P306 Motor cortex tRNS reduce pain and improve affective and cognitive impairment in patients with fibromyalgia: Preliminary results of a randomized sham-controlled trial

摘要

Background Fibromyalgia (FMS) is a clinical syndrome characterized by widespread musculoskeletal pain, chronic fatigue, cognitive deficit, sleep and mood disorders. Most pharmacological therapies showed limited effectiveness and there’s need for new effective and well tolerated therapeutic tools. Recently, transcranial direct-current stimulation (tDCS) of motor cortex showed able to reduce pain, while dorsolateral prefrontal cortex (DLPFC) tDCS improved anxiety, depression and cognitive impairment in FMS. A new application, random noise stimulation (tRNS), using randomly changing alternating currents, showed very recently ability to ameliorate working memory and pain in limited series of FMS and neuropathic pain patients. Here we explored the clinical effects of primary motor cortex (M1) tRNS in FMS patients. Materials and methods Twenty female patients with FMS between the ages of 26 and 67 were randomized into two treatment groups undergoing daily stimulation sessions for two weeks (weekend free): one received active, real tRNS and the other one sham, placebo tRNS. Each patient was evaluated, before and after treatment, through Visual Analogue Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS) and other specific neurophychological tests, such as Trail Making Test (TMT), Rey Auditory Verbal Learning Test (AVLT), Forward and Backward Digit Span, FAS verbal fluency test. Results M1 active tRNS, compared to sham, induced a general improvement of FMS clinical picture: pain, depression, anxiety and FIQ scores showed significant reduction. Even TMT A, AVLT and FAS scores improved significantly. Discussion and conclusions These findings suggest M1 tRNS can be very effective in relieving symptoms of fibromyalgia. Differently from motor cortex tDCS, tRNS seems able to counteract not only pain but also cognitive disturbance in these patients. This could follow to the invoked mechanism of stochastic resonance that would bring to a synchronization of neural firing and so more spreading and lasting effects. ]]>