Evidence for the improvement of fatigue in fibromyalgia: A 4‐week left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation randomized‐controlled trial
Open accessAbstract
Background: Fibromyalgia is a complex chronic disorder with few effective treatments currently available. One promising treatment option is repetitive transcranial magnetic stimulation (rTMS), a non‐invasive brain stimulation technique that has shown promise in disorders effecting the central nervous system. Methods: We assessed the efficacy of a course of high‐frequency (10 Hz) left‐hemisphere dorsolateral prefrontal cortex (DLPFC) rTMS in 26 patients (14 active; 12 sham) with a diagnosis of fibromyalgia. Participants underwent a double‐blind stimulation protocol of daily (Monday–Friday) rTMS sessions over four consecutive weeks (total of 20 sessions; 75 × 4‐s 10 Hz trains at 120% resting motor threshold). Assessments were conducted at baseline, 4 weeks and at 1‐month follow‐up. Results: Using mixed‐model analysis we did not identify a group difference for our primary outcome measures. However, we found that patients in the active group compared to sham treatment group had significantly greater improvement in the Physical Fatigue (p = 0.045) and General Fatigue (p = 0.023) scales of the Multidimensional Fatigue Inventory‐20 at the 1 month follow‐up. In a responder analysis, we also found the active group was significantly more likely (2.84 times) to achieve a minimum 30% improvement in pain intensity ratings. (p = 0.024). Conclusions: High‐frequency rTMS applied daily for 4 weeks to the left DLPFC induces significant relief from fatigue and a greater chance of clinically meaningful improvement in pain intensity in patients with fibromyalgia. These results suggest DLPFC rTMS may be a relevant therapy for fibromyalgia. Significance: This study provides evidence that 4‐weeks of daily rTMS to the left DLPFC is able to improve fatigue in fibromyalgia. This novel finding provides impetus for the further investigation of the utility of TMS approaches for the relief of fatigue, an otherwise difficult‐to‐treat symptom, in fibromyalgia and related disorders.
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Functional deficits have long been reported by patients with fibromyalgia.
“While pain is recommended as the primary outcome measure for chronic pain treatment interventions, functional deficits have long been reported by patients with FM and warrant investigation and appropriate, evidence-based intervention.33”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [33]
Pain is recommended as the primary outcome measure for chronic pain treatment interventions.
“While pain is recommended as the primary outcome measure for chronic pain treatment interventions, functional deficits have long been reported by patients with FM and warrant investigation and appropriate, evidence-based intervention.33”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [33]
Fatigue is rarely a primary measure of potential interventions in fibromyalgia despite its clinical relevance.
“Despite its clinical relevance, fatigue is rarely a primary measure of potential interventions.33”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [33]
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A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment
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- Authors
- Fitzgibbon, B. M., Hoy, K. E., Knox, L. A., Guymer, E. K., Littlejohn, G., Elliot, D., Wambeek, L. E., McQueen, S., Elford, K. A., Lee, S. J., Enticott, P. G., & Fitzgerald, P. B.
- Affiliations
- The Alfred Hospital (AU)
- Monash Medical Centre (AU)
- Deakin University (AU)
- Epworth Hospital (AU)
- Corresponding author
- Fitzgibbon, B.M.
- ORCID
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2018-04-10
- Volume
- 22
- Issue
- 7
- Pages
- 1255-1267
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W2791151815
- Cited by
- 72
- References
- 11
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 11 · 2023: 6 · 2022: 11 · 2021: 11 · 2020: 6 · 2019: 6 · 2018: 1
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (acceptedVersion, other-oa)
- Deakin Research Online (Deakin University) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- National Health and Medical Research Council (1070073, 1082894, 1078567, 1111428)
- Australian Research Council (FT160100077)
- Arthritis Australia
- Monash University
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- fibromyalgia, repetitive transcranial magnetic stimulation, dorsolateral prefrontal cortex, fatigue, high-frequency rTMS, pain intensity, non-invasive brain stimulation, responder analysis
- MeSH terms
- Adult, Chronic Disease, Double-Blind Method, Fatigue, Female, Fibromyalgia, Humans, Male, Middle Aged, Pain Measurement, Treatment Outcome, Prefrontal Cortex, Transcranial Magnetic Stimulation
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