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One promising treatment option is repetitive transcranial magnetic stimulation (<jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content>), a non\u2010invasive brain stimulation technique that has shown promise in disorders effecting the central nervous system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed the efficacy of a course of high\u2010frequency (10\u00a0Hz) left\u2010hemisphere dorsolateral prefrontal cortex (<jats:styled-content style=\"fixed-case\">DLPFC<\/jats:styled-content>) <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> in 26 patients (14 active; 12 sham) with a diagnosis of fibromyalgia. Participants underwent a double\u2010blind stimulation protocol of daily (Monday\u2013Friday) <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> sessions over four consecutive weeks (total of 20 sessions; 75\u00a0\u00d7\u00a04\u2010s 10\u00a0Hz trains at 120% resting motor threshold). Assessments were conducted at baseline, 4\u00a0weeks and at 1\u2010month follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Using mixed\u2010model analysis we did not identify a group difference for our primary outcome measures. However, we found that patients in the active group compared to sham treatment group had significantly greater improvement in the Physical Fatigue (<jats:italic>p\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.045) and General Fatigue (<jats:italic>p\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.023) scales of the Multidimensional Fatigue Inventory\u201020 at the 1\u00a0month follow\u2010up. In a responder analysis, we also found the active group was significantly more likely (2.84 times) to achieve a minimum 30% improvement in pain intensity ratings. (<jats:italic>p\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.024).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>High\u2010frequency <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> applied daily for 4\u00a0weeks to the left <jats:styled-content style=\"fixed-case\">DLPFC<\/jats:styled-content> induces significant relief from fatigue and a greater chance of clinically meaningful improvement in pain intensity in patients with fibromyalgia. These results suggest <jats:styled-content style=\"fixed-case\">DLPFC rTMS<\/jats:styled-content> may be a relevant therapy for fibromyalgia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>This study provides evidence that 4\u2010weeks of daily <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> to the left <jats:styled-content style=\"fixed-case\">DLPFC<\/jats:styled-content> is able to improve fatigue in fibromyalgia. This novel finding provides impetus for the further investigation of the utility of <jats:styled-content style=\"fixed-case\">TMS<\/jats:styled-content> approaches for the relief of fatigue, an otherwise difficult\u2010to\u2010treat symptom, in fibromyalgia and related disorders.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.1213","type":"journal-article","created":{"date-parts":[[2018,3,15]],"date-time":"2018-03-15T13:49:36Z","timestamp":1521121776000},"page":"1255-1267","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Evidence for the improvement of fatigue in fibromyalgia: A 4\u2010week left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation randomized\u2010controlled trial"],"prefix":"10.1002","volume":"22","author":[{"given":"B.M.","family":"Fitzgibbon","sequence":"first","affiliation":[{"name":"Monash Alfred Psychiatry Research Centre (MAPrc) the Alfred and Central Clinical School Monash 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