Background and Aims:
Long-term symptomatic relief following motor cortex repetitive transcranial magnetic stimulation (M1-rTMS) in fibromyalgia syndrome (FMS) patients has been proven, yet the accompanied neuroplastic changes are unknown. Therefore, we investigated how resting-state functional connectivity (rsFC) changes along with pain intensity, affect, and daily function in FMS patients following M1-rTMS. 

Methods:
Twenty-five female FMS patients underwent two 10-day series (real; sham) of 10Hz right M1-rTMS. Resting-state functional magnetic resonance imaging scans and clinical assessment took place before and after each series. rsFC was investigated in sensory and modulatory pain, and motor-related regions; and resting-state networks (RSNs) implicated in pain: salience (SN), executive-control (ECN), sensorimotor (SMN), and default-mode (DMN) networks. Treatment-specific post>pre-differences in FMS symptoms were regressed against changes in rsFC.

Results:
Real, but not sham, M1-rTMS, resulted in a significant symptomatic relief. Real M1-rTMS relief involved changes in the rsFC of the SMN and SN, along with improvement in clinical pain intensity and affect
 
Conclusions:
1.  Real M1-rTMS is superior to sham with regard to improvements in clinical pain and daily function in FMS patients
2. The improvement in FMS symptomatology following this treatment is related to changes in higher-order RSNs, in addition to the target system

This study was supported by the Israeli Science Foundation Grant #508/12.

CLINICAL PAIN RELIEF AFTER REAL AND SHAM MOTOR CORTEX REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IS PREDICTED BY DISSOCIABLE RESTING-STATE FUNCTIONAL CONNECTIVITY PATTERNS