title: Transcranial magnetic stimulation in the treatment of chronic widespread pain: a randomized controlled study.
abstract: OBJECTIVE
  Our objective was to assess transcranial magnetic stimulation (TMS) in the treatment of chronic widespread pain.
  
  
  METHODS
  Nineteen participants were randomized into 2 groups: one group receiving active TMS (n = 7) and another group receiving sham stimulation (n = 11) applied to the left dorsolateral prefrontal cortex. During sham stimulation, subjects heard a sound similar to the sound heard by those receiving the active treatment and received an active electrical stimulus to the scalp. The stimulation protocol consisted of 15 sessions completed within a 4-week period. Blind assessments were done at baseline and after each 5 sessions followed by blind assessments at 1 week, 1 month, and 3 months after the last TMS sessions. The primary outcome variable was a pain measure, the Gracely Box Intensity Scale (BIRS).
  
  
  RESULTS
  The percentage of subjects who guessed that they were receiving TMS was similar in the 2 groups. Both the TMS group and the sham group showed a statistically significant reduction in the BIRS scores from baseline during the acute phase of treatment and the follow-up phase. However, the TMS and sham groups did not differ in the change in the BIRS scores.
  
  
  CONCLUSIONS
  Although some previous clinical studies and basic science studies of TMS in treating pain are promising, this study found no difference in the analgesic effect of TMS and sham stimulation. Future studies should use a sham condition that attempts to simulate the sound and sensation of the TMS stimulation. Stimulus location and other stimulus parameters should be explored in future studies.
authors.affiliation: From the *Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine; †Psychiatric Medicine Associates; ‡Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA; §Department of Psychiatry of Catholic University of Korea College of Medicine, Seoul, South Korea; ∥Department of Radiology, University of Washington School of Medicine; and ¶Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: David H
authors.initials: DH
authors.lastname: Avery
authors.forename: Paul
authors.initials: P
authors.lastname: Zarkowski
authors.forename: Daniel
authors.initials: D
authors.lastname: Krashin
authors.forename: Wang-Ku
authors.initials: WK
authors.lastname: Rho
authors.forename: Chandra
authors.initials: C
authors.lastname: Wajdik
authors.forename: Jutta M
authors.initials: JM
authors.lastname: Joesch
authors.forename: David R
authors.initials: DR
authors.lastname: Haynor
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010147:Pain Measurement; D017397:Prefrontal Cortex / Q000502:physiology; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
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