Repetitive transcranial magnetic stimulation for musculoskeletal pain: A systematic review and meta-analysis

Abstract

Objective: In this study, a meta-analysis was conducted to characterize the therapeutic benefits of repetitive transcranial magnetic stimulation (rTMS) on musculoskeletal (MSK) pain and potential factors affecting the effect. Methods: A comprehensive search was performed in PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov for randomized and sham-controlled trials published from inception to 13 March 2024. We conducted this meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Based on the heterogeneity among studies, fixed effects or random-effects model was used for the effective analysis of rTMS on pain, quality of life, and depression. Results: A total of 23 eligible randomized controlled trials (RCTs) comprising 1158 patients were included in our systematic search. The analysis showed effect sizes of -0.94 (95% CI: -1.30 to -0.59), indicating that real rTMS was better than sham stimulation in reducing pain (p < 0.01). Also, rTMS reduced depression scores and improved follow-up effects and the quality of life of MSK pain patients. In the subgroup analysis, stimulation frequency, intensity, and session frequency were important factors affecting the therapeutic effect. Conclusions: Our review demonstrated that rTMS had the potential to relieve pain and depression, enhance the quality of life for patients with MSK pain. Stimulation frequency, intensity, and session frequency were important factors affecting the therapeutic effect.