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FibromyalgiaTMSFFINCT03658694

Repetitive Transcranial Magnetic Stimulation of Relief of Fibromyalgia Pain

A study testing Conventional rTMS - study 1, Conventional rTMS - study 2 and Patterned rTMS - stage 2 in people with Fibromyalgia, run by University of Sao Paulo at 6 sites in 3 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

There are currently several points concerning rTMS for pain relief that have a huge impact in the practical application of rTMS in clinical practice, but which have not been approached by previous studies. Also, an even more important issue is the frequency of the sessions in each treatment protocol. Read more about this study

Who is it for?
Ages 18 to 80 years, women only
Conditions the study is for
Fibromyalgia
What is being tested?
Conventional rTMS - study 1, Conventional rTMS - study 2 and Patterned rTMS - stage 2
Type of treatment
Surgery or procedure
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
80 participants
Where
6 sitesin 3 countries
Study dates
1 Apr 2019to 1 Mar 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Female patients with diagnosis fibromyalgia according to the ACR 2016 criteria (patient satisfies modified 2016 fibromyalgia criteria if the following 3 conditions are met: 1) widespread pain index (WPI) ≥ 7 and symptom severity scale (SSS) score 5 OR WPI of 4-6 and SSS score ≥ 9. 2) Generalized pain, defined as pain in at least 4 of 5 regions, must be present. Jaw, chest, and abdominal pain are not included in generalized pain definition. 3) Symptoms have been generally present for at least 3 months. 4) A diagnosis of fibromyalgia is valid irrespective of other diagnoses. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses).
  • Age ≥18 years;
  • Be able to understand study protocol and give signed, written informed consent
  • Not under opioids
  • VAS score ≥ 40/100 mm;

Who cannot join

  • Known abuse of alcohol or illicit drugs
  • Known psychiatric conditions
  • Contraindications to rTMS (42) (Head trauma or concussion, metal implants in the skull, pregnancy, cardiac pacemaker, medication infusion devices, previous troubles with TMS or MRI);
  • Not being under chronic contraceptive use (intrauterine dispositive or oral contraceptive)
  • Other medical conditions demand hospitalization;
  • Participation in other clinical studies at the same time

Trial locations and contacts

6 sites in 3 countries.

6 sites in 3 countries

Brazil4 sites
  • Universidade Federal de Pernambuco

    Recife, Pernambuco, 50670-901

  • Federal University of ABC

    São Bernardo do Campo, 09606-070

  • Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP)

    São Paulo, São Paulo, 05403900

  • Ambulatório de Fisioterapia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

    São Paulo, 05403-010

Other trials in Brazil

France1 site
  • Centre d'Evaluation et de Traitement de la Douleur Hôpital Ambroise Paré

    Paris, 92100

Other trials in France

Japan1 site
  • Department of Neuromodulation Osaka University

    Osaka, 565-0871

Other trials in Japan

About this study

Official title: Repetitive Transcranial Magnetic Stimulation of the Precentral-gyrus in the Relief of Fibromyalgia Pain: an International Multicenter Controlled Adaptative Trial

There are currently several points concerning rTMS for pain relief that have a huge impact in the practical application of rTMS in clinical practice, but which have not been approached by previous studies. Also, an even more important issue is the frequency of the sessions in each treatment protocol. The idea of performing stimulation in chronic pain patients on a consecutive daily basis for long-term treatments seem unrealistic and potentially costly. However, it has been reported in animals, healthy subjects and FM patients that the analgesic effects of rTMS can outlast the stimulation session for several minutes and even days. This has led to the proposal that pain treatment with rTMS could be performed in consecutive daily induction sessions, followed by spaced (weekly, fortnightly and even monthly) maintenance sessions. This approach is similar to what is performed routinely in patients with major depression treated by rTMS to the dorsolateral prefrontal cortex, and has successfully been tested in FM patients in a single- center study. Should this approach prove effective in larger prospective multicentric studies, rTMS could enter the armamentarium of non-invasive, non- pharmacological, low-adverse event therapeutic options to relieve fibromyalgia- related pain and associate symptoms. Hence, our aim is to conduct a multicentric international clinical trial on the influence of rTMS in the control of pain in a consecutive adaptive trial design where conventional rTMS (10Hz) and patterned rTMS (theta-burst) will be studied. Stimulations will be performed in a clinical practice-friendly approach, where daily maintenance sessions will be followed by weekly, and fortnightly stimulation sessions. There have been very scarce adaptive trials in the pain and non-invasive stimulation fields. This methodological approach allows for the use of lower number of patients in consecutive trials and, among other qualities, it allows for the imputation of data from the first trial into the second one, thus decreasing the duration of the studies and the number of participants.

Read the detailed description

There are currently several points concerning rTMS for pain relief that have a huge impact in the practical application of rTMS in clinical practice, but which have not been approached by previous studies. One of them refers to dosing of the treatment. rTMS sessions have been proposed to comprise from 1000 to 3000 pulses of stimulation in each session, which means that treatment sessions may last from 7 to 20 minutes. While there are positive studies reporting different numbers of pulses, the actual stimulation protocol chosen may impact not only the efficacy of the treatment, but also the duration of the stimulation session, the time patients stay at the health-care facility, and, thus, cost and compliance to treatment. Also, an even more important issue is the frequency of the sessions in each treatment protocol. The idea of performing stimulation in chronic pain patients on a consecutive daily basis for long-term treatments seem unrealistic and potentially costly. However, it has been reported in animals, healthy subjects and FM patients that the analgesic effects of rTMS can outlast the stimulation session for several minutes and even days. This has led to the proposal that pain treatment with rTMS could be performed in consecutive daily induction sessions, followed by spaced (weekly, fortnightly and even monthly) maintenance sessions. This approach is similar to what is performed routinely in patients with major depression treated by rTMS to the dorsolateral prefrontal cortex, and has successfully been tested in FM patients in a single- center study. Should this approach prove effective in larger prospective multicentric studies, rTMS could enter the armamentarium of non-invasive, non- pharmacological, low-adverse event therapeutic options to relieve fibromyalgia- related pain and associate symptoms. Hence, our aim is to conduct a multicentric international clinical trial on the influence of rTMS in the control of pain in a consecutive adaptive trial design where conventional rTMS and patterned rTMS will be studied. Stimulations will be performed in a clinical practice-friendly approach, where daily maintenance sessions will be followed by weekly, and fortnightly stimulation sessions. There have been very scarce adaptive trials in the pain and non-invasive stimulation fields. This methodological approach allows for the use of lower number of patients in consecutive trials and, among other qualities, it allows for the imputation of data from the first trial into the second one, thus decreasing the duration of the studies and the number of participants. Similarly, this technical approach allows for pre-planned interim analyses to be performed during data collection, allowing for the sample size to be readjusted during the trial, and, more importantly, allowing for trial termination due to futility or due to achievement of the primary endpoint before the end of the original preplanned data collection period, with lower risk of bias. Here, the adaptive approach will allow one not only to compare conventional rTMS (10Hz) to sham stimulation, but also, on second consecutive study, it will provide the first head-to-head study on rTMS to date comparing the analgesic effects of conventional (10Hz) and patterned (theta-burst) rTMS .

Conditions
Fibromyalgia
Being tested
Conventional rTMS - study 1, Sham rTMS - study 1, Conventional rTMS - study 2, Patterned rTMS - stage 2
Keywords
fibromyalgia, repetitive transcranial magnetic stimulation
Medical subject headings
Fibromyalgia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Conventional rTMS - study 1Procedure or surgery

    Patients will be undergoing to 10Hz transcranial magnetic stimulation session

  • Sham rTMS - study 1Procedure or surgery

    Patients will be undergoing to sham transcranial magnetic stimulation session

  • Conventional rTMS - study 2Procedure or surgery

    Patients will be undergoing to 10Hz transcranial magnetic stimulation session

  • Patterned rTMS - stage 2Procedure or surgery

    Patients will be undergoing to theta-burst transcranial magnetic stimulation session

Study groups in NCT03658694
Study groupRoleWhat they receive
Conventional rTMS - study 1ExperimentalIn study 1 patients were randomly allocated to receive conventional repetitive transcranial magnetic stimulation (10Hz).
Receives: Procedure: Conventional rTMS - study 1
Sham rTMS - study 1ExperimentalIn study 1 patients were randomly allocated to receive sham repetitive transcranial magnetic stimulation.
Receives: Procedure: Sham rTMS - study 1
Conventional rTMS - study 2ExperimentalIn study 2, after the end of the first trial will be allocated to receive conventional of repetitive transcranial magnetic stimulation (10Hz).
Receives: Procedure: Conventional rTMS - study 2
Patterned rTMS - study 2ExperimentalIn study 2, after the end of the first trial will be allocated to receive patterned of repetitive transcranial magnetic stimulation (Theta-burst).
Receives: Procedure: Patterned rTMS - stage 2

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Analgesic effects of motor cortex stimulation

    Percentage of responders based on the reduction of ≥50% in pain intensity (numerical rating scale 0-10) at the end of the study compared to baseline.

    Measured: 8th week of treatment

Secondary outcomes (8)
  1. Global impression of change

    Assess % of very much and much improved

    Measured: 8th and 16th weeks of treatment

  2. Pain intensity

    Measured by VAS (0 no pain -10 worst pain)

    Measured: At the end of the induction period (10th day) and 16th week

  3. Mood

    Assess mood by hospital anxiety and depression scale

    Measured: 8th week of treatment

  4. Impact of fibromyalgia daily

    Assess by fibromyalgia impact questionnaire

    Measured: 8th and 16th week of treatment

  5. Interference in daily activites

    Measured by brief pain inventory

    Measured: 8th week of treatment

  6. Medication use

    Measured by Brief Pain Inventory

    Measured: 8th week of treatment

  7. Phenotypical markers of analgesic response

    Assessment of phenotypical markers of analgesic response

    Measured: 8th and 16th week of treatment

  8. Adverse events

    Assess of adverse events by standardized questionnaire\'

    Measured: 8th and 16th week of treatment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Sep 2018
  2. Study start1 Apr 2019
  3. Primary completion1 Mar 2023
  4. Study completion1 Mar 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Sequential
Model description
This is an adaptive sequential trial of FM patients. In stage 1 patients were randomly allocated into two parallel arms (conventional rTMS, sham) using adaptive methodology. In stage 2, after the end of the first trial, patients will be allocated to two arms (conventional rTMS, patterned rTMS). Both stages will be conducted in a sequential methodology where an interim analysis will take place and indicate whether will take place trial is positive and of the scientific board agrees open its start. Recruitment time will be extended by 12 months due to dropouts related to the Covid-19 pandemic. We have had dropouts due to some patients who developed Covid-19 and also due to patients who were afraid of becoming infected during hospital visits. Those patients who dropped out of the study due to the pandemic will be excluded from the main analysis and will be analyzed as a secondary outcome.
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
80 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03658694
Sponsor's protocol ID
RGDCA03
Acronym
TMSFFI
Status last verified
Oct 2023
First submitted
3 Sep 2018
Last updated
5 Sep 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Lins CC, Fonseca AS, Martins PN, Oliveira JCB, Fernandes AM, Baptista AF, Kubota GT, da Silva VA, Teixeira MJ, de Andrade DC. Investigation of predictors of pain relief with high-frequency repetitive motor cortex transcranial magnetic stimulation among people with fibromyalgia. Neurophysiol Clin. 2025 Nov;55(6):103109. doi: 10.1016/j.neucli.2025.103109. Epub 2025 Oct 4.

    PubMed 41046849

Questions about this trial

What is this clinical trial studying?

A study testing Conventional rTMS - study 1, Conventional rTMS - study 2 and Patterned rTMS - stage 2 in people with Fibromyalgia, run by University of Sao Paulo at 6 sites in 3 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in Brazil, France, Japan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Analgesic effects of motor cortex stimulation (time frame: 8th week of treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03658694, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Sep 2024.

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