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Effect of non-invasive brain stimulation (NIBS) techniques on neuropathic pain in patients with peripheral
Jorge Menéndez-Cámara1, Alberto Arribas-Romano2, Yeray González-Zamorano3
1Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain.
Objectives:
Painful peripheral neuropathies (PN) are highly prevalent and often refractory to pharmacological treatment. Given the emerging evidence of central nervous system involvement in painful PN, noninvasive brain stimulation (NIBS) techniques have gained attention as potential treatment alternatives. However, findings in neuropathic pain (NP) remain inconsistent, with previous studies reporting small effect sizes and pooling heterogeneous stimulation techniques or NP conditions in single analyses, which could influence the results observed. To overcome these limitations, we aimed to systematically evaluate the efficacy of NIBS on NP in adults with painful PN using stratified analyses by pathology and stimulation modality.
Materials And Methods:
We conducted a systematic review and meta-analysis of randomized controlled trials. Searches were performed across seven data bases from inception to November 2025. Eligible trials included adults with painful PN receiving NIBS techniques compared with sham or usual care, with pain intensity as our primary outcome. Methodologic quality was assessed using risk-of-bias tool for randomized trials (RoB 2), and the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation.
Results:
A total of 18 trials met inclusion criteria and 13 (n = 569 participants) were included in quantitative synthesis. For postherpetic neuralgia, repetitive transcranial magnetic stimulation (rTMS) over the motor cortex produced modest reductions in pain intensity from immediate post treatment [MD (95% CI): -1.96 (-2.96 to -0.97)] to three-month follow-up [MD (95% CI): -1.23 (-2.34 to -0.14)], with low to moderate certainty. Sensitivity analyses confirmed effects at two-week and one-month follow-ups. Conversely, evidence for rTMS or transcranial direct current stimulation (tDCS) in diabetic neuropathy, radiculopathies, brachial plexus injuries, and post cancer treatment neuropathies was nonsignificant, with low to very low certainty.
Conclusions:
Although rTMS could provide short-term analgesic effects in certain PN, heterogeneity in protocols and populations underscores the need for standardized, high-quality trials with longer follow-ups.
