Posterior tibial nerve stimulation confers no improvement of symptoms in Fibromyalgia patients

The addition of posterior tibial nerve stimulation along with pharmacotherapy did not reduce pain or improve the quality of life in patients with Fibromyalgia even at the end of three months as per a study that was published in the Journal of Clinical Medicine. 

Fibromyalgia syndrome (FMS) is a musculoskeletal disorder caused by central and peripheral mechanisms involving genetic or environmental factors. It is characterized by chronic widespread body pain, fatigue, sleep disturbances, and functional symptoms. Peripheral nerve stimulation reduces the levels of glutamate and substance P that are increased in the central mechanism of fibromyalgia pathogenesis. Transcutaneous application of PNS is used to reduce pain in various systemic conditions.

Based on the hypothesis that peripheral nerve stimulation can be used considering the pathophysiology of fibromyalgia, researchers from Turkey conducted a prospective, single-blind, randomized controlled trial to investigate the effectiveness of posterior tibial nerve stimulation (PTNS) in reducing pain, improving quality of life, and decreasing disease severity in patients with fibromyalgia. 

Female patients who were recently diagnosed with fibromyalgia and on duloxetine treatment (30 mg/day) were included in the study. Participants were randomized to the study group and control group. Study group patients received six sessions of posterior tibial nerve stimulation, twice weekly, 3–4 days apart, in addition to duloxetine whereas the controls received duloxetine only. The patients were evaluated three times at baseline, after 1st month, and at 3rd month. Pain was evaluated using a numeric rating scale, the short-form McGill Pain Questionnaire, and quality of life with a 36-item short-form health survey (SF-36). Patient functional status and disease severity were evaluated using the fibromyalgia impact questionnaire (FIQ).

Findings:

• Out of 64 patients who met the inclusion criteria, 22 were included in the study group and 30 in the control group.
• Both groups showed statistical improvements in pain and FIQ scores. 
• The SF-36 scores indicated improved vitality only in the 1st month in both groups, with no significant changes in the other quality-of-life subscales in either group.
• There was no statistical difference between the two groups in terms of changes in pain, FIQ, and SF-36 scores compared with baseline at the 1st month and 3rd month.
• The addition of PTNS to pharmacological treatment did not contribute to the reduction in pain or improvement in quality of life in fibromyalgia either in the 1st or 3rd month.   

Thus, the present study is the first to test the effectiveness of PTNS and the second in the literature to study the effectiveness of PNS on fibromyalgia. However, the addition of PTNS to medical treatment did not reduce pain or fibromyalgia severity in patients with fibromyalgia. 

Further reading: Sarı İF, İlhanlı İ, Mızrak T, Kulaklı F, Kasap Z. The Effect of Transcutaneous Posterior Tibial Nerve Stimulation on Pain and Quality of Life in Patients with Fibromyalgia: A Single-Blind, Randomized Controlled Trial. J Clin Med. 2023;12(15):4989. Published 2023 Jul 29. doi:10.3390/jcm12154989