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Area of Science:

  • Neuroscience
  • Pain Management
  • Neuromodulation

Background:

  • Non-invasive brain stimulation techniques aim to reduce chronic pain by altering brain activity.
  • Techniques include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES), and transcranial direct current stimulation (tDCS).
  • This review is an update of previous Cochrane Reviews on these interventions for chronic pain.

Purpose of the Study:

  • To evaluate the efficacy of non-invasive cortical stimulation techniques in treating chronic pain.
  • To assess effects on pain intensity, disability, and quality of life.

Main Methods:

  • Searched multiple databases (CENTRAL, MEDLINE, Embase, etc.) for randomized and quasi-randomized studies from July 2013 to October 2017.
  • Included studies with sham control groups, adult patients with chronic pain (≥3 months), and pain outcome measures.
  • Extracted data, performed meta-analyses where possible, excluded high-risk bias studies, and used GRADE for evidence quality assessment.

Main Results:

  • Included 94 trials (2983 participants); 42 rTMS, 11 CES, 36 tDCS studies.
  • Low-quality evidence suggests rTMS and tDCS may offer short-term pain relief and improve quality of life, but effects may not be clinically significant.
  • No significant evidence found for CES, low-frequency rTMS, or rTMS on the dorsolateral prefrontal cortex; adverse events were generally minor, with rare seizures reported.

Conclusions:

  • Very low-quality evidence indicates potential short-term benefits of high-frequency rTMS and tDCS for chronic pain and quality of life, but biases limit certainty.
  • Low-frequency rTMS, prefrontal cortex rTMS, and CES showed no significant efficacy for pain reduction.
  • Larger, rigorously designed studies with longer follow-up are needed to confirm the effectiveness of these neuromodulation techniques.