Cuenca-Martínez Ferran, Sempere-Rubio Núria, Mollà-Casanova Sara, Muñoz-Gómez Elena, Fernández-Carnero Josué, Sánchez-Sabater Alberto, Suso-Martí Luis
Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain.
Brain Sci. 2023 Jul 11;13(7):1059. doi: 10.3390/brainsci13071059.
The main aim of this study was to assess the effects of repetitive-transcranial magnetic stimulation (rTMS) in patients with fibromyalgia (FMS).
We systematically searched PubMed, PEDro, EMBASE, and CINAHL. Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the guidelines advisory committee grading criteria. A total of 11 systematic reviews were included. The assessed variables were pain intensity, depressive symptoms, anxiety, and general health.
Regarding pain intensity, it seems that high-frequency rTMS significantly reduces pain intensity at a 1-month follow-up when the primary motor cortex (M1) is stimulated. However, we cannot robustly conclude the same for low-frequency protocols. When we look at the combination of high and low-frequency rTMS, there seems to be a significant effect on pain intensity up to 1-week post-intervention, but after that point of follow-up, the results are controversial. Regarding depressive symptoms and anxiety, results showed that the effects of rTMS are almost non-existent. Finally, in regard to general health, results showed that rTMS caused significant post-intervention effects in a robust way. However, the results of the follow-ups are contradictory.
The results obtained showed that high-frequency rTMS applied on the M1 showed some effect on the variable of pain intensity with a limited quality of evidence. Overall, rTMS was shown to be effective in improving general health with moderate quality of evidence. Finally, rTMS was not shown to be effective in managing depressive symptoms and anxiety with a limited to moderate quality of evidence. PROSPERO number: This review was previously registered in PROSPERO (CRD42023391032).
本研究的主要目的是评估重复经颅磁刺激（rTMS）对纤维肌痛（FMS）患者的影响。
我们系统检索了PubMed、PEDro、EMBASE和CINAHL。使用AMSTAR和ROBIS量表分析方法学质量，并根据指南咨询委员会分级标准确定证据强度。共纳入11项系统评价。评估的变量包括疼痛强度、抑郁症状、焦虑和总体健康状况。
关于疼痛强度，当刺激初级运动皮层（M1）时，高频rTMS似乎在1个月的随访中显著降低疼痛强度。然而，对于低频方案，我们不能有力地得出同样的结论。当我们观察高频和低频rTMS的联合应用时，干预后1周内对疼痛强度似乎有显著影响，但在该随访时间点之后，结果存在争议。关于抑郁症状和焦虑，结果表明rTMS的影响几乎不存在。最后，关于总体健康，结果表明rTMS以一种有力的方式在干预后产生了显著影响。然而，随访结果相互矛盾。
获得的结果表明，应用于M1的高频rTMS对疼痛强度变量有一定影响，但证据质量有限。总体而言，rTMS被证明在改善总体健康方面有效，证据质量中等。最后，rTMS在管理抑郁症状和焦虑方面未被证明有效，证据质量有限至中等。PROSPERO编号：本综述先前已在PROSPERO注册（CRD42023391032）。
