Fibromyalgia and the potential benefits of rTMS for relief of chronic pain

Blas saw an article in the Zaragoza newspaper El Heraldo de Aragón about a new treatment involving "transcranial magnetic stimulations" or TMS for people with fibromyalgia. Apparently, this treatment has been approved in Europe and is now being used in a few cities in Spain. It appears to have a huge success in alleviating the symptoms of pain and fatigue that afflict those of us with fibromyalgia, not permanently, but for significant periods of time and without side effects. I had never heard of this before, so I started digging.

First, I found this recent summary of how FM is being currently understood by the medical profession in the abstract of this article in the Oct 2008 issue of The Neuroscientist: "Fibromyalgia: A Disorder of the Brian?" Scientists have finally succeeded in using brain imaging techniques to detect specific differences in the brain images of people with FM and those without: "Fibromyalgia can no longer be called the 'Invisible' Syndrome":

"The researchers confirmed that patients with the syndrome exhibited brain perfusion abnormalities in comparison to the healthy subjects. Further, these abnormalities were found to be directly correlated with the severity of the disease. An increase in perfusion (hyperperfusion) was found in that region of the brain known to discriminate pain intensity, and a decrease (hypoperfusion) was found within those areas thought to be involved in emotional responses to pain.

In the past, some researchers have thought that the pain reported by fibromyalgia patients was the result of depression rather than symptoms of a disorder. "Interestingly, we found that these functional abnormalities were independent of anxiety and depression status," Guedj said."

This is important because for decades, people with FM have been treated as hysterics, malingerers, attention-seeking neurotics. For years, people with FM were angry and defensive that their symptoms were being dismissed as "all in your head," meaning "not real." This has changed somewhat, but I am still stymied by the fact that when I have a flare-up and must cut down on my work, I can't expect my colleagues or students to understand what is wrong or how they can support me.

Various types of TMS are now being studied for their usefulness in treating depression, migraines, Parkinson's disease, bi-polar disorder, cravings for alcohol and cocaine, as well as chronic pain relief and therapy after brain injuries such as stroke. A 2006 study from the Mayo clinic by Dr. Shirlene Sampson, et al, on a few patients pointed to the potential benefit of of repetitive cycles of TMS (rTMS) for relief of the chronic pain of fibromyalgia. Results of a larger 2007 French study on rTMS and fibromyalgia (published in the journal Brain) were based on an increased sample size and more systematic review of data. (Full text here). The blog Neuromod reviewed this study within the context of this emerging field called "neuromodulation." One of its major journals is the year-old Brain Stimulation (I love these journal names!).

Another study reviews some of these early research trials, and I've found calls for clinical trials specific to the use of rTMS for fibromyalgia that are being conducted now in the U.S.and France. Researchers are also now trying to find out how to refine their techniques of rTMS (where to apply it, what it seems to affect, etc). One hypothesis is that this treatment alleviates pain in people with FM because it reduces sleep disruption (maybe by correcting the alpha-wave disruption of delta waves in sleep cycles).

I've looked at some of the discussions of whether or not these non-invasive, non-convulsive, less expensive (but still experimental) treatments are as effective as ElectroConvulsive Treatment (ECT) or "electroshock therapy" (which still horrifies me because of past abuses, although I realize that for some people with severe depression that is resistant to all other treatments, it can be more effective than medications).

It is surprisingly difficult to find out who specializes in treating fibromyalgia in this area; in spite of the fact that I have a very sympathetic and competent doctor who has been great for me for the past fifteen years, my symptoms have been worse these past few years and the overall degradation of my quality of life is taking its toll on my resilience. I'm going to keep chipping away at finding more about new treatments and access to them in this area.