Randevu 0216 449 09 41
Prof. Dr. Cengiz BAHADIR

Fibromyalgia – Pain

Transcranial Magnetic Stimulation in Fibromyalgia Treatment

Fibromyalgia is a common chronic pain syndrome. It is a common disorder encountered in physiatry and rheumatology. According to USA data, it has been estimated that 4 to 10 million people suffer from fibromyalgia. It more common in women compared to men (approximately 75-90% of the patients are women). As per American College of Rheumatology criteria for diagnosis, the patients with common chronic pain and experiencing pain in at least 11 of 18 established points upon palpation are considered as fibromyalgia patients. Other symptoms can be outlined as poor sleep quality, extreme fatigue, mood disorders (depression, anxiety), impaired quality of life, morning stiffness, decrease in social and occupational productivity.agri

In most cases, fibromyalgia patients have a long history of examinations and tests resulting in normal ranges until the diagnosis. Fibromyalgia diagnosis requies the elimination of common reasons for pain. It is actually not hard to diagnose but it can be very difficult to treat. Fibromyalgia treatment requires a multi-disciplinary approach. Drug therapies are usually first choice of treatment. Physical therapy, exercise, alternative-supplementary medical methods, behavioral treatment methods are also adopted. No treatment method providing efficacy for all symptoms of fibromyalgia at the same time has been developed yet.
Fibromyalgia is basically considered to be a result of the impaired perception of pain on the patient’s brain. These patients somehow feels pain sensations more severely with compared to healthy individuals. Thus it is possible to state that these patients suffer from a low threshold of pain. This phenomenon called central sensitization has been recently well established and it has been discovered that the pain of fibromyalgia is a neuropathic pain (originating from central nervous system). The fact that drugs such as pregabalin used for neuropathic pain benefits for fibromyalgia patients supports that theory. It has also been discovered that anti-depressants, which are actually not pain killers, significantly decrease the pain for fibromyalgia patients.
Nevertheless, there are many fibromyalgia patients for whom the pain cannot be relieved despite of all established conventional treatment methods. These patients may suffer from depression due to unrelieved pain. A new alternative for these patients have been discovered in recent years. Transcranial magnetic stimulation (TMS) therapy is based on external stimulation of certain brain nerves with magnetic field. TMS therapy is performed by using a magnetic coil approximated to the patient’s head. TMS therapy makes it possible to stimulate neurons on the outer layer of the brain without disturbing the patient. Based on the frequency of the stimuli, the nerve cells on the relevant area are stimulated or suppressed. Thanks to these benefits, TMS therapy is now among the approved methods for the treatment of depression. It is also used for the treatment of hemiplegia and many brain disorders. Recent studies have shown that TMS therapy can change pain perception of brain, providing efficacy for fibromyalgia cases.

agri1For this method, the motor point (the part of the brain controlling voluntary movement) and motor threshold of the patient are determined via a simple test. Motor threshold is the lowest current producing hand movement via the magnetic current applied. This threshold is administered to the motor point of the left hemisphere on a range of current specific to the patient (80-110%). Approximately 1200-1500 stimuli of 10 Hz frequency are administered at intervals. The administration lasts 15-20 minutes. Various treatment protocols have been developed. The treatment protocols range from 10-20 days of application to daily administrations at the beginning then to weekly and monthly administrations with longer intervals. It has been established that the majority of the patients experienced pain relief thanks to TMS therapy. It also provides benefit in terms of depression symptoms and sleep disorders. This treatment is especially efficient for patients with drug resistant complaints. There are very few, mainly mild, side effects of this therapy. It is also extremely important for therapy adherence that patients do not experience any discomfort during the treatment.
TMS therapy has been a novel and effective treatment choice for fibromyalgia patients whose physiopathology has been better understood and it has been accepted that these patients are suffering from a central nervous system disorder. It has provided a new treatment option for fibromyalgia patients especially who are resistant to conventional therapies (drug, physical therapy etc.).