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Trial registered on ANZCTR
Registration number
ACTRN12613000561785
Ethics application status
Approved
Date submitted
13/05/2013
Date registered
17/05/2013
Date last updated
26/09/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
The effectiveness of repetitive transcranial magnetic stimulation in the treatment of fibromyalgia
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Scientific title
Repetitive transcranial magnetic stimulation in the treatment of fibromyalgia
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Secondary ID [1]
282493
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nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Fibromyalgia
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Chronic Pain
289140
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Mental Health
289141
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Condition category
Condition code
Musculoskeletal
289473
289473
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0
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Other muscular and skeletal disorders
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Mental Health
289474
289474
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0
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Depression
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Repetitive Transcranial Magnetic Stimulation (rTMS).
rTMS will be administered using the Magventure Magpro or NeuroStar TMS Therapy System (Neuronetics Inc). Prior to the administration of rTMS, each participants resting motor threshold (RMT) will be determined according to standard published methods.
Participants will undergo a total of 20 treatments, daily (mon-fri) for 4 weeks. In each treatment, participants will receive 75 trains of 4 second duration with a frequency of 10 Hz. Stimulation intensity will be set at 120% RMT and will applied to the dorsolateral prefrontal cortex.
The above protocol is in compliance with current published rTMS safety guidelines.
Participants will undergo an assessment at baseline, at the end of weeks 1, 2, 3 and 4, and at a subsequent one -month follow-up. The clinical outcome of rTMS treatments will be determined through these assessments.
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Intervention code [1]
287147
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Treatment: Devices
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Comparator / control treatment
Participants allocated to the sham condition will be administered sham rTMS that will be identical to the active condition (described above) except no stimulation will be applied.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Change in severity and impact of pain as measured by the Short-form McGill Pain Questionnaire and the Brief Pain Inventory.
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Assessment method [1]
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Timepoint [1]
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At the end of treatment course (week 4).
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Primary outcome [2]
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Change in quality of life as measured by the Short-form 36 Health Survey and the Fibromyalgia impact questionnaire.
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Assessment method [2]
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Timepoint [2]
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End of treatment course (week 4).
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Secondary outcome [1]
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Change in severity of depressive symptoms as shown by score of the Beck Depression Inventory (BDI).
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Assessment method [1]
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Timepoint [1]
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End of treatment course (week 4).
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Secondary outcome [2]
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Change in Multi-dimensional Fatigue Inventory score
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Assessment method [2]
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Timepoint [2]
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Baseline compared to end of treamtent at 4 weeks and 1 month follow up
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Secondary outcome [3]
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Change in Pain Catastrophisation Scale
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Assessment method [3]
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Timepoint [3]
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Baseline compared to end of treatment at 4 weeks and 1 month follow up
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Secondary outcome [4]
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Change in Beck Anxiety Inventory and State-Trait Anxiety Inventory scores
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Assessment method [4]
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Timepoint [4]
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Baseline compared to end of treatment (4 weeks) compared to follow-up (1 month post treatment).
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Eligibility
Key inclusion criteria
Participants will be included if they:
* are aged between 18-65 years,
* meet American College of Rheumatology Fibromyalgia Scale (2010) diagnostic criteria for Fibromyalgia
* have experienced symptoms for > 6 months
* have had no change in medication in the four weeks prior to trial initiation.
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* History of epilepsy or seizure disorder
* History of serious head injury
* Metal in the head (outside of the mouth)
* Medical implants in the body
* History or diagnosis of neurological/psychiatric illness
* Specific pathological entities, such as infection, neoplasm, metastasis, osteoporosis, rheumatoid arthritis or fracture
* Additional co-existing musculoskeletal conditions
* Pregnant
* Professional driver or machine operator.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
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Type of endpoint/s
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Statistical methods / analysis
40 participants with fibromyalgia will be recruited into the trial. As we are expecting that our DLPFC rTMS treatment course will result in a significant change in clinical outcomes (effect sizes of reduced pain intensity, secondary pain outcomes and quality of life reported by Mhalla and colleagues (2011) were generally around d = 0.80) we are predicting at least a moderate to large effect size. Therefore, our chosen sample size should provide power of 90% to detect (a = .05, two-tailed) moderate to large effect sizes (f = 0.50), while allowing for a drop-out rate of 15-20%, in a repeated measures ANOVA.
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Recruitment
Recruitment status
Stopped early
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Data analysis
Data analysis is complete
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Reason for early stopping/withdrawal
Other reasons/comments
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Other reasons
We have concluded the study prior to meeting our recruitment target as we exceeded the planned interval of the study and had secured funding for a next step-investigation.
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Date of first participant enrolment
Anticipated
12/08/2013
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Actual
25/10/2013
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Date of last participant enrolment
Anticipated
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Actual
3/04/2017
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Date of last data collection
Anticipated
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Actual
24/05/2017
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Sample size
Target
40
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Accrual to date
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Final
26
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Recruitment in Australia
Recruitment state(s)
VIC
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Funding & Sponsors
Funding source category [1]
287277
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University
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Name [1]
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Monash University, Monash Alfred Psychiatry Research Center
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Address [1]
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Level 4, 607 St Kilda Road
Melbourne 3004 VIC
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Dr Bernadette Fitzgibbon
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Address
Monash Alfred Psychiatry Research Center,
Level 4, 607 St Kilda Road
Melbourne 3004 VIC
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
286030
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Country [1]
286030
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Alfred Health
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Ethics committee address [1]
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The Alfred, Commercial Rd, Melbourne, Victoria, 3004
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Ethics committee country [1]
289257
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Australia
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Date submitted for ethics approval [1]
289257
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27/05/2013
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Approval date [1]
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04/07/2013
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Ethics approval number [1]
289257
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249/13
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Ethics committee name [2]
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Monash University Human Research Ethics Committee
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Ethics committee address [2]
289757
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Building 3E, Room 111, Clayton Campus, Wellington Road, Clayton VIC 3800
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Ethics committee country [2]
289757
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Australia
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Date submitted for ethics approval [2]
289757
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05/07/2013
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Approval date [2]
289757
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10/07/2013
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Ethics approval number [2]
289757
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CF13/2067 - 2013001080
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Ethics committee name [3]
289758
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Monash Health
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Ethics committee address [3]
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Monash Medical Center 246 Clayton Rd, Clayton VIC 3168
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Ethics committee country [3]
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Australia
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Date submitted for ethics approval [3]
289758
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11/07/2013
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Approval date [3]
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25/07/2013
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Ethics approval number [3]
289758
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13253X
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Summary
Brief summary
Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, is an approved treatment option for patients with depression in the Canada and several EU nations, with significant evidence demonstrating greater clinical outcomes following longer treatment courses. For patients with fibromyalgia, studies suggest rTMS may also offer a novel treatment approach for pain relief. However these effects are short-lasting thereby limiting its clinical application. Yet no studies to date have explored the effects of a treatment course of similar duration to that used in depression. In addition, there is a dearth of literature exploring target sites other than the motor cortex, such as the dorsolateral prefrontal cortex (DLPFC); a brain region directly implicated in the control of pain perception. In the proposed world-first study, we will carry-out a randomised double-blind placebo-controlled trial to assess the use of an rTMS treatment course applied to the DLPFC in patients who suffer from fibromyalgia. To do so, we will recruit a total of 40 patients with a diagnosis of fibromyalgia who will undergo a blind 4-week acute rTMS daily treatment course. We expect our proposed treatment course of rTMS to the DLPFC in patients with fibromyalgia will provide a model for an interventional treatment course that may be extended to other pain syndromes. Thereby reducing dependence on pharmaceutical treatments in patients who suffer from chronic pain and increasing quality of life for the millions of chronic pain sufferer's worldwide.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Bernadette Fitzgibbon
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Address
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Monash Alfred Psychiatry Research Center
Level 4, 607 St Kilda Road
Melbourne 3004 VIC
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Country
40002
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Australia
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Phone
40002
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+61 3 90769860
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Fax
40002
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Email
40002
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[email protected]
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Contact person for public queries
Name
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Bernadette Fitzgibbon
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Address
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Monash Alfred Psychiatry Research Center
Level 4, 607 St Kilda Road
Melbourne 3004 VIC
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Country
40003
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Australia
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Phone
40003
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+61 3 90769860
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Fax
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Email
40003
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[email protected]
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Contact person for scientific queries
Name
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Bernadette Fitzgibbon
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Address
40004
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Monash Alfred Psychiatry Research Center
Level 4, 607 St Kilda Road
Melbourne 3004 VIC
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Country
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Australia
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Phone
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+61 3 90769860
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Evidence for the improvement of fatigue in fibromyalgia: A 4-week left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation randomized-controlled trial.
2018
https://dx.doi.org/10.1002/ejp.1213
N.B. These documents automatically identified may not have been verified by the study sponsor.
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