Efficacy of High-Frequency Repetitive Transcranial Magnetic Stimulation at 10 Hz in Fibromyalgia: A Systematic Review and Meta-analysis

Objective: The purpose of this review was to systematically assess the effectiveness of 10-Hz repetitive transcranial magnetic stimulation (rTMS) in fibromyalgia.Data Sources: We searched PubMed, Cochrane Library, Embase, Web of Science, and Ovid databases as of November 6, 2021.Study Selection: The inclusion criteria for this review were randomized controlled trials of 10-Hz rTMS for fibromyalgia, exploring the effects of 10-Hz rTMS on pain, depression, and quality of life in patients with fibromyalgia.Data Extraction: Data extraction was performed independently by 2 evaluators according to predefined criteria, and the quality of the included lit-erature was assessed using the Cochrane Bias Risk Assessment Tool. The measurement outcomes include visual analog scale, Hamilton Depres-sion Rating Scale, and Fibromyalgia Impact Questionnaire, and so on.Data Synthesis: A total of 488 articles were screened, and the final 7 selected high-quality articles with 217 patients met our inclusion criteria. Analysis of the results showed that high-frequency transcranial magnetic stimulation at 10 Hz was significantly associated with reduced pain com-pared with sham stimulation in controls (standardized mean difference [SMD]=-0.72; 95% confidence interval [CI],-1.12 to-0.33; P<.001; I2=46%) and was able to improve quality of life (SMD=-0.70; 95% CI,-1.00 to-0.40; P<.001; I2=15%) but not improve depression (SMD=-0.23; 95% CI,-0.50 to 0.05; P=.11; I2=33%). In addition, a subgroup analysis of pain conducted based on stimulation at the primary motor cortex and dorsolateral prefrontal cortex showed no significant difference (SMD=-0.72; 95% CI,-1.12 to-0.33; P=.10; I2=62%).Conclusions: Overall, 10-Hz rTMS has a significant effect on analgesia and improved quality of life in patients with FMS but did not improve depression.Archives of Physical Medicine and Rehabilitation 2023;104:151-9 (c) 2022 by the American Congress of Rehabilitation Medicine.