Effectiveness of Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation in Patients with Fibromyalgia: Meta-analysis.

Objective: The purpose of this study is to assess the effectiveness of using repetitive transcranial magnetic stimulation (rTMS) as well as transcranial direct current stimulation (tDCS) for patients suffering from fibromyalgia syndrome (FMS) through a systematic review of randomized clinical trials (RCT). Data sources: Articles were discovered by conducting searches on the following databases: the Cochrane Controlled Trials Register, PubMed and PEDro. Methods: Randomized controlled trials were selected through [2012 to 2024]. Random-effects meta-analyses were done for pooling effect sizes for pain intensity (primary outcome), fatigue, and quality of life (secondary outcomes). Two review authors independently screened articles and evaluated bias risks. Outcome measures were extracted and summarized through qualitative and quantitative methods. Results: The results from 12 studies (n=635 participants) revealed that active tDCS significantly reduced pain intensity (mean difference [MD] = -1.54; 65% CI [-2.55 to -0,52], P=0.003) compared to sham stimulation. In contrast, rTMS showed no significant effects on pain (MD = -0.90; 83% CI [-2.47 to 0.67], P=0.26; P>0.05) or other outcomes with high heterogeneity was observed (I² = 65-83%). Subgroup analyses suggested greater tDCS efficacy with [specific parameters, e.g., dorsolateral prefrontal cortex stimulation or occipital nerve]. Conclusions: This meta-analysis provides level 1a evidence supporting that tDCS is effective for pain relief in FM, while current evidence does not support rTMS efficacy. The results support considering tDCS as a therapeutic option, though further studies should optimize protocols and assess long-term effects.