Regenerative injection therapy and repetitive transcranial magnetic stimulation in primary fibromyalgia treatment: A comparative study

Article type: Research Article

Authors: Abd Elghany, Salwa Elmorsy^a | Al Ashkar, Doaa S.^a | El-Barbary, Amal M.^a | El Khouly, Radwa M.^{a; *} | Aboelhawa, Marwa A.^a | Nada, Doaa W.^a | Darwish, Nivine F.^a | Hussein, Manal S.^a | Rageh, El Sayed^a | Abo-Zaid, Mohamed H.^a | Eldesoky, Islam F.^b | Afifi, Samah^b

Affiliations: [a] Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt | [b] Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

Correspondence: [*] Corresponding author: Radwa M. El Khouly, Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt. Tel.: +20 1223827097; E-mail: r_elkhouly@yahoo.com.

Abstract: OBJECTIVE: This study compared the effectiveness of regenerative injection therapy (RIT), i.e. prolotherapy, and repetitive transcranial magnetic stimulation (rTMS) in the treatment of fibromyalgia syndrome. PATIENTS AND METHODS: This study included 120 female, age-matched fibromyalgia patients. All patients underwent a clinical examination, pain assessment by VAS, assessment of tender points, psychiatric and functional assessment using the Beck Depression Inventory (BDI), Fibromyalgia Impact Questionnaire Revised (RFIQ), and measurement of cortical auditory evoked potentials CAEPs elicited at 1000 Hz. Patients were divided into two equal groups; Group 1 received prolotherapy three times, two weeks apart, and Group 2 received rTMS sessions every other day for one month. Assessment was performed before treatment, immediately after treatment, and one month later. RESULTS: A significant improvement of pain measured by the mean score of VAS was remarked in Group 1 compared to Group 2 immediately after treatment and one month later. There was statistically significant difference of mean scores for the number of tender points in Group 1 compared to Group 2 after treatment and one month later. The patients improved functionally, with a statistically significant difference in mean score of RFIQ, in Group 1 compared to Group 2 one month after treatment. However, there was a significant difference in mean score of BDI in Group 2 compared to Group 1 after treatment and one month later. Further, CAEPs showed better improvement, with a significant difference in Group 2, one month after treatment. CONCLUSION: RIT had the advantage in clinical and functional improvement in fibromyalgia patients, while rTMS had better results regarding depression and the cortical component of AEPs. These results might draw attention to the evaluability of a combination of both techniques for a better therapeutic response.

Keywords: Regenerative injection therapy, repetitive transcranial magnetic stimulation, fibromyalgia syndrome

DOI: 10.3233/BMR-181127

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 1, pp. 55-62, 2019