• Ricardo Galhardoni, Guilherme S Correia, Haniel Araujo, Lin T Yeng, Diego T Fernandes, Helena H Kaziyama, Marco A Marcolin, Didier Bouhassira, Manoel Jacobsen Teixeira, and Daniel Ciampi de Andrade.
• Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
• Arch Phys Med Rehabil. 2015 Apr 1;96(4 Suppl):S156-72.

ObjectiveTo review the literature on the analgesic effects of repetitive transcranial magnetic stimulation (rTMS) in chronic pain according to different pain syndromes and stimulation parameters.Data SourcesPublications on rTMS and chronic pain were searched in PubMed and Google Scholar using the following key words: chronic pain, analgesia, transcranial magnetic stimulation, neuropathic pain, fibromyalgia, and complex regional pain syndrome.Study SelectionThis review only included double-blind, controlled studies with >10 participants in each arm that were published from 1996 to 2014 and written in English. Studies with relevant information for the understanding of the effects of rTMS were also cited.Data ExtractionThe following data were retained: type of pain syndrome, type of study, coil type, target, stimulation intensity, frequency, number of pulses, orientation of induced current, number of session, and a brief summary of intervention outcomes.Data SynthesisA total of 33 randomized trials were found. Many studies reported significant pain relief by rTMS, especially high-frequency stimulation over the primary motor cortex performed in consecutive treatment sessions. Pain relief was frequently >30% compared with control treatment. Neuropathic pain, fibromyalgia, and complex regional pain syndrome were the pain syndromes more frequently studied. However, among all published studies, only a few performed repetitive sessions of rTMS.ConclusionsrTMS has potential utility in the management of chronic pain; however, studies using maintenance sessions of rTMS and assessing the effects of rTMS on the different aspects of chronic pain are needed to provide a more solid basis for its clinical application for pain relief.Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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