Electroconvulsive therapy (ECT) for the treatment of fibromyalgia (FM): a prospective randomized single-blind, sham-controlled study
E. Guertzenstein, S. P. RigonattiIntroduction
Fibromyalgia (FM) is considered a chronic musculoskeletal pain condition of clinical complexity, likely resulting from dysfunction of central pain processing pathways. FM and depressive disorder share similar neurobiological mechanisms, particularly dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, which may be influenced by genetic inheritance or early developmental factors. The condition is characterized by widespread musculoskeletal pain, sleep disturbances, anxiety/depression, cognitive impairment, fatigue, and stiffness. Management of FM should primarily be non-pharmacological; however, pharmacological interventions may be indicated in generalized FM with increasing pain severity and additional symptoms. Patients experiencing severe pain and marked sleep disturbances may benefit from a multimodal therapeutic approach.
Objectives
This prospective, randomized, single-blind, sham-controlled study aimed to evaluate the effects of electroconvulsive therapy (ECT) in drug-free patients with fibromyalgia.
Methods
Patients were diagnosed according to ICD-11, DCR-10, and DSM-5-TR criteria. Clinical assessment included the Impact of Event Scale-Revised (IES-R, 22 items) and the Hamilton Depression Rating Scale (HAMD-17).
Functional impact was evaluated using the Fibromyalgia Impact Questionnaire (FIQ), Portuguese and Brazilian versions.
Assessments were performed at three time points: T0 (before initiation of ECT), T1 (after the 6th treatment session), and T2 (after the 12th treatment session).
Patients were randomly assigned to receive either active ECT (n = 162) or sham ECT (n = 163) in a simple randomization design.
Patients presenting with anxious symptoms (AD) following fibromyalgia were treated over a six-week period with a total of 12 sessions of transcranial direct current stimulation (tDCS). Each session lasted 30 minutes and was conducted twice weekly. Two bifrontal electrodes were placed on the scalp, delivering 2 mA with the anode positioned over the left dorsolateral prefrontal cortex (DLPFC) and the cathode over the right DLPFC.
Results
Active ECT (A):
After the 12th treatment session (T2), 150 patients achieved complete remission of fibromyalgia (FM) and remained asymptomatic throughout the three-year follow-up. Additionally, 12 patients showed partial symptom remission after the 6th treatment (T1), which persisted through T2.
Sham ECT (S):
At T2, 155 patients showed no remission of FM. One patient experienced partial remission after T1 but relapsed after T2. Seven patients discontinued treatment.
Conclusions
Electroconvulsive therapy (ECT) was effective in achieving remission of fibromyalgia symptoms in 150 patients, altering the clinical course regardless of whether patients presented with pre-FM depressive disorder, post-FM depressive symptoms (AD), pre-FM anxiety disorder, or post-FM anxiety symptoms (AD).
Disclosure of Interest
None Declared