Low-frequency rTMS in fibromyalgia: a case report

Abstract

Background: Fibromyalgia is a chronic pain syndrome featuring widespread pain, sleep disturbance, fatigue, and psychological distress. Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-invasive option for neuromodulation of symptoms.

Case summary: A 56-year-old female private employee with a 7-year history of persistent pain, fatigue, sleep disturbance, anxiety, depression, and functional limitation despite 6 years of treatment with pregabalin and duloxetine was diagnosed using the 2016 revised American College of Rheumatology criteria with fibromyalgia. She received 20 sessions of low-frequency right dorsolateral prefrontal cortex (DLPFC) rTMS over 4 weeks using 1 Hz stimulation, 1200 pulses/session, 8 trains, and 90% resting motor threshold. Post-treatment assessment showed improvement in numerical pain rating scale (NPRS) from 7 to 3, McGill pain questionnaire (MPQ) total pain score from 24 to 8, Hamilton anxiety rating scale (HAM-A) from 15 to 9, Hamilton depression rating scale (HAM-D) from 16 to 8, and 36-item short form health survey (SF-36) physical functioning from 20 to 75. No adverse events were reported.

Conclusion: Low-frequency right DLPFC rTMS may be a safe adjunctive care option for selected patients of fibromyalgia with associated mood symptoms. However, without long-term follow-up or sham control, causality cannot be proven from a single case.