Robert Bonakdar MD, FAAFP, FACN
Treating fibromyalgia with electrical neuromodulation
Study key point
- Electrical neuromodulation of various types, including transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS), appears clinically effective in improving pain, depression, and functioning in fibromyalgia and worthy of increased awareness by clinicians when planning therapy.
Fibromyalgia can be a difficult-to-treat condition. As per the most recent EULAR guidelines, initial treatment should focus on nonpharmacological options.
“Initial management should involve patient education and focus on non-pharmacological therapies. In case of nonresponse, further therapies (all of which were evaluated as ‘weak for’ based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation program (for severe disability).”
Finding additional nonpharmacological therapies that are well-tolerated would expand available tools for patients, especially those refractory to current treatments.
- A systematic review and meta-analysis of 25 studies comparing the effect of various electrical treatments, including DCS and TENS in patients with fibromyalgia.
- Main outcome: subjective pain
- Secondary outcomes: depression, anxiety, and functioning
- Results: Several electrical therapies showed significant effects on pain, depression, and functioning. In several cases, the level of improvement paralleled that seen with current pharmacotherapy.
Clinical bottom line
- Although clinicians have a number of treatments available for the management of fibromyalgia, the overall clinical utility of these treatments is often modest. Having additional well-tolerated and patient-directed tools, which can reduce pain and improve compliance with other therapies such as exercise is worth considering.
- Electrical stimulation devices, such as TENS- type devices, which have recently been approved by the FDA for fibromyalgia, are a good first consideration while additional devices become more widely available.
- Have staff reach out to available device companies for demonstration and training to learn more about accessing devices for interested patients.
- Future needs in this area:
- Increased clinician training and educational opportunities
- Additional device approvals
- Long-term device outcomes
- Improved payor coverage on par with medications
- Comparative and combination trials
Several types of electrical neuromodulation (such as transcranial direct current stimulation, tDCS; transcutaneous electrical nerve stimulation) have been applied in the treatment of fibromyalgia. These trials had different outcome measurements, such as subjective pain, pain threshold, depression, anxiety, and functioning. We intended to integrate data from different trials into a meta-analysis to clearly present the clinical value of electrical neuromodulation in fibromyalgia.
A systematic review and meta-analysis of randomized controlled trials comparing the effect of all types of electrical neuromodulation in patients with fibromyalgia was conducted. The main outcome was subjective pain; the secondary outcomes included depression, anxiety, and functioning.
Twenty-five studies and 1061 fibromyalgia patients were included in the quantitative analysis. Active electrical neuromodulation and active tDCS both showed significant effects on subjective pain, depression, and functioning. For different anode tDCS electrode positions, only F3-F4 revealed a significant effect on depression. Meta-regression tDCS effects on depression were significantly associated with age.
Electrical neuromodulation is significantly effective in treating pain, depression, and functioning in patients with fibromyalgia.
The results may help clinicians to arrange effective treatment plans for patients with fibromyalgia, especially in those patients who reveal limited response to pharmacotherapy and psychotherapy.
Treating fibromyalgia with electrical neuromodulation: A systematic review and meta-analysis
Clin Neurophysiol 2023 Feb 01;148(xx)17-28, YC Cheng, CY Hsiao, MI Su, CC Chiu, YC Huang, WL Huang
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.