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FibromyalgiaNCT06006130

Neurophysiology of Fibromyalgia

A study of Fibromyalgia, run by McMaster University at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Fibromyalgia is a syndrome associated with fatigue and chronic pain, leading to significant physical limitations and impaired quality of life. There are several challenges that complicate the diagnosis and management of fibromyalgia. Read more about this study

Who is it for?
Ages 18 to 65 yearsHealthy volunteers can take part
Conditions the study is for
Fibromyalgia
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
36 participants
Where
1 siteCanada
Study dates
1 Feb 2024to 31 Dec 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • 18-65 years old

Who cannot join

  • contraindications to TMS
  • chronic pain associated with diagnoses other than fibromyalgia

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • McMaster University

    Hamilton, Ontario, L8S4L1

Other trials in Canada

About this study

Official title: Investigating the Neurobiological Contributions to Pain in Patients With Fibromyalgia

Fibromyalgia is a syndrome associated with fatigue and chronic pain, leading to significant physical limitations and impaired quality of life. There are several challenges that complicate the diagnosis and management of fibromyalgia. The etiology is not well defined, as there are several proposed factors that may trigger the genesis of pain in fibromyalgia including physical and/or emotional life stressors, and genetic predispositions involving neuromodulator pathways. Chronic pain in fibromyalgia arises in the absence of tissue pathology, and consequently a lack of consensus on reliable diagnostic criteria. Understanding the neurophysiology of fibromyalgia would aid in the discovery of objective biomarkers for diagnosis. Therefore, the goals of this study are to:

  1. Compare the neurophysiological responses in fibromyalgia compared to healthy controls.
  2. Determine whether a two-week cTMS protocol will alter pain in individuals with fibromyalgia.
Read the detailed description

Fibromyalgia is a syndrome associated with fatigue and chronic pain, leading to significant physical limitations and impaired quality of life. Fibromyalgia affects 1.7% of Canadians, with a higher prevalence in females compared to males at 9:1 [1]. There are several challenges that complicate the diagnosis and management of fibromyalgia. The etiology is not well defined, as there are several proposed factors that may trigger the genesis of pain in fibromyalgia. Chronic pain in fibromyalgia arises in the absence of tissue pathology, and consequently a lack of consensus on reliable diagnostic criteria. Understanding the pathophysiology of fibromyalgia would aid in the identification of objective biomarkers that could be used for diagnosis.

Multiple theories have been posited to explain the genesis of chronic pain. The gate control theory describes the attenuation of pain signals in the spinal cord prior to cortical processing, and it has been hypothesized that loss of this gate control leads to the genesis of chronic pain [2]. Gate control can be observed by reduction of afferent signals during active muscle contraction. For example, the amplitude of the somatosensory-evoked potential (SEP) is attenuated during active contraction [3]. To our knowledge, it is unknown whether such gate control is observed in fibromyalgia. The lack of gate control may contribute to chronic pain in this population.

The sensorimotor theory suggests that incongruency between motor intention and sensory feedback underlies chronic pain where there is an absence of tissue pathology [4]. This may align with the genesis of fibromyalgia, given the findings that those with fibromyalgia have altered tactile and proprioceptive functioning [5]. Corticomuscular coherence (CMC) is a useful tool that uses electroencephalography (EEG) and electromyography (EMG) to probe the synchrony of neural firing between the brain and muscle [6]. To our knowledge, it is unknown how the magnitude of CMC varies in fibromyalgia compared to healthy controls.

Non-invasive brain stimulation in the form of Transcranial Magnetic Stimulation (TMS) has been used to probe the activity of corticospinal and cortical networks in fibromyalgia. When TMS pulses are delivered in a repetitive train, a protocol known as repetitive TMS (rTMS), short-term neuroplasticity can be induced (i.e., a change in the activity of neurons in the brain). In fibromyalgia, Mhalla et al. [7] found that 5 days of 10 Hz rTMS reduced pain intensity and improved quality of life metrics. Controlled pulse parameter transcranial magnetic stimulation (cTMS) is a novel technique that may produce stronger analgesic effects by delivering monophasic pulses that could enhance neuroplasticity compared with conventional rTMS. It is unknown whether a longer intervention period or the use of cTMS could lead to greater analgesic effects.

Finally, central sensitization may explain the widespread chronic pain experienced in fibromyalgia. There are several neuromodulators that contribute to the neurobiology of central sensitization and may be implicated in this condition including serotonin, dopamine, and brain-derived neurotrophic factor (BDNF). Serotonin is linked to pain modulation, such that increased levels of 5-HT are associated with hyperalgesia [8]. BDNF has been implicated in the genesis of neuropathic pain [9]. In fibromyalgia compared to healthy controls, serum BDNF levels have been reported to be higher [10]. Abnormal dopamine function may also be associated with fibromyalgia [11]. Positron-emission tomography (PET) studies show lower cortical dopamine D2/D3 binding availability in fibromyalgia compared to healthy controls [12].

Ultimately, a combination of events may lead to widespread chronic pain in fibromyalgia. Understanding the neurophysiology of fibromyalgia would aid in the discovery of objective biomarkers for diagnosis. Therefore, the goals of this study are to:

  1. Compare the neurophysiological responses in fibromyalgia compared to healthy controls.
  2. Determine whether a two-week cTMS protocol will alter pain in individuals with fibromyalgia.
Conditions
Fibromyalgia
Being tested
Active Controlled Pulse Parameter Transcranial Magnetic Stimulation (cTMS), Sham Controlled Pulse Parameter Transcranial Magnetic Stimulation (cTMS)
Keywords
fibromyalgia, transcranial magnetic stimulation, neuroplasticity, pain
Medical subject headings
Fibromyalgia, Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Active Controlled Pulse Parameter Transcranial Magnetic Stimulation (cTMS)Device

    cTMS is a non-invasive, non-painful procedure used to relieve chronic pain and promote short-term changes. The first dorsal interosseous (FDI) muscle of the left motor cortex will be targeted using neuronavigation software. 2000 pulses will be delivered at 10 Hz stimulation. Stimulation will be delivered at 80% of the resting motor threshold obtained from the right FDI muscle. The delivery of cTMS requires 11 minutes in total.

  • Sham Controlled Pulse Parameter Transcranial Magnetic Stimulation (cTMS)Device

    A sham coil will be utilized for the sham cTMS condition. It is important to note that from the participant perspective, the sham stimulation will feel and sound identical to active. The location and all other parameters of Sham cTMS will be identical to Active cTMS.

Study groups in NCT06006130
Study groupRoleWhat they receive
Active cTMSActive comparatorControlled Pulse Parameter Transcranial Magnetic Stimulation (cTMS) will be delivered at 10 Hz, 2000 pulses targeting the hand representation of the left primary motor cortex. cTMS delivery will require ~11 min to complete. In Experiment 1, this intervention will be performed for 1 session (~11min). In Experiment 2, this intervention will be performed approximately 5 days per week for 2 weeks. In addition, participants will experience their standard medical care.
Receives: Device: Active Controlled Pulse Parameter Transcranial Magnetic Stimulation (cTMS)
Sham cTMSSham comparatorSham cTMS will be delivered at as a placebo control. It is important to note that from the participant perspective, the sham stimulation will feel and sound identical to active cTMS. In Experiment 2, this intervention will be performed approximately 5 days per week for 2 weeks. In addition, participants will experience their standard medical care.
Receives: Device: Sham Controlled Pulse Parameter Transcranial Magnetic Stimulation (cTMS)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in PROMIS-29 v2.0 Profile

    Using numerical rating (0 to 5) to assess the change in seven health domains including physical function, anxiety, depression, fatigue, sleep disturbances, ability to participate in social roles and activities, and pain interference. Each category consists of 4 questions. Also uses a numerical rating to asses pain intensity (0-10).

    Measured: Experiment 1: At baseline pre-intervention, Experiment 2: At baseline pre-intervention and 2 weeks post-intervention

  2. Change in Fibromyalgia impact questionnaire (FIQ)

    This instrument will be used to assess the patients feeling and emotion related to their pain experience.

    Measured: Experiment 1: At baseline pre-intervention, Experiment 2: At baseline pre-intervention and 2 weeks post-intervention

Secondary outcomes (10)
  1. Change in Pain catastrophizing scale-EN-SF

    Will be used to assess the patients feeling and emotion related to their pain experience

    Measured: Experiment 1: At baseline pre-intervention, Experiment 2: At baseline pre-intervention and 2 weeks post-intervention

  2. Change in Patient Health Questionnaire-4 (PHQ-4)

    Will be used to assess for symptoms of for Major Depressive Disorder and Generalized Anxiety Disorder

    Measured: Experiment 1: At baseline pre-intervention, Experiment 2: At baseline pre-intervention and 2 weeks post-intervention

  3. Change in Short-form Posttraumatic Checklist-5 (Short-form PCL-5)

    Will be used to screen for symptoms of Posttraumatic Stress Disorder (PTSD)

    Measured: Experiment 1: At baseline pre-intervention, Experiment 2: At baseline pre-intervention and 2 weeks post-intervention

  4. Change in Motor-evoked potentials (MEPs)

    This will include an assessments of MEPs obtained using Transcranial Magnetic Stimulation (TMS).

    Measured: Experiment 1: At baseline pre-intervention and immediately following 1 treatment session, Experiment 2: At baseline pre-intervention and 2 weeks post-intervention

  5. Change in Short-Interval Intracortical Inhibition (SICI)

    This will include an assessments of SICI obtained using Transcranial Magnetic Stimulation (TMS).

    Measured: Experiment 1: At baseline pre-intervention and immediately following 1 treatment session, Experiment 2: At baseline pre-intervention and 2 weeks post-intervention

  6. Change in performance on sensorimotor tasks

    Tasks include tactile localization, temporal order judgement (TOJ), and sequential amplitude discrimination

    Measured: Experiment 1: At baseline pre-intervention, Experiment 2: At baseline pre-intervention and 2 weeks post-intervention

  7. EEG assessment of Somatosensory-evoked potentials (SEPs)

    This will include an assessment of SEPs using EEG electrodes.

    Measured: Experiment 1: At baseline pre-intervention only

  8. EEG assessment of Pain-related evoked potentials (PREPs)

    This will include an assessment of PREPs using EEG electrodes.

    Measured: Experiment 1: At baseline pre-intervention only

  9. EEG assessment of Corticomuscular coherence (CMC)

    This will include an assessment of CMC using EEG electrodes.

    Measured: Experiment 1: At baseline pre-intervention only

  10. EEG assessment of Event-related desynchronization (ERD)

    This will include an assessment of ERD using EEG electrodes.

    Measured: Experiment 1: At baseline pre-intervention only

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Aug 2023
  2. Study start1 Feb 2024
  3. Primary completion31 Dec 2025
  4. Study completion31 Dec 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Experiment 1: Response to real intervention compared between fibromyalgia and healthy control group Experiment 2: Fibromyalgia participants allocated to real or sham intervention
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
36 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06006130
Sponsor's protocol ID
16482
Status last verified
Dec 2025
First submitted
28 Jul 2023
Last updated
4 Jun 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Obata K, Noguchi K. BDNF in sensory neurons and chronic pain. Neurosci Res. 2006 May;55(1):1-10. doi: 10.1016/j.neures.2006.01.005. Epub 2006 Mar 3.

    PubMed 16516994
  • Ovrom EA, Mostert KA, Khakhkhar S, McKee DP, Yang P, Her YF. A Comprehensive Review of the Genetic and Epigenetic Contributions to the Development of Fibromyalgia. Biomedicines. 2023 Apr 7;11(4):1119. doi: 10.3390/biomedicines11041119.

    PubMed 37189737
  • Mhalla A, Baudic S, de Andrade DC, Gautron M, Perrot S, Teixeira MJ, Attal N, Bouhassira D. Long-term maintenance of the analgesic effects of transcranial magnetic stimulation in fibromyalgia. Pain. 2011 Jul;152(7):1478-1485. doi: 10.1016/j.pain.2011.01.034. Epub 2011 Mar 11.

    PubMed 21397400
  • Chowdhury A, Raza H, Meena YK, Dutta A, Prasad G. An EEG-EMG correlation-based brain-computer interface for hand orthosis supported neuro-rehabilitation. J Neurosci Methods. 2019 Jan 15;312:1-11. doi: 10.1016/j.jneumeth.2018.11.010. Epub 2018 Nov 16.

    PubMed 30452976
  • Toprak Celenay S, Mete O, Coban O, Oskay D, Erten S. Trunk position sense, postural stability, and spine posture in fibromyalgia. Rheumatol Int. 2019 Dec;39(12):2087-2094. doi: 10.1007/s00296-019-04399-1. Epub 2019 Jul 31.

    PubMed 31367796
  • Vitterso AD, Halicka M, Buckingham G, Proulx MJ, Bultitude JH. The sensorimotor theory of pathological pain revisited. Neurosci Biobehav Rev. 2022 Aug;139:104735. doi: 10.1016/j.neubiorev.2022.104735. Epub 2022 Jun 12.

    PubMed 35705110
  • Nakata H, Inui K, Wasaka T, Nishihira Y, Kakigi R. Mechanisms of differences in gating effects on short-and long-latency somatosensory evoked potentials relating to movement. Brain Topogr. 2003 Summer;15(4):211-22. doi: 10.1023/a:1023908707851.

    PubMed 12866825
  • Melzack R. Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004. Pain Pract. 2005 Jun;5(2):85-94. doi: 10.1111/j.1533-2500.2005.05203.x.

    PubMed 17177754
  • Yunus MB. The role of gender in fibromyalgia syndrome. Curr Rheumatol Rep. 2001 Apr;3(2):128-34. doi: 10.1007/s11926-001-0008-3.

    PubMed 11286669

Questions about this trial

What is this clinical trial studying?

A study of Fibromyalgia, run by McMaster University at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in PROMIS-29 v2.0 Profile (time frame: Experiment 1: At baseline pre-intervention, Experiment 2: At baseline pre-intervention and 2 weeks post-intervention). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06006130, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Jun 2026.

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