This review looked at whether repetitive transcranial magnetic stimulation (rTMS) helps people with spinal cord injury who also have neuropathic pain. The analysis pooled data from seven small randomized trials involving 159 patients. The main finding was that rTMS, compared to a sham treatment, appeared to reduce pain severity. However, the review did not find a significant impact on anxiety or depressive symptoms. Safety data were not reported in the included studies, so we do not know about side effects or tolerability. The results are based on pooled data, which show an association but not direct cause-and-effect. A key reason to be cautious is the high variability between the studies, which means the findings may not be consistent. For readers, this suggests rTMS shows promise for pain relief in this group, but more research is needed to confirm its benefits and understand its effects on mood.
Meta-analysis finds rTMS improves neuropathic pain in spinal cord injury patientsrTMS may ease nerve pain after spinal cord injury, but not anxiety or depression
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Key Takeaway
Consider rTMS for neuropathic pain in spinal cord injury, but note no significant effect on anxiety or depression.
This is a meta-analysis of 7 randomized controlled trials involving 159 patients with spinal cord injury and neuropathic pain. The authors synthesized evidence on repetitive transcranial magnetic stimulation (rTMS) versus sham stimulation for pain and emotional symptoms.
The analysis found rTMS effectively improved neuropathic pain compared to sham, with a pooled standardized mean difference (SMD) of -1.41 (95% CI = -2.44 to -0.59; p = 0.0007). However, rTMS did not have a significant impact on anxiety symptoms (SMD = -0.67; 95% CI = -1.82 to 0.48; p = 0.25) or depressive symptoms (SMD = -1.04; 95% CI = -2.26 to 0.19; p = 0.1).
The authors note high heterogeneity across studies (I2 = 78% for pain, 66% for anxiety, 74% for depression), suggesting variability in results. Safety data, follow-up duration, and absolute event numbers were not reported.
Practice relevance is restrained; rTMS shows promise for pain relief but does not support a significant effect on comorbid emotional states. The findings indicate association from pooled data, not direct causation.
What this means for you:
rTMS may help nerve pain after spinal cord injury, but evidence for mood benefits is unclear. More on Postoperative Pain
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View Original Abstract ↓
ObjectiveThe incidence of neuropathic pain following spinal cord injury (SCI-NP) is increasing, and current pharmacological treatments are often limited by severe side effects and diminishing efficacy. This study aims to systematically evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on SCI-NP and its frequently comorbid emotional disorders.MethodsWe conducted a comprehensive search across five databases (PubMed, Embase, Cochrane Library, Web of Science, and Pedro) up to April 13, 2025. Randomized controlled trials (RCTs) investigating the impact of rTMS on SCI-NP against sham stimulation were included. Pain was the primary outcome, while changes in anxiety and depressive symptoms were secondary outcomes. Data were pooled using standardized mean differences (SMDs) and 95% confidence intervals (CIs).ResultsA total of 131 studies were retrieved from the five databases, and 7 RCTs involving 159 SCI patients were ultimately included. The results indicated that, compared to the control group (sham stimulation), rTMS effectively improved SCI-NP (SMD = −1.41; 95% CI = −2.44 to −0.59; p = 0.0007, I2 = 78%). However, rTMS did not have a significant impact on anxiety (SMD = −0.67; 95% CI = −1.82 to 0.48; p = 0.25, I2 = 66%) or depressive symptoms (SMD = −1.04; 95% CI = −2.26 to 0.19; p = 0.1, I2 = 74%) compared to the control group.ConclusionrTMS demonstrates promising potential in alleviating the severity of SCI-NP. However, current evidence does not support a significant therapeutic effect on comorbid emotional states.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251074707, identifier PROSPERO (CRD420251074707).
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