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Objective: The goal of this study is to evaluate the effectiveness of occipital nerve stimulation (ONS) as a surgical treatment for fibromyalgia in a placebo-controlled design., Materials and Methods: Eleven patients were selected based on the American College of Rheumatology-90 criteria and implanted with an occipital nerve trial-lead stimulator. Baseline scores for pain, mood, and fatigue were acquired, and patients were randomized in a ten-week double-blinded crossover design with placebo and effective subsensory threshold stimulation (no paresthesias). After finalizing the trial, nine patients were implanted permanently; evaluation was performed prior to surgery and at six months after surgery for pain, fatigue, and mood of the number of trigger points and overall morbidity., Results: Significant results were found during the trial for a decrease in pain intensity (39.74%) on visual analogue scale (VAS; p < 0.001) and pain catastrophizing scale (PCS) during effective stimulation. A total of 9/11 patients responded to trial treatment; however, in two patients, this might be a placebo effect, recognizable due to the study design. Six months after permanent implantation, pain intensity remained decreased (44.01%) on VAS (p < 0.05). Besides the VAS, significant changes were noted for PCS, fatigue (modified fatigue impact scale), the number of trigger points, and overall morbidity (fibromyalgia impact questionnaire). There were no serious adverse events., Conclusions: Our data strongly suggest that ONS is beneficial in the treatment of fibromyalgia. The beneficial effects are stable at six months after permanent implantation. Subsensory threshold stimulation is feasible in designing a placebo-controlled trial., (© 2013 International Neuromodulation Society.)

Fibromyalgia is a condition marked by widespread chronic pain, accompanied by a variety of other symptoms, including sleep and fatigue disorders, headaches, disorders of the autonomic nervous system, as well as cognitive and psychiatric symptoms. It occurs predominantly in women and is often associated with other systemic or autoimmune diseases. Despite its serious socio economical burden, the treatment options remain poor. In this chapter, the authors discuss the possibilities of using greater occipital nerve stimulation as a treatment for fibromyalgia, based on available clinical studies. Greater occipital nerve stimulation has already been used successfully to treat occipital neuralgia and various primary headache syndromes. Testable hypothetical working mechanisms are proposed to explain the surprising effect of this treatment on widespread bodily pain., (Copyright © 2011 S. Karger AG, Basel.)

Background: Fibromyalgia (FM), a disorder characterized by diffuse pain, fatigue, and a variety of other symptoms, is thought to derive from dysfunction of the central nervous system. Neuromodulation is a technique to treat pain from a variety of causes, including disorders of the central nervous system (CNS). Occipital nerve stimulation is a neuromodulation technique currently under study to treat various migraine headache disorders. This study examines a technique of neurostimulation that appears to affect the pain and symptoms of FM., Objective: To evaluate the effect of a new technique of peripheral neurostimulation of the C2 scalp area on pain, fatigue, depression, and quality of life in FM patients., Methods: In total, 12 patients (nine females and three males; mean age 48 years) who met criteria for FM, and with comorbid headache disorder, were trialed and implanted with this C2 area stimulation technique. Outcome was prospectively studied with standard evaluation tools at baseline, 3 and 6 months post implant., Results: Visual Analog Scale (VAS) pain levels for FM-related pain decreased significantly at 6 months, and pain-drawing total area and number of areas colored in also decreased dramatically. Chronic fatigue and depression as assessed by the Beck Depression Inventory and Fatigue Impact Scale were markedly improved. Overall quality of life as assessed by the Health Survey Short Form 36 (SF-36) was markedly improved. There were no infectious or technical complications., Conclusion: C2 area scalp stimulation may diminish pain and related symptoms in patients with FM.