• Abrahão Fontes Baptista, Ana Mércia B L Fernandes, Katia Nunes Sá, Alexandre Hideki Okano, André Russowsky Brunoni, Argelia Lara-Solares, Aziza Jreige Iskandar, Carlos Guerrero, César Amescua-García, Kraychete Durval Campos DC Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil., Egas Caparelli-Daquer, Elias Atencio, Fabián Piedimonte, Frantz Colimon, Fuad Ahmed Hazime, Garcia João Batista S JBS Departamento de Medicina, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil., Hernández-Castro John Jairo JJ Escuela de Medicina y Ciencias de La Salud, Universidad de Rosario, Bogotá, Colombia., Cantisani José Alberto Flores JAF Programa Regional de Cuidados Paliativos, Unidad Médica de Alta Especialidad No. 25, IMSS, Monterrey, Nuevo León, México., Kátia Karina do Monte-Silva, Lemos Correia Luis Claudio LC Departamento de Pós-graduação, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil. , Gallegos Manuel Sempértegui MS Clinica de Dolor, Hospital Metropolitano, Quito, Ecuador., Marco Antonio Marcolin, María Antonieta Ricco, Cook María Berenguel MB Departamento de Medicina Paliativa y Tratamiento del Dolor, Totalcare-Oncosalud-Auna, Lima, Peru., Patricia Bonilla, Pedro Schestatsky, Ricardo Galhardoni, Valquíria Silva, William Delgado Barrera, Wolnei Caumo, Didier Bouhassira, Lucy S Chipchase, Jean-Pascal Lefaucheur, Manoel Jacobsen Teixeira, and de Andrade Daniel Ciampi DC Department of Neurology, Pain Center, Universidade de São Paulo, São Paulo, Brazil. .
• Universidade Federal do ABC, Centro de Matemática, Computação e Cognição, São Bernardo do Campo, São Paulo, Brazil.
• Pain Rep. 2019 Jan 1; 4 (1): e692.

IntroductionChronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP.ObjectiveTo provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice.MethodsSystematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study.ResultsThe systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain.ConclusionTranscranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.

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