Wednesday, May 16, 2007

Slow-Frequency rTMS and Fibromyalgia Pain

This was the first article I read that introduced me to the concept of transcranial magnetic stimulation. I had just seen a patient the day before in a Rheumatology clinic I was visiting and had a long chat with the Rheumatologist I was working with about the etiology of Fibromyalgia and what sorts of treatments were available. Needless to say, he was fairly pessimistic about what was possible. I ran across this article in Rehab in Review, it piqued my interest and I pulled the article.
Some thoughts about the article: an n of four is always concerning, so it needs to be considered a limited case series. But if you examine the response of the patients to repetitive transcranial stimulation (rTMS), it was pretty amazing. A baseline pain of 8.2(ranging from 7-9.5 on a scale of 0-10) that was dropped to 1.5 (0-3.5) is not only statistically significant, but if you consider the functional ramifications it is amazing. These subjects received rTMS five days per week for four weeks, one of the patients received sham rTMS prior to the four weeks and one got an additional twelve treatments because she (they were all women) had remission of depressive symptoms. All had been diagnosed by board certified Rheumatologists and all had been evaluated by Psychiatrists.
The results showed one patient had resolution of depression and two of the four had resolution of their pain. Pain was improved, defined as not increasing more than 1.5 points on the 0-10 scale, for 15-27 weeks.
This was a real eye-opener for me even when taken with a large grain of salt. Just something to think about.
PubMed Citation