ArticleBMJ open2019
Optimised transcranial direct current stimulation (tDCS) for fibromyalgia-targeting the endogenous pain control system: a randomised, double-blind, factorial clinical trial protocol.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Optimized tDCS for Fibromyalgia: Targeting the Endogenous Pain Control System
Use of Transcranial Direct Current Stimulation (TDCS) in an Active Pain Coping Program for Patients With Fibromyalgia: A Randomized Control Trial.
High-Intensity Interval Training (HIIT) and Transcranial Direct Current Stimulation (tDCS) in Women With Fibromyalgia - Effects on Clinical and Neuro-physiological Variables: Randomized Clinical Trial Protocol
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- The Analgesic Effect of Transcranial Direct Current Stimulation in Fibromyalgia: A Systematic Review, Meta-Analysis, and Meta-Regression of Potential Influencers of Clinical Effect.Neuromodulation : journal of the International Neuromodulation Society · 2023Pooled it
- Noninvasive brain stimulation combined with exercise in chronic pain: a systematic review and meta-analysis.Expert review of neurotherapeutics · 2020Pooled it
- Brain compensatory mechanisms in depression and memory complaints in fibromyalgia: the role of theta oscillatory activity.Pain medicine (Malden, Mass.) · 2024Trial
- Modulation of central pain mechanisms using high-definition transcranial direct current stimulation: A double-blind, sham-controlled study.European journal of pain (London, England) · 2023Trial
- Decreased neural inhibitory state in fibromyalgia pain: A cross-sectional study.Neurophysiologie clinique = Clinical neurophysiology · 2020Trial
- A randomised, double-blind, sham-controlled, 2×2 factorial trial of aerobic vs. non-aerobic exercise and motor cortex transcranial direct current stimulation in fibromyalgia: effects on clinical outcomes and descending pain modulation.Lancet regional health. Americas · 2026Article
- Therapeutic approach to fibromyalgia: a consensus statement on pharmacological and non-pharmacological treatment from the neuropathic pain special interest group of the Italian neurological society.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Pain and the Brain: A Systematic Review of Methods, EEG Biomarkers, Limitations, and Future Directions.Neurology international · 2025Review
- The Association of Pain Medication Usage and Quantitative Sensory Testing Outcomes in Fibromyalgia Patients: A Secondary Data Analysis.NeuroSci · 2025Article
- Disruptive compensatory mechanisms in fibromyalgia syndrome and their association with pharmacological agents.Experimental brain research · 2024Article
- The Link between Endogenous Pain Modulation Changes and Clinical Improvement in Fibromyalgia Syndrome: A Meta-Regression Analysis.Biomedicines · 2024Review
- The Endogenous Pain Modulatory System as a Healing Mechanism: A Proposal on How to Measure and Modulate It.NeuroSci · 2024Review
- Adaptive and Compensatory Neural Signatures in Fibromyalgia: An Analysis of Resting-State and Stimulus-Evoked EEG Oscillations.Biomedicines · 2024Article
- Cross-sectional and longitudinal analysis of conditioned pain modulation and pain in fibromyalgia: CPM as an effect modifier of pain changes over time.Physiotherapy research international : the journal for researchers and clinicians in physical therapy · 2024Article
- Aquatic Exercise in Physical Therapy Treatment for Fibromyalgia: Systematic Review.Healthcare (Basel, Switzerland) · 2024Review
- The role of symptoms severity, heart rate, and central sensitization for predicting sleep quality in patients with fibromyalgia.Pain medicine (Malden, Mass.) · 2023Article
- Motor Cortex Inhibition and Facilitation Correlates with Fibromyalgia Compensatory Mechanisms and Pain: A Cross-Sectional Study.Biomedicines · 2023Article
- Temporal Summation in Fibromyalgia Patients: Comparing Phasic and Tonic Paradigms.Frontiers in pain research (Lausanne, Switzerland) · 2022Article
- Recruitment characteristics and non-adherence associated factors of fibromyalgia patients in a randomized clinical trial: A retrospective survival analysis.Contemporary clinical trials communications · 2021Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors at 2 institutions in 2 countries.
Funding
Abstract
introductionFibromyalgia (FM) is a common debilitating condition with limited therapeutic options. Medications have low efficacy and are often associated with adverse effects. Given that FM is associated with a defective endogenous pain control system and central sensitisation, combining interventions such as transcranial direct current stimulation (tDCS) and aerobic exercise (AE) to modulate pain-processing circuits may enhance pain control. METHODS AND ANALYSIS: A prospective, randomised (1:1:1:1), placebo-controlled, double-blind, factorial clinical trial will test the hypothesis that optimised tDCS (16 anodal tDCS sessions combined with AE) can restore of the pain endogenous control system. Participants with FM (n=148) will undergo a conditioning exercise period and be randomly allocated to one of four groups: (1) active tDCS and AE, (2) sham tDCS and AE, (3) active tDCS and non-aerobic exercise (nAE) or (4) sham tDCS and nAE. Pain inhibitory activity will be assessed using conditioned pain modulation (CPM) and temporal slow pain summation (TSPS)-primary outcomes. Secondary outcomes will include the following assessments: Transcranial magnetic stimulation and electroencephalography as cortical markers of pain inhibitory control and thalamocortical circuits; secondary clinical outcomes on pain, FM, quality of life, sleep and depression. Finally, the relationship between the two main mechanistic targets in this study-CPM and TSPS-and changes in secondary clinical outcomes will be tested. The change in the primary efficacy endpoint, CPM and TSPS, from baseline to week 4 of stimulation will be tested with a mixed linear model and adjusted for important demographic variables. ETHICS AND DISSEMINATION: This study obeys the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of Partners Healthcare under the protocol number 2017P002524. Informed consent will be obtained from participants. Study findings will be reported in conferences and peer-reviewed journal publications. TRIAL REGISTRATION NUMBER: NCT03371225.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.