World Neurosurg. 2024 Jan 5:S1878-8750(24)00021-4. doi: 10.1016/j.wneu.2024.01.010. Online ahead of print.

ABSTRACT

INTRODUCTION: RTMS has been shown to be effective for pain modulation in a variety of pathological conditions causing neuropathic pain. The purpose of this study is to conduct a network meta-analysis (NMA) of randomized control trials to identify the most optimal frequency required to achieve chronic pain modulation using rTMS.

METHODS: A comprehensive search was conducted in electronic databases to identify randomized controlled trials investigating the efficacy of rTMS for chronic pain management. A total of 24 studies met the inclusion criteria, and a network meta-analysis was conducted to identify the most effective rTMS frequency for chronic pain management.

RESULTS: Our analysis revealed that high frequency rTMS (20 Hz) was the most effective frequency for chronic pain modulation. Patients treated with 20 Hz had lower pain levels than those treated at 5 Hz (MD = -3.11 (95% CI: -5.61 – -0.61), p = 0.032), and control (MD = -1.99 (95% CI: -3.11 – -0.88), p = 0.023). Similarly, treatment with 10 Hz had lower pain levels compared to 5 Hz (MD = -2.56 (95% CI: -5.05 – -0.07), p = 0.045), and control (MD = -1.44 (95% CI: -2.52 – -0.36), p = 0.031). 20 Hz and 10 Hz were not statistically different.

DISCUSSION: This network meta-analysis suggests that high frequency rTMS (20 Hz) is the most optimal frequency for chronic pain modulation. These findings have important clinical implications and can guide healthcare professionals in selecting the most effective frequency for rTMS treatment in patients with chronic pain.

PMID:38185460 | DOI:10.1016/j.wneu.2024.01.010