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Updated: Jun 10, 2026
A Randomized, Sham-Controlled Trial of Cranial Electrical Stimulation for Fibromyalgia Pain and Physical Function, Using Brain Imaging Biomarkers
Published on: January 5, 2024
Fibromyalgia: From treatment to rehabilitation
Marta Imamura1, David A Cassius, Felipe Fregni
1Collaborative Professor University of Sao Paulo School of Medicine, Division of Physical Medicine and Rehabilitation, Department of Orthopaedics and Traumatology, São Paulo, Brazil.
Abstract:
Fibromyalgia is a clinical syndrome of chronic widespread pain and reduced pain thresholds to palpation. The pathophysiology remains unknown, but there is increasing evidence that peripheral and central sensitization cause an amplification of sensory impulses that may alter pain perception in fibromyalgia patients. Interventions to treat fibromyalgia should aim at different targets simultaneously in order to reduce peripheral and central sensitization. There are both pharmacologic and non-pharmacologic approaches with evidence for effectiveness in the treatment of fibromyalgia and its associated symptoms. Evidence from randomized trials and meta-analyses shows that partial and short-term improvements in fibromyalgia symptoms can be achieved with low doses of antidepressants and with physical activity such as aerobic and strengthening exercises. A multidimensional approach which emphasizes education and integration of exercise and cognitive behavior therapy improves quality of life and reduces pain, fatigue and depressive symptoms when measured on a short term basis. More recently, trials have shown the neuromodulators gabapentin and pregabalin to be effective in reducing pain and improving quality of sleep in fibromyalgia. In addition, small trials of noninvasive brain stimulation have also shown benefits in reducing pain in fibromyalgia. It is essential to keep in mind that some important clinical conditions can mimic and overlap with fibromyalgia and should always be ruled out by a complete history, physical examination and appropriate laboratory testing.
Insights
Fibromyalgia treatment involves addressing central and peripheral sensitization. Effective strategies include medications, exercise, cognitive behavioral therapy, and neuromodulators for symptom relief.
Area of Science:
- Clinical Medicine
- Neuroscience
- Pain Management
Background:
- Fibromyalgia is characterized by chronic widespread pain and heightened pain sensitivity.
- The exact pathophysiology is unknown, but central and peripheral sensitization are implicated.
- Effective treatment requires targeting multiple mechanisms simultaneously.
Purpose of the Study:
- To review current pharmacologic and non-pharmacologic interventions for fibromyalgia.
- To highlight evidence-based approaches for managing fibromyalgia symptoms.
- To emphasize the importance of a multidimensional treatment strategy.
Main Methods:
- Review of evidence from randomized trials and meta-analyses.
- Examination of pharmacologic treatments including antidepressants, gabapentin, and pregabalin.
- Evaluation of non-pharmacologic approaches such as exercise, cognitive behavior therapy, and brain stimulation.
Main Results:
- Low-dose antidepressants and physical activity provide partial, short-term symptom improvement.
- Multidimensional approaches improve quality of life and reduce pain, fatigue, and depression short-term.
- Neuromodulators and noninvasive brain stimulation show promise for pain reduction and sleep quality.
Conclusions:
- A combination of pharmacologic and non-pharmacologic therapies is essential for fibromyalgia management.
- Multidimensional approaches offer short-term benefits for quality of life and symptom reduction.
- Further research into underlying mechanisms and novel treatments is warranted, while ruling out mimicking conditions is crucial.
