Pharmacologists of India, APPICON 2018. Karnataka India. 62(Supplement 1) (pp 79), 2018.


AUTHORS: Tiwari V.K.; Mattoo B.; Kumar U.; Kumaran S.S.; Bhatia R.

Intractable widespread body pain is the chief complaint of patients with fibromyalgia syndrome (FMS) besides insomnia and cognitive impairments. A multidisciplinary approach is needed to address the wide spectrum of symptoms. This study utilized neuronavigation based repeated transcranial magnetic stimulation (rTMS) over the Dorso-Lateral Prefrontal Cortex (DLPFC) as a novel approach for pain management in FMS.

OBJECTIVE(S): The aim of this study was to explore the effect of neural navigation based rTMS on pain status in FMS by subjective pain assessment tests.

METHOD(S): Twenty-six patients diagnosed with primary Fibromyalgia based on the diagnostic criteria of American College of Rheumatology were recruited from the Rheumatology outpatient
department, at AIIMS, New Delhi. The patients were randomized into sham (n=13) and real (n=13) rTMS groups following which they underwent a standardized fMRI-based Stroop test protocol to locate DLPFC. This was followed by 20 sessions of either real or sham rTMS therapy. The pre and
post rTMS effects were compared using Numerical Pain rating scale (NPRS) and McGill pain questionnaires (MPQ) for subjective pain improvement.

RESULT(S): Study suggested significant subjective pain improvements. The NPRS scores were significantly lower in patients (p <0.0001) treated with real as compared sham (p=0.29).