Expert review of neurotherapeutics · 2025
Exploring the role of transcranial direct current stimulation (tDCS) for the treatment of fibromyalgia: a narrative review.
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Calandre Elena P, Bassila Christine, Slim Mahmoud, Rico-Villademoros Fernando
Аннотация
INTRODUCTION: Fibromyalgia is a chronic pain syndrome characterized by widespread nociplastic pain, fatigue, sleep disturbances, and mood symptoms. Conventional treatments often yield limited benefits, prompting interest in noninvasive brain stimulation techniques such as transcranial direct current stimulation (tDCS).
AREAS COVERED: This review synthesizes evidence from 31 randomized controlled trials (RCTs) evaluating the efficacy, safety, and tolerability of tDCS in fibromyalgia. A systematic search of Embase and Medline were conducted without date or language restrictions. Most studies assessed anodal tDCS targeting the primary motor cortex (M1) or dorsolateral prefrontal cortex (DLPFC), with outcomes spanning pain, global symptom burden, psychological symptoms, fatigue, and sleep quality. Ten of 14 sham-controlled trials reported significant pain reductions with M1 stimulation. Seven trials showed improvements in overall symptom severity (FIQ/FIQR), though most did not meet the minimal clinically important difference. Outcomes for fatigue, sleep, and mood were less consistent and often underreported.
EXPERT OPINION: While tDCS appears safe and effective for fibromyalgia-related pain, variability in protocols and limited reporting of non-pain outcomes hinder broader conclusions. As an adjunctive therapy, its role may be enhanced through protocol standardization, longer-term follow-up, and combination strategies such as pairing with repetitive transcranial magnetic stimulation (rTMS) to address the full spectrum of fibromyalgia symptoms.
AREAS COVERED: This review synthesizes evidence from 31 randomized controlled trials (RCTs) evaluating the efficacy, safety, and tolerability of tDCS in fibromyalgia. A systematic search of Embase and Medline were conducted without date or language restrictions. Most studies assessed anodal tDCS targeting the primary motor cortex (M1) or dorsolateral prefrontal cortex (DLPFC), with outcomes spanning pain, global symptom burden, psychological symptoms, fatigue, and sleep quality. Ten of 14 sham-controlled trials reported significant pain reductions with M1 stimulation. Seven trials showed improvements in overall symptom severity (FIQ/FIQR), though most did not meet the minimal clinically important difference. Outcomes for fatigue, sleep, and mood were less consistent and often underreported.
EXPERT OPINION: While tDCS appears safe and effective for fibromyalgia-related pain, variability in protocols and limited reporting of non-pain outcomes hinder broader conclusions. As an adjunctive therapy, its role may be enhanced through protocol standardization, longer-term follow-up, and combination strategies such as pairing with repetitive transcranial magnetic stimulation (rTMS) to address the full spectrum of fibromyalgia symptoms.