What is the best therapy for fibromyalgia? This is a difficult and complex question, but at TMS London, we believe that we may have found the answer.

How is it currently managed?

For years, people with Fibromyalgia have been told that there is very little that can be done for them. There are no licensed medications and no surgical options available, often leaving GPs without much to offer. Recommendations to exercise regularly and eat healthily are regularly given, and can be quite effective, but when the symptoms of this illness include severe fatigue and pain all over the body, these changes can be incredibly difficult to implement. Antidepressant medications are also commonly prescribed to help people deal with the effects of being in constant pain, but the well-documented unpleasant side effects of these drugs means that they are unsuitable for many.

Historically, fibromyalgia was managed with painkillers, although these were ineffective for a large number of people, and issues with their addictiveness meant that it was eventually decided that they were doing more harm than good. These are now no longer offered to anyone in chronic pain, making the need for good alternatives even more urgent.

Why the lack of options?

The lack of effective therapies has largely been related to limitations in the understanding of what actually causes fibromyalgia. The condition has been described for over 100 years, and during this time many theories have been put forward. However, as technology and testing improved, each of these ideas was eventually disproved. It was not until the 21^st century, when advances in neurological imaging allowed brain activity to be viewed in real time, that a plausible cause was finally found. Brain activity in the region responsible for processing pain was found to be consistently overactive in patients diagnosed with fibromyalgia, when compared to the brains of “healthy” individuals.

The suggestion that altered brain activity was the cause of the condition came as a surprise to many sufferers, as the symptoms and pain that they feel in their body are very real. However when you gain a better understanding of the complex and fascinating way that pain really works (a story for another time), this theory actually fits very well. It also helps to explain the sensitivity to bright lights and loud noises that many patients experience, as these same areas of the brain also deal with the processing of sensory input from the outside world.

Why is this understanding useful?

With an understanding of the cause of the problem came the potential for a treatment. Many mental health conditions have been shown to be related to similar alterations in brain activity, and therapies which target these areas have often been found to be effective at either reducing symptoms, or curing the illness altogether. With this in mind, researchers turned their attention to fibromyalgia.

The theory was simple – if we can reduce the overactivity of the pain processing area, we can reduce the severity of the fibromyalgia. All they needed was a way to do this.

How do you change the activity in someone’s brain?

Electrical stimulation of the brain has been attempted for around 150 years, although early attempts were crude to say the least. However, as technology advanced through the decades, the process was eventually refined to the point that it could be used accurately and safely. This became known as transcranial magnetic stimulation (TMS), and found uses in a number of different applications.

TMS has been shown to have the fascinating ability to either increase or decrease the activity of a specific area of a patient’s brain, depending on how it is applied. This unique function of TMS has allowed it to be used to slow down overactive regions of the brains of people with OCD and anxiety, or turn up underactive areas in people with depression, as well as many others.

Does it actually work?

To date, only a few studies have been undertaken to assess the impact of TMS on people with fibromyalgia, however the results of these studies have been very exciting. Each trial has shown statistically significant improvements in reducing the pain or improving the quality of life of people with the condition, when compared to a placebo treatment. The most recent study even included a six-month follow up of the participants and found that the benefits of TMS lasted throughout this period.

As with almost every medical intervention, not everybody in the trials reported the same level of improvement. However, given the fact that TMS treatment is medication free, non-invasive and very well tolerated by most, it is a low risk option, with the potential to be life changing for many.

The future

Research into fibromyalgia continues, with our understanding of the condition broadening year by year. A recent discovery of a possible autoimmune link has shed further light on this difficult condition, and all of us at TMS London are following these developments closely to see how we can make our treatment even more effective.

For updates be sure to visit our website, where we regularly post content on all things fibromyalgia and TMS.

Posted on 25th November 2021