{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:20:39Z","timestamp":1791282039020,"version":"4.1.0"},"reference-count":54,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,1,12]],"date-time":"2015-01-12T00:00:00Z","timestamp":1421020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Foundation for Support of Research at Rio Grande do Sul (FAPERGS)","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"National Council for Scientific and Technological Development - CNPq","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Postgraduate Program in Medical Sciences at the School of Medicine of the Federal University of Rio Grande do Sul","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Postgraduate Research Group at the Hospital de Cl\u00c3\u00adnicas de Porto Alegre","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fibromyalgia (<jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content>) is a prevalent chronic pain syndrome with few effective therapeutic options available. Repetitive transcranial magnetic stimulation (<jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content>) is an emerging therapeutic alternative for this condition; however, results have been mixed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the efficacy of <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> on <jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content>, a comprehensive systematic review and meta\u2010analysis were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Relevant published, English and Portuguese language, randomized clinical trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>) comparing <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> (irrespective of the stimulation protocol) to sham stimulation for treating <jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content> pain intensity, depression, and\/or quality of life (QoL) were identified, considering only those with low risk for bias. Trials available until April 2014 were searched through <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> EMBASE<\/jats:styled-content>, the Cochrane Library Databases, and other 26 relevant medical databases covering from every continent. The outcomes for pain, depression, and QoL assessed closest to the 30th day after <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> treatment were extracted, and changes from baseline were calculated to compare the effects of <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> vs. placebo.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and sixty\u2010three articles were screened, and five with moderate to high quality were included. <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> improved QoL with a moderate effect size (Pooled <jats:styled-content style=\"fixed-case\">SMD<\/jats:styled-content>\u00a0=\u00a0\u22120.472 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a0\u22120.80 to \u22120.14); it showed a trend toward reducing pain intensity (<jats:styled-content style=\"fixed-case\">SMD<\/jats:styled-content>\u00a0=\u00a0\u22120.64 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a0\u22120.31 to 0.017), but did not change depressive symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In comparison with sham stimulation, <jats:styled-content style=\"fixed-case\">rTMS<\/jats:styled-content> demonstrated superior effect on the QoL of patients with <jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content> 1\u00a0month after starting therapy. However, further studies are needed to determine optimal treatment protocols and to elucidate the mechanisms involved with this effect, which does not seem to be mediated by changes in depression, but that may involve pain modulation. Level of evidence 1b.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12276","type":"journal-article","created":{"date-parts":[[2015,1,12]],"date-time":"2015-01-12T11:03:58Z","timestamp":1421060638000},"page":"294-304","source":"Crossref","is-referenced-by-count":65,"title":["Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"16","author":[{"given":"Leonardo M.","family":"Knijnik","sequence":"first","affiliation":[{"name":"Laboratory of Pain and Neuromodulation Hospital de Cl\u00ednicas de Porto Alegre (HCPA) Porto Alegre Brazil"},{"name":"School of Medicine Rio Grande do Sul Federal University (UFRGS) Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jairo A.","family":"Duss\u00e1n\u2010Sarria","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation Hospital de Cl\u00ednicas de Porto Alegre (HCPA) Porto Alegre Brazil"},{"name":"Post\u2010Graduate Program in Medical Sciences School of Medicine UFRGS Porto Alegre Brazil"},{"name":"Pain and Palliative Care Service at HCPA UFRGS Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna R.","family":"Rozisky","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation Hospital de Cl\u00ednicas de Porto Alegre (HCPA) Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iraci L. 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