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| Name | Class |
|---|---|
| Fondation Apicil | OTHER |
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The purpose of this study is to determine the analgesic effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) used as an additional procedure to rehabilitation exercises in patient suffering from fibromyalgia.
A double blind clinical trial with two randomized parallel groups:
Fibromyalgia is the most frequent chronic diffuse painful disease (3 to 4% of the general population).
Analgesic drugs are widely used in fibromyalgia, pain being the main symptom. However the effectiveness of analgesic drugs is often insufficient.
Among non-drug therapies, rehabilitation exercise plays an important role with a special interest in terms of the quality of life, strain and pain.
More recently the Transcranial Magnetic Stimulation effects have been evaluated in patients suffering from fibromyalgia with a statistically significative analgesic effect.
Both rehabilitation exercise and Transcranial Magnetic Stimulation (rTMS) have shown their respective analgesic effectiveness in fibromyalgia. It now seems important to evaluate the combination of these two therapies.
Main objective: To evaluate the analgesic effect of rTMS in fibromyalgia patients doing rehabilitation exercise.
Primary endpoint:
The evaluation methode used is a visual analog scale (VAS) of pain. Patients will note down every day VAS of over the last 24 hours.
The evolution of the VAS during the treatment period with respect to baseline, will be compared in both groups, active rTMS and placebo rTMS.
The investigators will analyze the average daily VAS for different weeks (W2, W4, W8, W14) compared to the average daily VAS at the baseline.
After a baseline period of 15 days, patients will begin sessions of rTMS and rehabilitation exercise for a period of 14 weeks.
The study is composed of three assessment visits : a baseline visit, a visit corresponding to the end of the therapy with exercise period and a last assessment visit at 26 weeks after the end of the treatment.
These visits will include clinical examination, blood test, an effort test, an orthostatic test, a resistance to fatigue test and polysomnography.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| active rTMS + rehabilitation exercise | Experimental | 14 weeks of active repetitive transcranial magnetic stimulation associated with rehabilitation exercise |
|
| placebo rTMS + rehabilitation exercise | Placebo Comparator | 14 weeks of placebo repetitive transcranial magnetic stimulation associated with rehabilitation exercise |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| active rTMS + rehabilitation exercise | Device | 14 weeks program of active repetitive transcranial magnetic stimulation associated with rehabilitation exercise |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline in pain Visual Analog Scale (VAS) at 14 weeks of treatment | Patient will note down each day the VAS for the last 24 hours. | Daily average VAS at baseline, week 2, week 4, week 8, week 14 |
| Measure | Description | Time Frame |
|---|---|---|
| Change from base line in quality of life at 14 weeks and 26 weeks | Fibromyalgia Impact Questionnaire (FIQ) | At the beginning of the program, at the end (14 weeks), and 26 weeks after the end of the program |
| Change from base line in depression assessment at 14 weeks and 26 weeks |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Caroline Maindet-Dominici, MD | Centre de la Douleur CHU de Grenoble | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU de Grenoble | Grenoble | Isère | 38043 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 8478854 | Background | Burckhardt CS, Clark SR, Bennett RM. Fibromyalgia and quality of life: a comparative analysis. J Rheumatol. 1993 Mar;20(3):475-9. | |
| 18464301 | Background | Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber KA. Exercise for fibromyalgia: a systematic review. J Rheumatol. 2008 Jun;35(6):1130-44. Epub 2008 May 1. |
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| ID | Term |
|---|---|
| D005356 | Fibromyalgia |
| D010146 | Pain |
| ID | Term |
|---|---|
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
| D009468 | Neuromuscular Diseases |
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| ID | Term |
|---|---|
| D005081 | Exercise Therapy |
| ID | Term |
|---|---|
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
| D005791 | Patient Care |
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| placebo rTMS+ rehabilitation exercise | Device | 14 week program of placebo repetitive transcranial magnetic stimulation associated with rehabilitation exercise |
|
Beck Depression Inventory (BDI) |
| at the beginning of the program, at the end (14 weeks), and 26 weeks after the end of the program |
| Change from baseline in Covi's anxiety scale | Covi's anxiety scale | at the beginning of the program, at the end (14 weeks), and 26 weeks after the end of the program |
| Change from baseline in sleep quality at 14 weeks abd 26 weeks | Number of times awaking at night | At the beginning of the program, at the end (14 weeks), and 26 weeks after the end of the program |
| Change from baseline in neuromuscular fatigability at 14 weeks and 26 weeks | Maximal voluntary activation level | At the beginning of the program, at the end (14 weeks), and 26 weeks after the end of the program |
| Change from baseline in cardiac variability at 14 weeks and 26 weeks | RMSSD values, power of spectral density HF, KF, LF/HF, alpha index (baroreflex sensitivity) | At the beginning of the program, at the end (14 weeks), and 26 weeks after the end of the program |
| Evolution of the analgesic effect after the end of the program | Patient will note down each day the VAS for the last 24 hours. | Daily average VAS at the end (14 weeks) and 26 weeks after the end of the program |
| 17943797 | Background | Busch AJ, Barber KA, Overend TJ, Peloso PM, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2007 Oct 17;2007(4):CD003786. doi: 10.1002/14651858.CD003786.pub2. |
| 17009309 | Background | Cook DB, Nagelkirk PR, Poluri A, Mores J, Natelson BH. The influence of aerobic fitness and fibromyalgia on cardiorespiratory and perceptual responses to exercise in patients with chronic fatigue syndrome. Arthritis Rheum. 2006 Oct;54(10):3351-62. doi: 10.1002/art.22124. |
| 11281066 | Background | Dauvilliers Y, Touchon J. [Sleep in fibromyalgia: review of clinical and polysomnographic data]. Neurophysiol Clin. 2001 Feb;31(1):18-33. doi: 10.1016/s0987-7053(00)00240-9. French. |
| 17872930 | Background | Passard A, Attal N, Benadhira R, Brasseur L, Saba G, Sichere P, Perrot S, Januel D, Bouhassira D. Effects of unilateral repetitive transcranial magnetic stimulation of the motor cortex on chronic widespread pain in fibromyalgia. Brain. 2007 Oct;130(Pt 10):2661-70. doi: 10.1093/brain/awm189. Epub 2007 Sep 14. |
| 31785190 | Result | Guinot M, Maindet C, Hodaj H, Hodaj E, Bachasson D, Baillieul S, Cracowski JL, Launois S. Effects of Repetitive Transcranial Magnetic Stimulation and Multicomponent Therapy in Patients With Fibromyalgia: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2021 Mar;73(3):449-458. doi: 10.1002/acr.24118. |
| D009422 |
| Nervous System Diseases |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D013812 |
| Therapeutics |
| D026741 | Physical Therapy Modalities |