From the Department of Psychological Medicine (Toh, Ng, R. Ho, C. Ho), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Mood Disorders Psychopharmacology Unit (McIntyre), University Health Network, University of Toronto, Toronto, Canada; Bloomberg School of Public Health (Tran), Johns Hopkins University, Baltimore, Maryland; Institute for Preventive Medicine and Public Health (Tran), Hanoi Medical University, Hanoi, Vietnam; Institute of Health Innovation and Technology (iHealthtech) (R. Ho) and Alice Lee School of Nursing (Tam), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Psychosom Med. 2022 May 1;84(4):400-409. doi: 10.1097/PSY.0000000000001062. Epub 2022 Jan 28.
OBJECTIVE: Meta-analysis was performed to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in fibromyalgia on the domains of pain, depression, anxiety and quality of life. METHOD: Publications were searched with the keywords "repetitive transcranial magnetic stimulation" and "fibromyalgia" for randomized controlled trials that compare rTMS with sham stimulation for treating pain, depression, anxiety, and quality of life. Trials available until April 2021 were searched through PubMed, Scopus, Web of Science, and Cochrane Controlled Trials Register. The postintervention scores after 4 weeks for pain, depression, anxiety, and quality of life were extracted to compare the effects of rTMS and sham. Subgroup analysis was conducted based on the stimulation site. RESULTS: From 265 screened articles, 11 eligible randomized controlled trials involving 303 patients were included. The results show that rTMS is more effective than sham stimulation in improving pain (standardized mean difference [SMD] = -0.35; 95% confidence interval [CI] = -0.62 to -0.08; p = .01) and quality of life (SMD = -0.51; 95% CI = -0.78 to -0.23; p = .0003). It is not more effective than sham stimulation for depression, and anxiety. After sensitivity analysis, subgroup analysis revealed that primary motor cortex stimulation was more effective than sham for improving pain (SMD = -0.57; 95% CI = -0.91 to -0.23; p = <0.01). Neither dorsolateral prefrontal cortex nor primary motor cortex stimulation was more effective than sham in improving depression and anxiety. CONCLUSIONS: rTMS is more effective than sham in improving pain and quality of life, but it does not demonstrate reduction in depression or anxiety.
目的：进行荟萃分析以评估重复经颅磁刺激（rTMS）在纤维肌痛领域的有效性，具体涉及疼痛、抑郁、焦虑和生活质量等方面。
方法：使用“重复经颅磁刺激”和“纤维肌痛”等关键词，在 PubMed、Scopus、Web of Science 和 Cochrane 对照试验登记处等数据库中检索比较 rTMS 与假刺激治疗疼痛、抑郁、焦虑和生活质量的随机对照试验。检索截至 2021 年 4 月的试验。提取干预后 4 周的疼痛、抑郁、焦虑和生活质量评分，以比较 rTMS 和假刺激的效果。根据刺激部位进行亚组分析。
结果：从 265 篇筛选出的文章中，纳入了 11 项符合条件的随机对照试验，共涉及 303 名患者。结果表明，rTMS 比假刺激更能有效改善疼痛（标准化均数差 [SMD] = -0.35；95%置信区间 [CI] = -0.62 至 -0.08；p =.01）和生活质量（SMD = -0.51；95% CI = -0.78 至 -0.23；p =.0003）。rTMS 对抑郁和焦虑的改善效果并不优于假刺激。经过敏感性分析和亚组分析显示，初级运动皮层刺激比假刺激更能有效改善疼痛（SMD = -0.57；95% CI = -0.91 至 -0.23；p = <0.01）。但无论是外侧前额叶皮层还是初级运动皮层刺激，都不如假刺激能有效改善抑郁和焦虑。
结论：rTMS 比假刺激更能有效改善疼痛和生活质量，但对抑郁和焦虑没有改善作用。
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