stimulation Noninvasive brain stimulation includes methods such as transcranial direct current stimulation and high-frequency repetitive transcranial magnetic stimulation (TMS). Both methods have been found to improve pain scores in neuropathic pain and fibromyalgia. A 2023 meta analysis of 16 RCTs found that transcranial direct current stimulation (tDCS) of over 4 weeks can decrease pain in patients with fibromyalgia. A 2021 meta-analysis of multiple intervention types concluded that magnetic field therapy and transcranial magnetic stimulation may diminish pain in the short-term, but conveyed an uncertainty about the relevance of the result. Several 2022 meta-analyses focusing on transcranial magnetic stimulation found positive effects on fibromyalgia. Repetitive transcranial magnetic stimulation improved pain in the short-term and quality of life after 5–12 weeks. Repetitive transcranial magnetic stimulation did not improve anxiety, depression, and fatigue. Transcranial magnetic stimulation to the left dorsolateral prefrontal cortex was also ineffective. Hyperbaric oxygen therapy Hyperbaric oxygen therapy (HBOT) has shown beneficial effects in treating chronic pain. However, treating fibromyalgia with hyperbaric oxygen therapy is still controversial, in light of the scarcity of large-scale clinical trials. In addition, hyperbaric oxygen therapy raises safety concerns due to the oxidative damage that may follow it. An evaluation of nine trials with 288 patients in total found that HBOT was more effective at relieving fibromyalgia patients' pain than the control intervention. In most of the trials HBOT improved sleep disturbance, multidimensional function, patient satisfaction, and tender spots. Unfortunately, 24% of the patients experienced negative outcomes. Prognosis Although in itself fibromyalgia is neither degenerative nor fatal, the chronic pain of fibromyalgia is pervasive and persistent. Most people with fibromyalgia report that their symptoms do not improve over time. However, most patients learn to adapt to the symptoms over time. The German guidelines for patients explain that: The symptoms of fibromyalgia are persistent in nearly all patients. Total relief of symptoms is seldom achieved. The symptoms do not lead to disablement and do not shorten life expectancy. An 11-year follow-up study on 1,555 patients found that most remained with high levels of self-reported symptoms and distress. However, there was a great deal of patient heterogeneity accounting for almost half of the variance. At the final observation, 10% of the patients showed substantial improvement with minimal symptoms. An additional 15% had moderate improvement. This state, though, may be transient, given the fluctuations in symptom severity. A study of 97 adolescents diagnosed with fibromyalgia followed them for