Chronic pathology;

Affects about 1% to 3% of the population;

Hard to manage and understand;

Prevalence increases with age, being more frequent in women and between 30 and 35 years;

Symptoms: widespread pain (the most common), cognitive impairment ("fibro-fog” and memory loss), sleep changes, physical and mental exhaustion, blurred vision, among others.

Has no specific signals or exams that can lead to a diagnostic, although there is some criteria sets.

Changes in cortical-subcortical processing;

Reduced intrinsic conectivity between important areas of the brain linked to pain and the primary sensorimotor sites;

Increased activity in pain areas of the brain;

Less grey matter in cortical and subcortical sites;

Excitatory neurotransmitters, which leads to hypersensitivity (linked to issues in the amplification of pain or in the central nervous system).

Pain generated by mental status when the copying systems fail (makes a difference in the intensity of the pain felt);

Psychological disorders (e.g. depression).

Hypersensitivity to surrounding stimulus (e.g. light, sounds, odors and pain).

Pain felt in FM;

Pain that continues to exist even after the stimulus that causes her its gone;

Major sensitivity to pressure at some precise locations, which is not enough to define the condition, but helps excluding others.

It is also possible to give a questionnaire to evaluate the ones who have more risk of developing the disease.

Gives the degree of connection between the different brain sites, the neuronal activation of brain areas linked to pain and studies physiologic factors associated with pain.

This condition can develop due to genetic causes, life experiences, cognitive and emotional status, and the ability to deal with stress.

Has no stipulated effective treatments, since it is difficult to define agreed criteria for its classification and diagnostic.

Some approaches: physical exercise, drugs, education about the condition and psychotherapy.

Neurostimulation: transcranial magnetic stimulation (TMS) and transcranial electric stimulation (TES).

Both strategies are considered safe and noninvasive with the aim of adjust the activity of the cortex.

Although both are effective, studies indicate that TMS has better results in controlling the symptoms.

Help control the pain;

Leads to motor-evoked potential (MEP).

Uses a coil placed in the scalp to produce magnetic fields, which leads to electrical currents.

Intensity can be affected by: scalp, meninges, bones, direction and shape of the coil, number and pattern of pulses, among others.

Electric fields are stronger in superficial regions of the cortex than in subcortical sites.

M1 and dorsolateral prefrontal cortex (DLPFC) are two sites of the brain that are connected with the operation and control of the feeling of pain.

Ideal for TMS modulation since it is easily accessible and is responsible for the accomplishment of the movements.

Some studies indicate that M1 can be affected by muscle pain, being related to chronic musculoskeletal disorders.

In FM patients, it is possible to have a M1 neuronal metabolic dysfunction.

Circular coil: stimulation of surface motor areas of the brain and leads to a more spread stimulus;

Figure-of-eight coil: focused current;

H-coil: stimulation of deep layers of the brain;

Double-cone coil: stimulation of deep layers (up to 6 cm) of the cortex.

Among others.

To evaluate the excitability of the motor sites of the brain and to provide information about the sensorimotor system, which is essential to the prognostic and diagnostic of the disease.

For long periods of time can improve the quality of life of FM patients since it helps to reduce pain.

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Pain: High-frequency rTMS (≥10 Hz) applied to the left DLPCB can reduce the intensity of subjective pain (short-term), improve symptoms, such as fatigue and cognitive dysfunction, influence connectivity with the limbic system (amygdala, cingulate), responsible for the emotional component of pain.

Quality of Life: Effective in improving pain and associated symptoms (depression and anxiety) along with QoL. Improving of physical functioning in fibromyalgia, and it may also improve aspects of pain beyond pain intensity, such as stifness.

Pain: High-frequency stimulation (10–20 Hz) on M1 appears to activate descending inhibitory circuits that reduce pain perception. It can also modulate pain-related subcortical areas, such as the thalamic nucleus and periaqueductal gray matter. Low-frequency also reduces pain perception.

Quality of Life: Significant improvement in the quality of life of the patients although it manifests late (detected during the follow-ups after the stimulation sessions).

Functional Connectivity: Active rTMS led to improvements in fibromyalgia symptoms, associated with changes in functional connectivity in brain areas related to pain processing and modulation.