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Area of Science:

  • Neuroscience
  • Pain Management
  • Neuromodulation

Background:

  • Chronic pain affects millions globally, necessitating novel therapeutic approaches.
  • Non-invasive brain stimulation (NIBS) techniques offer a potential avenue for pain management by modulating neural activity.
  • This review synthesizes evidence on the efficacy of various NIBS methods for chronic pain.

Purpose of the Study:

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

Main Methods:

  • Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
  • Included studies utilized repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES), transcranial direct current stimulation (tDCS), and other NIBS methods.
  • Searched multiple databases from July 2013 to October 2017, assessing risk of bias and quality of evidence using GRADE criteria.

Main Results:

  • Low-quality evidence suggests short-term, small reductions in pain intensity with high-frequency rTMS of the motor cortex and tDCS, not meeting the minimum clinically important difference.
  • No significant evidence of effectiveness for low-frequency rTMS, rTMS on the dorsolateral prefrontal cortex, or CES in reducing pain intensity.
  • Some evidence indicates potential short-term improvements in quality of life with rTMS and tDCS, though overall evidence quality is low to very low.

Conclusions:

  • Very low-quality evidence suggests potential short-term benefits of high-frequency rTMS and tDCS for chronic pain and quality of life, but biases limit certainty.
  • Current evidence does not support the efficacy of other tested NIBS protocols for chronic pain reduction.
  • Larger, rigorously designed studies with longer follow-up are crucial to establish the true efficacy and safety of NIBS for chronic pain.