Meta-analysis finds rTMS improves neuropathic pain in spinal cord injury patients.

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).