Please select the eligibility criteria that correspond to the clinical trial below.
Title: Transcranial Magnetic Stimulation and/or Neurofunctional Electrical Acupuncture in the Rehabilitation of Patients With Myofascial Chronic Pain
Brief Summary: To evaluate the hypothesis: the effects of repetitive transcranial magnetic (rTMS) stimulation and/or peripheral stimulation (neurofunctional electrical acupuncture) treatments are more effective in pain relief than placebo-sham in patients with myofascial chronic pain.


Options:
A: Inclusion Criteria:

1. Males and females greater than equal to 18 years old.
2. Females with a confirmed negative pregnancy test (which is conducted within 24 hours of admission to the hospital as part of standard of clinical care).
3. Confirmed diagnosis of chronic pain.
4. Must be admitted to the Pain Management Program at The Menninger Clinic.

Exclusion Criteria:

1. Presence of actively psychosis, cognitively impairment.
2. Contraindications to tDCS:

   1. Presence of any preexisting irritation, cuts, or lesions where the tDCS will be placed (i.e., the forehead).
   2. Presence of any preexisting unstable medical conditions, or conditions that may increase the risk of stimulation such as uncontrolled epilepsy.
   3. Presence of history of severe cranial trauma with alteration of the cranial anatomy or metallic intracranial implants.
3. None fluent in the English language.
4. Presence of known sensitivity to Lidocaine 4%.
B: Inclusion Criteria:

* Over 18 years of age
* History of moderate to severe sublesional pain

Exclusion Criteria:

* Active alcohol or drug dependence, as self-reported
* A history of bipolar disorder or psychosis, as self-reported
* Inability to travel to the study site,
* Current use of any of the following anti-epileptic medications or dopaminergic medications known to reduce or inhibit the benefits of tDCS treatment \[53\]: carbamazepine, oxcarbazepine, phenytoin, ropinirole (Requip), pramipexole (Mirapex), and cabergoline (Dostinex),
* The following contradictions to tDCS: implanted metal plates in the head, or deep brain stimulator (spinal cord implants, including baclofen pumps, are not a contraindication as cranial currents do not reach the spinal cord \[24\]).
* Pregnancy at time of enrollment
* Current use of ventilator.
C: Inclusion Criteria:

* Patients diagnosed as fibromyalgia according to the American college of rheumatology classification, (ACR) 2010 and referred to any of the above clinics for treatment.

  * Patients must have a mean pain score ≥ 4 on a 10-point visual analog scale (VAS) during the 2 weeks preceding the clinical trial.
  * Patients from nearby districts to ensure good availability for follow-up.

Exclusion Criteria:

* Patients refused to participate in the trial.
* Patients with any uncontrolled clinical disease (as evaluated by each patient's clinician), such as any associated rheumatologic, thyroid, cardiovascular, pulmonary, hematologic, or renal diseases, pregnancy, lactation, and neuropsychiatric disorders.
D: Inclusion Criteria:

* Providing informed consent to participate in the study ;
* 18 to 70 years old;
* Myofascial pain in the cranial- cervical- mandibular complex, with duration more than 3 months;
* In the last week, score higher or equal to 3cm (0 cm = 'no pain' and 10cm ='worst possible pain') on the VAS for pain perception at the baseline in the most part of seven days before;
* Refractoriness to drugs for pain relieve - such as tricyclic antidepressants, antiepileptic drugs and/or narcotics (pain resistant to at least 2 of these drugs supplied in adequate dosages for six months).

Exclusion Criteria:

* Inflammatory chronic disease;
* Neurological deficits;
* History of substance abuse;
* Neuropsychiatric co-morbidity;
* Systemic diseases not well balance;
* Habitual use of anti-inflammatory steroids;
* Implanted devices for pain control, such as vagal or deep brain stimulators;
* Contraindications to rTMS: metal in the head, implanted brain medical devices, previous convulsion or epilepsy, serious cranial trauma, audition problem, cochlear implant, neurostimulador implantable, spinal cord surgery, bypass valve ventriculoperitoneal peritonenal,cardiac pacemaker or other metal in the body;
* Pregnancy;
* Prior experience with acupuncture.

Answer: D