{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:34:31Z","timestamp":1790188471745,"version":"4.1.0"},"reference-count":42,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: The main aim of this study was to assess the effects of repetitive-transcranial magnetic stimulation (rTMS) in patients with fibromyalgia (FMS). Methods: We systematically searched PubMed, PEDro, EMBASE, and CINAHL. Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the guidelines advisory committee grading criteria. A total of 11 systematic reviews were included. The assessed variables were pain intensity, depressive symptoms, anxiety, and general health. Results: Regarding pain intensity, it seems that high-frequency rTMS significantly reduces pain intensity at a 1-month follow-up when the primary motor cortex (M1) is stimulated. However, we cannot robustly conclude the same for low-frequency protocols. When we look at the combination of high and low-frequency rTMS, there seems to be a significant effect on pain intensity up to 1-week post-intervention, but after that point of follow-up, the results are controversial. Regarding depressive symptoms and anxiety, results showed that the effects of rTMS are almost non-existent. Finally, in regard to general health, results showed that rTMS caused significant post-intervention effects in a robust way. However, the results of the follow-ups are contradictory. Conclusions: The results obtained showed that high-frequency rTMS applied on the M1 showed some effect on the variable of pain intensity with a limited quality of evidence. Overall, rTMS was shown to be effective in improving general health with moderate quality of evidence. Finally, rTMS was not shown to be effective in managing depressive symptoms and anxiety with a limited to moderate quality of evidence. PROSPERO number: This review was previously registered in PROSPERO (CRD42023391032).<\/jats:p>","DOI":"10.3390\/brainsci13071059","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T00:50:41Z","timestamp":1689123041000},"page":"1059","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effects of Repetitive-Transcranial Magnetic Stimulation (rTMS) in Fibromyalgia Syndrome: An Umbrella and Mapping Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4644-3758","authenticated-orcid":false,"given":"Ferran","family":"Cuenca-Mart\u00ednez","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6564-0936","authenticated-orcid":false,"given":"N\u00faria","family":"Sempere-Rubio","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3700-9968","authenticated-orcid":false,"given":"Sara","family":"Moll\u00e0-Casanova","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9137-1656","authenticated-orcid":false,"given":"Elena","family":"Mu\u00f1oz-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1314-624X","authenticated-orcid":false,"given":"Josu\u00e9","family":"Fern\u00e1ndez-Carnero","sequence":"additional","affiliation":[{"name":"Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain"},{"name":"La Paz Hospital Institute for Health Research, IdiPAZ, 28922 Madrid, Spain"},{"name":"Grupo de Investigaci\u00f3n en Neurociencia Cognitiva, Dolor y Rehabilitaci\u00f3n en Ciencias de la Salud (NECODOR), Universidad Rey Juan Carlos, 28922 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0247-8363","authenticated-orcid":false,"given":"Alberto","family":"S\u00e1nchez-Sabater","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9191-4243","authenticated-orcid":false,"given":"Luis","family":"Suso-Mart\u00ed","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1038\/s41584-020-00506-w","article-title":"Fibromyalgia: An update on clinical characteristics, aetiopathogenesis and treatment","volume":"16","author":"Giorgi","year":"2020","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.berh.2007.03.006","article-title":"Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain","volume":"21","author":"Yunus","year":"2007","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"788","DOI":"10.3389\/fnins.2020.00788","article-title":"A Cross-Sectional Study on Central Sensitization and Autonomic Changes in Fibromyalgia","volume":"14","author":"Hazra","year":"2020","journal-title":"Front. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1176\/appi.neuropsych.19050107","article-title":"Fibromyalgia: Centralized Pain Processing and Neuroimaging","volume":"31","author":"Richard","year":"2019","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3389\/fncel.2018.00035","article-title":"Potential Mechanisms Underlying Centralized Pain and Emerging Therapeutic Interventions","volume":"12","author":"Nicol","year":"2018","journal-title":"Front. Cell. Neurosci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1089\/brain.2014.0274","article-title":"Fibromyalgia is associated with decreased connectivity between pain- and sensorimotor brain areas","volume":"4","author":"Flodin","year":"2014","journal-title":"Brain Connect."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"de Oliveira Franco, \u00c1., da Silveira Alves, C.F., Vicu\u00f1a, P., Bandeira, J., de Aratanha, M.A., Torres, I.L.S., Fregni, F., and Caumo, W. (2022). Hyper-connectivity between the left motor cortex and prefrontal cortex is associated with the severity of dysfunction of the descending pain modulatory system in fibromyalgia. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0247629"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"108950","DOI":"10.1016\/j.jneumeth.2020.108950","article-title":"TMS-induced silent periods: A review of methods and call for consistency","volume":"346","author":"Hupfeld","year":"2020","journal-title":"J. Neurosci. Methods"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"88","DOI":"10.4103\/2773-2398.348254","article-title":"Motor cortex inhibition as a fibromyalgia biomarker: A meta-analysis of transcranial magnetic stimulation studies","volume":"1","author":"Lima","year":"2022","journal-title":"Brain Netw. Modul."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"40","DOI":"10.3389\/fnhum.2019.00040","article-title":"Brain Modulation by Electric Currents in Fibromyalgia: A Structured Review on Non-invasive Approach with Transcranial Electrical Stimulation","volume":"13","author":"Brighina","year":"2019","journal-title":"Front. Hum. Neurosci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1176\/appi.ajp.2010.10060864","article-title":"Daily left prefrontal repetitive transcranial magnetic stimulation for acute treatment of medication-resistant depression","volume":"168","author":"George","year":"2011","journal-title":"Am. J. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/npp.2011.225","article-title":"Somatic treatments for mood disorders","volume":"37","author":"Rosa","year":"2012","journal-title":"Neuropsychopharmacology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1212\/WNL.0000000000000280","article-title":"rTMS in fibromyalgia: A randomized trial evaluating QoL and its brain metabolic substrate","volume":"82","author":"Boyer","year":"2014","journal-title":"Neurology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1016\/j.neuroimage.2007.10.035","article-title":"High frequency rTMS modulation of the sensorimotor networks: Behavioral changes and fMRI correlates","volume":"39","author":"Yoo","year":"2008","journal-title":"Neuroimage"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1093\/rheumatology\/kew205","article-title":"The effects of add-on non-invasive brain stimulation in fibromyalgia: A meta-analysis and meta-regression of randomized controlled trials","volume":"55","author":"Hou","year":"2016","journal-title":"Rheumatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1111\/papr.12276","article-title":"Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: Systematic Review and Meta-Analysis","volume":"16","author":"Knijnik","year":"2016","journal-title":"Pain Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1093\/pm\/pnab354","article-title":"Effectiveness of Repetitive Transcranial Magnetic Stimulation on Managing Fibromyalgia: A Systematic Meta-Analysis","volume":"23","author":"Choo","year":"2022","journal-title":"Pain Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/MRR.0000000000000207","article-title":"Effectiveness of repetitive transcranial magnetic stimulation in patients with fibromyalgia: A meta-analysis","volume":"40","author":"Saltychev","year":"2017","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_19","first-page":"427","article-title":"Effects of transcranial direct current stimulation and transcranial magnetic stimulation in patients with fibromyalgia. A systematic review","volume":"38","year":"2020","journal-title":"Neurologia"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kim, H., Jung, J., Park, S., Joo, Y., Lee, S., and Lee, S. (2022). Effects of Repetitive Transcranial Magnetic Stimulation on the Primary Motor Cortex of Individuals with Fibromyalgia: A Systematic Review and Meta-Analysis. Brain Sci., 12.","DOI":"10.3390\/brainsci12050570"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/PSY.0000000000001062","article-title":"Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: An Updated Systematic Review and Meta-Analysis","volume":"84","author":"Toh","year":"2022","journal-title":"Psychosom. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/pm\/pnab276","article-title":"Repetitive Transcranial Magnetic Stimulation for Patients with Fibromyalgia: A Systematic Review with Meta-Analysis","volume":"23","author":"Sun","year":"2022","journal-title":"Pain Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Su, Y.C., Guo, Y.H., Hsieh, P.C., and Lin, Y.C. (2021). Efficacy of repetitive transcranial magnetic stimulation in fibromyalgia: A systematic review and meta-analysis of randomized controlled trials. J. Clin. Med., 10.","DOI":"10.3390\/jcm10204669"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.apmr.2022.05.006","article-title":"Efficacy of High-Frequency Repetitive Transcranial Magnetic Stimulation at 10 Hz in Fibromyalgia: A Systematic Review and Meta-analysis","volume":"104","author":"Zhu","year":"2022","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/j.1533-2500.2012.00562.x","article-title":"Efficacy of Transcranial Direct Current Stimulation and Repetitive Transcranial Magnetic Stimulation for Treating Fibromyalgia Syndrome: A Systematic Review","volume":"13","author":"Marlow","year":"2013","journal-title":"Pain Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jclinepi.2017.10.002","article-title":"Preferred reporting items for overviews of systematic reviews including harms checklist: A pilot tool to be used for balanced reporting of benefits and harms","volume":"93","author":"Bougioukas","year":"2018","journal-title":"J. Clin. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1053\/apnr.2002.34181","article-title":"Popping the (PICO) question in research and evidence-based practice","volume":"15","author":"Stone","year":"2002","journal-title":"Appl. Nurs. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S0140-6736(98)01085-X","article-title":"Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?","volume":"352","author":"Moher","year":"1998","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"529","DOI":"10.2519\/jospt.2008.2861","article-title":"Evaluation of the scope and quality of systematic reviews on nonpharmacological conservative treatment for patellofemoral pain syndrome","volume":"38","author":"Barton","year":"2008","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: The kappa statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Medica"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.jclinepi.2015.06.005","article-title":"ROBIS: A new tool to assess risk of bias in systematic reviews was developed","volume":"69","author":"Whiting","year":"2016","journal-title":"J. Clin. Epidemiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1123\/jpah.2018-0372","article-title":"Umbrella and systematic review methodology to support the 2018 physical activity guidelines advisory committee","volume":"15","author":"Torres","year":"2018","journal-title":"J. Phys. Act. Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13643-016-0204-x","article-title":"What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products","volume":"5","author":"Hempel","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/j.pain.2011.01.034","article-title":"Long-term maintenance of the analgesic effects of transcranial magnetic stimulation in fibromyalgia","volume":"152","author":"Mhalla","year":"2011","journal-title":"Pain"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.1002\/hbm.22097","article-title":"Cortical representation of pain in primary sensory-motor areas (S1\/M1)--a study using intracortical recordings in humans","volume":"34","author":"Frot","year":"2013","journal-title":"Hum. Brain Mapp."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1212\/01.WNL.0000144177.61125.85","article-title":"An fMRI study of cortical representation of mechanical allodynia in patients with neuropathic pain","volume":"63","author":"Peyron","year":"2004","journal-title":"Neurology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/S0304-3959(99)00114-1","article-title":"Electrical stimulation of motor cortex for pain control: A combined PET-scan and electrophysiological study","volume":"83","author":"Peyron","year":"1999","journal-title":"Pain"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1212\/01.wnl.0000242731.10074.3c","article-title":"Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain","volume":"67","author":"Lefaucheur","year":"2006","journal-title":"Neurology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1126\/science.add4391","article-title":"Layer-specific pain relief pathways originating from primary motor cortex","volume":"378","author":"Gan","year":"2022","journal-title":"Science"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1111\/j.1528-1167.2011.03215.x","article-title":"Theory of mind in frontal and temporal lobe epilepsy: Cognitive and neural aspects","volume":"52","author":"Giovagnoli","year":"2011","journal-title":"Epilepsia"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1093\/brain\/122.9.1765","article-title":"Haemodynamic brain responses to acute pain in humans: Sensory and attentional networks","volume":"122","author":"Peyron","year":"1999","journal-title":"Brain"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.jpain.2021.11.001","article-title":"Clinical Effects of Repetitive Transcranial Magnetic Stimulation of the Motor Cortex Are Associated with Changes in Resting-State Functional Connectivity in Patients With Fibromyalgia Syndrome","volume":"23","author":"Argaman","year":"2022","journal-title":"J. Pain"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/7\/1059\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:10:52Z","timestamp":1760127052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/7\/1059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,11]]},"references-count":42,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["brainsci13071059"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13071059","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,11]]}}}