Repetitive transcranial magnetic stimulation of the prefrontal cortex for fibromyalgia syndrome: a randomised controlled trial with 6-months follow up

Abstract Objectives Fibromyalgia Syndrome (FMS), is a chronic pain disorder with poorly understood pathophysiology. In recent years, repetitive transcranial magnetic stimulation (rTMS) has been recommended for pain relief in various chronic pain disorders. The objective of the present research was to study the effect of low frequency rTMS over the right dorsolateral prefrontal cortex (DLPFC) on pain status in FMS. Methods Ninety diagnosed cases of FMS were randomized into Sham-rTMS and Real-rTMS groups. Real rTMS (1 Hz/1200 pulses/8 trains/90% resting motor threshold) was delivered over the right DLPFC for 5 consecutive days/week for 4 weeks. Pain was assessed by subjective and objective methods along with oxidative stress markers. Patients were followed up for 6 months (post-rTMS;15 days, 3 months and 6 months). Results In Real-rTMS group, average pain ratings and associated symptoms showed significant improvement post rTMS. The beneficial effects of rTMS lasted up to 6 months in the follow-up phase. In Sham-rTMS group, no significant change in pain ratings was observed. Conclusion Right DLPFC rTMS can significantly reduce pain and associated symptoms of FMS probably through targeting spinal pain circuits and top-down pain modulation . Trial registration: Ref No: CTRI/2013/12/004228.(AU)

Estimated features from surface EMG of the lower limb correlate with the subjective sensation of pain

Pain assessment is very important in establishing the efficacy of analgesics and therapies, but because pain is a subjective experience, using methods that represent pain objectively is necessary. A number of biopotentials have been employed in studies of the objective assessment of pain. However, few investigations have considered the peripheral nervous system response to electrical stimulation. The present study evaluated a method for pain quantification based on the analysis of biopotentials. We assessed electromyographic activity that resulted from evoked movements from the nociceptive flexion reflex (NFR). We investigated correlations between stimulus intensity, features extracted from surface electromyography (EMG), and subjective pain reported by subjects using a Visual Analog Scale (VAS). A total of 10 healthy male subjects without any pain disorder, aged 20-27 years, participated in the study. A high correlation (r2 > .87) was found between stimulus intensity and the following features extracted from the EMG: area, root mean square (RMS), and entropy. A high correlation (r2 > .99) was also found between stimulus intensity and subjective pain reported on the VAS. We conclude that estimating features from electromyographic signals that are correlated with subjective pain sensations and the intensity of the electrical stimulus is possible. Entropy, RMS, and the area of the electromyographic signal appear to be relevant parameters in correlations with subjective pain.

Estimated features from surface EMG of the lower limb correlate with the subjective sensation of pain

Pain assessment is very important in establishing the efficacy of analgesics and therapies, but because pain is a subjective experience, using methods that represent pain objectively is necessary. A number of biopotentials have been employed in studies of the objective assessment of pain. However, few investigations have considered the peripheral nervous system response to electrical stimulation. The present study evaluated a method for pain quantification based on the analysis of biopotentials. We assessed electromyographic activity that resulted from evoked movements from the nociceptive flexion reflex (NFR). We investigated correlations between stimulus intensity, features extracted from surface electromyography (EMG), and subjective pain reported by subjects using a Visual Analog Scale (VAS). A total of 10 healthy male subjects without any pain disorder, aged 20-27 years, participated in the study. A high correlation (r2 > .87) was found between stimulus intensity and the following features extracted from the EMG: area, root mean square (RMS), and entropy. A high correlation (r2 > .99) was also found between stimulus intensity and subjective pain reported on the VAS. We conclude that estimating features from electromyographic signals that are correlated with subjective pain sensations and the intensity of the electrical stimulus is possible. Entropy, RMS, and the area of the electromyographic signal appear to be relevant parameters in correlations with subjective pain.(AU)