A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia.
OBJECTIVE
Recent evidence suggests that fibromyalgia is a disorder characterized by dysfunctional brain activity. Because transcranial direct current stimulation (tDCS) can modulate brain activity noninvasively and can decrease pain in patients with refractory central pain, we hypothesized that tDCS treatment would result in pain relief in patients with fibromyalgia.


METHODS
Thirty-two patients were randomized to receive sham stimulation or real tDCS with the anode centered over the primary motor cortex (M1) or the dorsolateral prefrontal cortex (DLPFC) (2 mA for 20 minutes on 5 consecutive days). A blinded evaluator rated the patient's pain, using the visual analog scale for pain, the clinician's global impression, the patient's global assessment, and the number of tender points. Other symptoms of fibromyalgia were evaluated using the Fibromyalgia Impact Questionnaire and the Short Form 36 Health Survey. Safety was assessed with a battery of neuropsychological tests. To assess potential confounders, we measured mood and anxiety changes throughout the trial.


RESULTS
Anodal tDCS of the primary motor cortex induced significantly greater pain improvement compared with sham stimulation and stimulation of the DLPFC (P < 0.0001). Although this effect decreased after treatment ended, it was still significant after 3 weeks of followup (P = 0.004). A small positive impact on quality of life was observed among patients who received anodal M1 stimulation. This treatment was associated with a few mild adverse events, but the frequency of these events in the active-treatment groups was similar to that in the sham group. Cognitive changes were similar in all 3 treatment groups.


CONCLUSIONS
Our findings provide initial evidence of a beneficial effect of tDCS in fibromyalgia, thus encouraging further trials.
Fregni
Felipe
F
Harvard Medical School, Boston, Massachusetts 02215, USA. ffregni@bidmc.harvard.edu
Gimenes
Rafaela
R
Valle
Angela C
AC
Ferreira
Merari J L
MJ
Rocha
Renata R
RR
Natalle
Luane
L
Bravo
Riviane
R
Rigonatti
Sergio P
SP
Freedman
Steven D
SD
Nitsche
Michael A
MA
Pascual-Leone
Alvaro
A
Boggio
Paulo S
PS
D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement; D017397:Prefrontal Cortex; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome