Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Pilot Study of Transcranial Magnetic Stimulation (TMS) Effects on Pain and Depression in Patients With Fibromyalgia
Brief Summary: In this pilot study, the PI proposes to include 20 African American participants with Fibromyalgia to explore the effect of r TMS on pain and depressive symptoms.


Options:
A: 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.
B: Inclusion Criteria:

* they have self-reported unilateral or bilateral knee OA pain according to American College of Rheumatology criteria
* they can understand, speak and read English
* they are able to walk for 6-minutes
* they are willing to be randomized to either the intervention or control group
* they are available for five consecutive daily sessions and for a follow-up phone interview each week for three weeks post-stimulation sessions
* they have no plan to change medication regimens for pain throughout the trial
* they are willing and able to provide written informed consent

Exclusion Criteria:

* knee replacement or non-arthroscopic surgery to the affected knee
* serious medical illness, such as uncontrolled hypertension (i.e., Systolic Blood Pressure/Diastolic Blood Pressure of ≥ 150/95), congestive heart failure, pacemaker, or history of acute myocardial infarction
* peripheral neuropathy
* systemic rheumatic disorders, including rheumatoid arthritis, systemic lupus erythematosus, and fibromyalgia
* alcohol/substance abuse
* cognitive impairment (i.e., Mini-Mental Status Exam score ≤ 23)
* history of brain surgery, tumor, seizure, stroke, or intracranial metal implantation
* pregnancy or lactation for females
* hospitalization within the preceding year due to psychiatric illness
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:

* age 18-80,
* meet ACR criteria for FM for more than 6 months,
* may or may not have a diagnosis of major depressive disorder (not bipolar) past or present,
* Current major depressive episode must be without psychotic features
* Not be on medication known to increase risk of TMS-induced seizures
* No prescription medication changes in the previous 4 weeks with agreement not to change during the treatment course (2 weeks) and 2 weeks thereafter
* No history of epilepsy or stroke or recent head trauma (LOC \> 5 minutes) within the past 6 months
* African Americans will be initially sought out for study, however the recruitment may extend to include Caucasian and Hispanic subjects to carry out the study.

Exclusion Criteria:

* Primary, current diagnosis of schizophrenia
* Other (non-mood disorder) psychosis
* Mental retardation
* Substance dependence or abuse within the past 6 months (except nicotine)
* Psychotic features in this episode, dementia, or delirium
* Contraindication to rTMS
* Increased intracranial pressure
* Brain surgery, or head trauma with loss of consciousness for \> 15 minutes
* Implanted electronic device
* Metal in the head, or pregnant
* Has an active autoimmune, endocrine, viral, or vascular disorder affecting the brain or unstable cardiac disease
* Uncontrolled hypertension, or severe renal or liver insufficiency
* Unstable and active suicidal intent or plan
* History of attempt requiring medical hospitalization within in the past 6 months
* -currently an involuntary inpatient on a psychiatric ward.

Answer: D