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Effectiveness of high-frequency transcranial magnetic stimulation and physical exercise in women with fibromyalgia: a randomized controlled trial
Izquierdo-Alventosa R, Ingles M, Cortes-Amador S, Gimeno-Mallench L, Sempere-Rubio N, Serra-Ano P
Physical Therapy & Rehabilitation Journal 2021 Oct;101(10):pzab159
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: Fibromyalgia (FM) is characterized by chronic widespread pain and both physical and emotional alterations, which in turn may affect the individual's quality of life. Thus, interventions aimed at treating such symptoms, without increasing fatigue, are needed. The aim of this study was to explore the effect of high-frequency transcranial magnetic stimulation (HF-TMS) and physical exercise (PE) on pain, impact of FM, physical conditioning, and emotional status in people with FM. METHODS: Forty-nine women with FM were randomly allocated to a PE group (PEG, n = 16), who underwent an 8-week (two 60-minute sessions/week) low intensity PE program; TMS group (TMSG, n = 17), receiving a 2-week (five 20-minute sessions/week) HF-TMS intervention and a control group (CG, n = 16). Pain (ie, perceived pain and average pressure pain threshold (PPT), perceived impact of FM (ie, overall impact, symptoms, and perceived physical function), physical conditioning (ie, endurance and functional capacity, fatigue, gait velocity, and power) and emotional status (ie, anxiety, depression, stress, and satisfaction) were assessed at baseline (T1) and after the intervention (T1, at 2 weeks for TMSG and at 8 weeks for PEG and CG). RESULTS: TMSG showed to significantly improve all studied variables after the intervention except for satisfaction, whereas PEG improved average PPT, perceived overall impact of FM and total score, endurance and functional capacity, velocity and power, anxiety, depression, and stress. In contrast, the CG showed no improvements in any variable. CONCLUSIONS: Both PE and HF-TMS are effective in improving pain, impact of FM, physical conditioning, and emotional status in people with FM, while HF-TMS achieved larger improvements in emotional status than PE. IMPACT: Physical status achieves similar benefits with TMS and PE whilst emotional status experiences larger benefits with TMS than with PE in women with FM.

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