Electrical Brain Stimulation for Fibromyalgia

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Fibromyalgia is a chronic disorder

Fibromyalgia is a chronic disorder that causes long-term pain and tenderness in the joints, muscles, and tendons throughout the body, as well as severe fatigue. People with fibromyalgia may also experience a number of other symptoms, including sleep disturbances, irritable bowel syndrome, restless leg syndrome, numbness or tingling in the arms and legs, and depression, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD).

Sensory hypersensitivity

Fibromyalgia is a poorly understood disorder that likely involves central nervous system sensory hypersensitivity. There are a host of genetic, neuroendocrine and environmental abnormalities associated with the disease, and recent research findings suggest enhanced sensory processing, and abnormalities in central monoamines and cytokines expression in patients with fibromyalgia.

The morbidity and financial costs associated with fibromyalgia are quite high despite conventional treatments with antidepressants, anticonvulsants, low-impact aerobic exercise and psychotherapy. Noninvasive brain stimulation techniques, such as transcranial direct current stimulation, transcranial magnetic stimulation, and electroconvulsive therapy are beginning to be studied as possible treatments for fibromyalgia pain. Early studies appear promising but more work is needed.

 

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Future directions in clinical care may include innovative combinations of noninvasive brain stimulation, pharmacological augmentation, and behavior therapies.

Transcranial magnetic stimulation

By using magnetic brain stimulation on patients with fibromyalgia, French researchers say they were able to improve some of the patients’ symptoms. Specifically, the technique, called transcranial magnetic stimulation, raised quality of life and emotional and social well-being among patients suffering from the condition, the researchers found in a small study.

This improvement is associated with an increase in brain metabolism, which argues for a physical cause for this disorder and for the possibility of changes in areas of the brain to improve the symptoms,” said lead researcher Dr. Eric Guedj, of Aix-Marseille University and the National Center for Scientific Research, in Marseille. “Previous studies in patients with fibromyalgia have suggested an alteration of brain areas is involved in the regulation of pain and emotion,” he said.

The objective of this study was to demonstrate that it is possible to modulate these brain areas using transcranial magnetic stimulation to correct brain abnormalities and improve patients’ symptoms, Guedj said.

How Electrical Brain Stimulation Works for Pain Relief

Fibromyalgia is as mysterious as it is painful. Experts and patients alike have struggled with the unknowns behind the disorder, and treatment options are limited. Luckily, the mystery that frustrates so many has also led to some ground-breaking research in fibromyalgia: a recent study shows that the pain and discomfort likely originate in the brain,and these symptoms could be corrected with a new electronic approach called electrical brain stimulation.

Benefits of Electrical Brain Stimulation

Pain relief is the obvious goal, but there are more specific rewards that electrical brain stimulation could bring to fibromyalgia patients, like:

  • >Decrease in fatigue
  • >Less depression
  • >Better emotional states
  • >Increase in sociability
  • >Better work performance
  • >Fewer episodes of anger and anxiety

Cognitive dysfunction in fibromyalgia

Patients with fibromyalgia often have cognitive dysfunction that appears to result from a reduced capacity to maintain the endogenous level of brain activation necessary to perform a task. This deficiency can be particularly obvious when attentional demands are increased, suggesting that patients with fibromyalgia have a reduced ability to filter distracting information.

The combination of impaired sustained attention and reduced processing speed can, therefore, compromise cognitive performance in this patient population. Although these observations have been made in multiple studies, the underlying mechanisms behind the cognitive dysfunctions seen in fibromyalgia have not been well explained.

The Link between Fibromyalgia and Brain Activity

The results of a recent French study have confirmed the suspicion that fibromyalgia symptoms can be traced to problems in the brain. More importantly, the research has uncovered a new, non-invasive technique that could help fibromyalgia patients live much more comfortably.

The technique called transcranial magnetic stimulation uses a cap fitted with electrodes to send targeted electrical charges to specific spots in the brain, which stimulate brain metabolism. That metabolic boost can correct abnormalities in the pain and emotion centers of the brain, and in turn, decrease painful symptoms.

These findings are important, not only because fibromyalgia is so difficult to treat, but because it’s often been thought of as a mental, rather than physical, disorder. Now that there is proof of a physical source, greater attention can be directed to more advanced, targeted physical treatment.

Effect of transcranial magnetic stimulation on dorsolateral prefrontal cortex (DLPFC)

Researchers have investigated the ability of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) to modulate attention in patients with fibromyalgia. The approach has been effective, possibly because the DLPFC influences cognitive-executive control and the descendent pain modulation system. Adriana Ferreira Silva, a graduate student at the Federal University of Rio Grande do Sul in Brazil, and colleagues published the results of their investigation of tDCS over the DLPFC in patients with fibromyalgia and published the results online March 9 in Scientific Reports.

Results

The investigators tested the effects of a single, uniform dose of tDCS (anodal stimulation of 1 mA for 20 minutes) coupled with a go/no-go task in modulating alerting, orienting and executive attention indices. They randomly allocated 20 patients to the sequence sham-active group and another 20 to the sequence active-sham group. The researchers measured attention using the Attention Network Test. While acknowledging that this uniform dosage may not be optimal for all patients, the team notes that a single session of anodal tDCS over the left DLPFC had a modulatory effect on the orienting and executive attentional networks. They did not, however, see any effect on alertness.

Supplement for your current therapy

Transcranial magnetic stimulation can be a smart supplement for your current therapy, but it may not be an appropriate replacement. For one thing, the long-term effects are not yet known, and the amount of pain relief it offers cannot really be measured. Moreover, experts aren’t sure how often the treatment will need to be repeated to sustain the positive effects.

 

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References:

  • Electrical Brain Stimulation for Fibromyalgia By Steven Reinberg via Web Md
  • SOURCES: Eric Guedj, M.D., Ph.D., Aix-Marseille University and National Center for Scientific Research, Marseille, France; Alan Manevitz, M.D., clinical psychiatrist, Lenox Hill Hospital, New York City; March 26, 2014, Neurology

 

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