Cochrane Database of Systematic Reviews 2018, Updated April 2018 Issue 4. Art. No.: CD008208. DOI: 10.1002/14651858.CD008208.pub5.
- An updated review of non-invasive brain simulation techniques for chronic pain has identified 94 RCTs of the five treatment types - 42 of repetitive transcranial magnetic stimulation (rDCS), 11 of cranial electrotherapy stimulation CES), 36 of transcranial direct current stimulation tDCS), two of reduced impedance non-invasive cortical electrostimulation (RINCE), two of transcranial random noise stimulation (tRNS) and one study which evaluated both tDCS and rTMS).
- Key findings
- rTMS applied to the motor cortex may lead to small, short-term reductions in pain but these effects are not likely to be clinically important. tDCS may reduce pain when compared with sham but for rTMS and tDCS our estimates of benefit are likely to be exaggerated by the small number of participants in each of the studies and limitations in the way the studies were conducted. Low- or very low-quality evidence suggests that low-frequency rTMS and rTMS that is applied to prefrontal areas of the brain are not effective. Low-quality evidence does not suggest that CES is an effective treatment for chronic pain. For all forms of stimulation the evidence is not conclusive and there is substantial uncertainty about the possible benefits and harms of the treatment. Of the studies that clearly reported side effects, short-lived and minor side effects such as headache, nausea and skin irritation were usually reported both with real and sham stimulation. Two cases of seizure were reported following real rTMS. Our conclusions for rTMS, CES, tDCS, and RINCE have not changed substantially in this update.
