Non-invasive brain stimulation techniques for chronic pain

Neil E O'Connell, Louise Marston, Sally Spencer, Lorraine H DeSouza, Benedict M Wand, Neil E O'Connell, Louise Marston, Sally Spencer, Lorraine H DeSouza, Benedict M Wand

Abstract

Background: This is an updated version of the original Cochrane Review published in 2010, Issue 9, and last updated in 2014, Issue 4. Non-invasive brain stimulation techniques aim to induce an electrical stimulation of the brain in an attempt to reduce chronic pain by directly altering brain activity. They include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES), transcranial direct current stimulation (tDCS), transcranial random noise stimulation (tRNS) and reduced impedance non-invasive cortical electrostimulation (RINCE).

Objectives: To evaluate the efficacy of non-invasive cortical stimulation techniques in the treatment of chronic pain.

Search methods: For this update we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, LILACS and clinical trials registers from July 2013 to October 2017.

Selection criteria: Randomised and quasi-randomised studies of rTMS, CES, tDCS, RINCE and tRNS if they employed a sham stimulation control group, recruited patients over the age of 18 years with pain of three months' duration or more, and measured pain as an outcome. Outcomes of interest were pain intensity measured using visual analogue scales or numerical rating scales, disability, quality of life and adverse events.

Data collection and analysis: Two review authors independently extracted and verified data. Where possible we entered data into meta-analyses, excluding studies judged as high risk of bias. We used the GRADE system to assess the quality of evidence for core comparisons, and created three 'Summary of findings' tables.

Main results: We included an additional 38 trials (involving 1225 randomised participants) in this update, making a total of 94 trials in the review (involving 2983 randomised participants). This update included a total of 42 rTMS studies, 11 CES, 36 tDCS, two RINCE and two tRNS. One study evaluated both rTMS and tDCS. We judged only four studies as low risk of bias across all key criteria. Using the GRADE criteria we judged the quality of evidence for each outcome, and for all comparisons as low or very low; in large part this was due to issues of blinding and of precision.rTMSMeta-analysis of rTMS studies versus sham for pain intensity at short-term follow-up (0 to < 1 week postintervention), (27 studies, involving 655 participants), demonstrated a small effect with heterogeneity (standardised mean difference (SMD) -0.22, 95% confidence interval (CI) -0.29 to -0.16, low-quality evidence). This equates to a 7% (95% CI 5% to 9%) reduction in pain, or a 0.40 (95% CI 0.53 to 0.32) point reduction on a 0 to 10 pain intensity scale, which does not meet the minimum clinically important difference threshold of 15% or greater. Pre-specified subgroup analyses did not find a difference between low-frequency stimulation (low-quality evidence) and rTMS applied to the prefrontal cortex compared to sham for reducing pain intensity at short-term follow-up (very low-quality evidence). High-frequency stimulation of the motor cortex in single-dose studies was associated with a small short-term reduction in pain intensity at short-term follow-up (low-quality evidence, pooled n = 249, SMD -0.38 95% CI -0.49 to -0.27). This equates to a 12% (95% CI 9% to 16%) reduction in pain, or a 0.77 (95% CI 0.55 to 0.99) point change on a 0 to 10 pain intensity scale, which does not achieve the minimum clinically important difference threshold of 15% or greater. The results from multiple-dose studies were heterogeneous and there was no evidence of an effect in this subgroup (very low-quality evidence). We did not find evidence that rTMS improved disability. Meta-analysis of studies of rTMS versus sham for quality of life (measured using the Fibromyalgia Impact Questionnaire (FIQ) at short-term follow-up demonstrated a positive effect (MD -10.80 95% CI -15.04 to -6.55, low-quality evidence).CESFor CES (five studies, 270 participants) we found no evidence of a difference between active stimulation and sham (SMD -0.24, 95% CI -0.48 to 0.01, low-quality evidence) for pain intensity. We found no evidence relating to the effectiveness of CES on disability. One study (36 participants) of CES versus sham for quality of life (measured using the FIQ) at short-term follow-up demonstrated a positive effect (MD -25.05 95% CI -37.82 to -12.28, very low-quality evidence).tDCSAnalysis of tDCS studies (27 studies, 747 participants) showed heterogeneity and a difference between active and sham stimulation (SMD -0.43 95% CI -0.63 to -0.22, very low-quality evidence) for pain intensity. This equates to a reduction of 0.82 (95% CI 0.42 to 1.2) points, or a percentage change of 17% (95% CI 9% to 25%) of the control group outcome. This point estimate meets our threshold for a minimum clinically important difference, though the lower confidence interval is substantially below that threshold. We found evidence of small study bias in the tDCS analyses. We did not find evidence that tDCS improved disability. Meta-analysis of studies of tDCS versus sham for quality of life (measured using different scales across studies) at short-term follow-up demonstrated a positive effect (SMD 0.66 95% CI 0.21 to 1.11, low-quality evidence).Adverse eventsAll forms of non-invasive brain stimulation and sham stimulation appear to be frequently associated with minor or transient side effects and there were two reported incidences of seizure, both related to the active rTMS intervention in the included studies. However many studies did not adequately report adverse events.

Authors' conclusions: There is very low-quality evidence that single doses of high-frequency rTMS of the motor cortex and tDCS may have short-term effects on chronic pain and quality of life but multiple sources of bias exist that may have influenced the observed effects. We did not find evidence that low-frequency rTMS, rTMS applied to the dorsolateral prefrontal cortex and CES are effective for reducing pain intensity in chronic pain. The broad conclusions of this review have not changed substantially for this update. There remains a need for substantially larger, rigorously designed studies, particularly of longer courses of stimulation. Future evidence may substantially impact upon the presented results.

Conflict of interest statement

NOC: none known

LM: none known

SS: none known

LHD: none known

BW: none known

Figures

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1
Study flow diagram
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
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4
Funnel plot of comparison 3. Transcranial direct current stimulation (tDCS), outcome 3.1. Pain: short‐term follow‐up
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5
Funnel plot of comparison 3. Transcranial direct current stimulation (tDCS), outcome 3.5. Pain: short‐term follow‐up, subgroup analysis: motor cortex studies only

References

References to studies included in this review Ahmed 2011 {published data only}

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Ahn 2017 {published data only}
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André‐Obadia 2006 {published and unpublished data}
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André‐Obadia 2008 {published and unpublished data}
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André‐Obadia 2011 {published and unpublished data}
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Antal 2010 {published and unpublished data}
    1. Antal A, Terney D, Kühnl S, Paulus W. Anodal transcranial direct current stimulation of the motor cortex ameliorates chronic pain and reduces short intracortical inhibition. Journal of Pain & Symptom Management 2010;39(5):890‐903.
Attal 2016 {published data only (unpublished sought but not used)}
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Avery 2013 {unpublished data only}
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Boggio 2009 {published data only}
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Borckardt 2009 {published data only}
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Boyer 2014 {published data only}
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Brietzke 2016 {published data only}
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Capel 2003 {published data only (unpublished sought but not used)}
    1. Capel ID, Dorrell HM, Spencer EP, Davis MW. The amelioration of the suffering associated with spinal cord injury with subperception transcranial electrical stimulation. Spinal Cord 2003;41(2):109‐17.
Carretero 2009 {published data only}
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Chang 2017 {published data only}
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Cork 2004 {published data only (unpublished sought but not used)}
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Curatolo 2017 {published data only}
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Dall'Agnol 2014 {published data only}
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Deering 2017 {unpublished data only}
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Defrin 2007 {published and unpublished data}
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de Oliveira 2014 {published data only}
    1. Oliveira RAA, Andrade DC, Mendonça M, Barros R, Luvisoto T, Myczkowski ML, et al. Repetitive transcranial magnetic stimulation of the left premotor/dorsolateral prefrontal cortex does not have analgesic effect on central poststroke pain. Journal of Pain 2014;15(12):1271‐81.
Donnell 2015 {published data only}
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Fagerlund 2015 {published data only}
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Fenton 2009 {published and unpublished data}
    1. Fenton BW, Palmieri PA, Boggio P, Fanning J, Fregni F. A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain. Brain Stimulation 2009;2(2):103‐7.
Fregni 2005 {published data only (unpublished sought but not used)}
    1. Fregni F, DaSilva D, Potvin K, Ramos Estebanez C, Cohen D, Pascual‐Leone A, et al. Treatment of chronic visceral pain with brain stimulation. Annals of Neurology 2005;58(6):971‐2.
Fregni 2006a {published and unpublished data}
    1. Fregni F, Boggio PS, Lima MC, Ferreira MJ, Wagner T, Rigonatti SP, et al. A sham‐controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain 2006;122(1‐2):197‐209.
Fregni 2006b {published and unpublished data}
    1. Fregni F, Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L, et al. A randomized, sham‐controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Arthritis and Rheumatism 2006;54(12):3988‐98.
    1. Roizenblatt S, Fregni F, Gimenez R, Wetzel T, Rigonatti SP, Tufik S, et al. Site‐specific effects of transcranial direct current stimulation on sleep and pain in fibromyalgia: a randomized, sham‐controlled study. Pain Practice 2007;7(4):297‐306.
Fregni 2011 {published data only (unpublished sought but not used)}
    1. Fregni F, Potvin K, Dasilva D, Wang X, Lenkinski RE, Freedman SD, et al. Clinical effects and brain metabolic correlates in non‐invasive cortical neuromodulation for visceral pain. European Journal of Pain 2011;15(1):53‐60.
Gabis 2003 {published and unpublished data}
    1. Gabis L, Shklar B, Geva D. Immediate influence of transcranial electrostimulation on pain and beta‐endorphin blood levels: an active placebo‐controlled study. American Journal of Physical Medicine & Rehabilitation 2003;82(2):81‐5.
Gabis 2009 {published and unpublished data}
    1. Gabis L, Shklar B, Baruch YK, Raz R, Gabis E, Geva D. Pain reduction using transcranial electrostimulation: a double blind "active placebo" controlled trial. Journal of Rehabilitation Medicine 2009;41(4):256‐61.
Hagenacker 2014 {published data only}
    1. Hagenacker T, Bude V, Naegel S, Holle D, Katsarava Z, Diener HC, et al. Patient‐conducted anodal transcranial direct current stimulation of the motor cortex alleviates pain in trigeminal neuralgia. Journal of Headache and Pain 2014;15(1):78.
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Hargrove 2012a {published and unpublished data}
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Harvey 2017 {published data only}
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Hazime 2017 {published data only}
    1. Hazime FA, Baptista AF, Freitas DG, Monteiro RL, Maretto RL, Hasue RH. Treating low back pain with combined cerebral and peripheral electrical stimulation: a randomized, double‐blind, factorial clinical trial. European Journal of Pain 2017; Vol. 21, issue 7:1132‐43.
Hirayama 2006 {published and unpublished data}
    1. Hirayama A, Saitoh Y, Kishima H, Shimokawa T, Oshino S, Hirata M, et al. Reduction of intractable deafferentation pain by navigation‐guided repetitive transcranial magnetic stimulation of the primary motor cortex. Pain 2006;122(1‐2):22‐7.
Hosomi 2013 {published and unpublished data}
    1. Hosomi K, Shimokawa T, Ikoma K, Nakamura Y, Sugiyama K, Ugawa Y, et al. Daily repetitive transcranial magnetic stimulation of primary motor cortex for neuropathic pain: a randomized, multicenter, double‐blind, crossover, sham‐controlled trial. Pain 2013;154(7):1065‐72.
Irlbacher 2006 {published data only}
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Jales Junior 2015 {published data only}
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Jensen 2013 {published data only}
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Jetté 2013 {published and unpublished data}
    1. Jetté F, Côté I, Meziane HB, Mercier C. Effect of single‐session repetitive transcranial magnetic stimulation applied over the hand versus leg motor area on pain after spinal cord injury. Neurorehabilitation & Neural Repair 2013;27(7):636‐43.
Kang 2009 {published data only}
    1. Kang BS, Shin HI, Bang MS. Effect of repetitive transcranial magnetic stimulation over the hand motor cortical area on central pain after spinal cord injury. Archives of Physical Medicine & Rehabilitation 2009;90(10):1766‐71.
Katsnelson 2004 {published data only (unpublished sought but not used)}
    1. Katsnelson Y, Khokhlov A, Tsvetkov V, Bartoo G, Bartoo M. Temporary pain relief using transcranial electrotherapy stimulation: results of a randomized, double‐blind pilot study. Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine & Biology Society 2004;6:4087‐90.
Khedr 2005 {published and unpublished data}
    1. Khedr EM, Kotb H, Kamel NF, Ahmed MA, Sadek R, Rothell JC. Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. Journal of Neurology Neurosurgery & Psychiatry 2005;76:833‐8.
Khedr 2017 {published data only}
    1. Khedr EM, Omran EAH, Ismail NM, El‐Hammady DH, Goma SH, Kotb H. Effects of transcranial direct current stimulation on pain, mood and serum endorphin level in the treatment of fibromyalgia: a double blinded, randomized clinical trial. Brain Stimulation 2017; Vol. 10, issue 5:893‐901.
Kim 2013 {published data only}
    1. Kim YJ, Ku J, Kim HJ, Im DJ, Lee HS, Han KA, et al. Randomized, sham controlled trial of transcranial direct current stimulation for painful diabetic polyneuropathy. Annals of Rehabilitation Medicine 2013;37(6):766‐76.
Lagueux 2017 {published data only}
    1. Lagueux E, Bernier M, Bourgault P, Whittingstall K, Mercier C, Leonard G. The effectiveness of transcranial direct current stimulation as an add‐on modality to graded motor imagery for treatment of complex regional pain syndrome: a randomized proof of concept atudy. Clinical Journal of Pain (in press).
Lee 2012 {published data only}
    1. Lee SJ, Kim DY, Chun MH, Kim YG. The effect of repetitive transcranial magnetic stimulation on fibromyalgia: a randomized sham‐controlled trial with 1‐mo follow‐up. American Journal of Physical Medicine & Rehabilitation 2012;91(12):1077‐85.
Lefaucheur 2001a {published and unpublished data}
    1. Lefaucheur JP, Drouot X, Nguyen JP. Interventional neurophysiology for pain control: duration of pain relief following repetitive transcranial magnetic stimulation of the motor cortex [Neurophysiologie interventionnelle dans le contrôle de la douleur: la durée du soulagement de la douleur après la stimulation magnétique transcranienne répétitive du cortex moteur]. Neurophysiologie Clinique 2001;31(4):247‐52.
Lefaucheur 2001b {published data only}
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Lefaucheur 2004 {published data only}
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Lefaucheur 2006 {published and unpublished data}
    1. Lefaucheur JP, Drouot X, Ménard‐Lefaucheur I, Keravel Y, Nguyen JP. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. Neurology 2006;67(9):1568‐74.
Lefaucheur 2008 {published data only}
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Lichtbroun 2001 {published data only (unpublished sought but not used)}
    1. Lichtbroun AS, Raicer M‐MC, Smith RB, Katz RS. The treatment of fibromyalgia with cranial electrotherapy stimulation. Journal of Clinical Rheumatology 2001;7(2):72‐8.
Luedtke 2015 {published data only}
    1. Luedtke K, Rushton A, Wright C, Jürgens T, Polzer A, Mueller G, et al. Effectiveness of transcranial direct current stimulation preceding cognitive behavioural management for chronic low back pain: sham controlled double blinded randomised controlled trial. BMJ (Clinical Research Ed.) 2015;350:h1640.
Malavera 2013 {published data only}
    1. Malavera M, Silva F, Garcia R, Quiros J, Dallos M, Pinzon A. Effects of transcranial magnetic stimulation in the treatment of phantom limb pain in landmine victims: a randomized clinical trial. Journal of the Neurological Sciences 2013;333:e534.
Medeiros 2016 {published data only}
    1. Medeiros LF, Caumo W, Dussán‐Sarria J, Deitos A, Brietzke A, Laste G, et al. Effect of deep intramuscular stimulation and transcranial magnetic stimulation on neurophysiological biomarkers in chronic myofascial pain syndrome. Pain Medicine 2016;17(1):122‐35.
Mendonca 2011 {published data only (unpublished sought but not used)}
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Mendonca 2016 {published data only}
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Mhalla 2011 {published and unpublished data}
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Mori 2010 {published and unpublished data}
    1. Mori F, Codecà C, Kusayanagi H, Monteleone F, Buttari F, Fiore S, et al. Effects of anodal transcranial direct current stimulation on chronic neuropathic pain in patients with multiple sclerosis. Journal of Pain 2010;11(5):436‐42.
Nardone 2017 {published data only}
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Ngernyam 2015 {published and unpublished data}
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Nurmikko 2016 {published data only}
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Oliveira 2015 {published and unpublished data}
    1. Oliveira LB, Lopes TS, Soares C, Maluf R, Goes BT, Sa KN, et al. Transcranial direct current stimulation and exercises for treatment of chronic temporomandibular disorders: a blind randomised‐controlled trial. Journal of Oral Rehabilitation 2015;42(10):723‐32.
Onesti 2013 {published data only (unpublished sought but not used)}
    1. Onesti E, Gabriele M, Cambieri C, Ceccanti M, Raccah R, Stefano G, et al. H‐coil repetitive transcranial magnetic stimulation for pain relief in patients with diabetic neuropathy. European Journal of Pain 2013;17(9):1347‐56.
    1. Onesti E, Tartaglia G, Gabriele M, Gilio F, Frasca V, Pichiorri F, et al. The effect of H‐coil repetitive transcranial magnetic stimulation on painful diabetic neuropathy: a randomized placebo‐controlled crossover study. Journal of the Peripheral Nervous System 2012;17:S41.
    1. Tartaglia G, Gabriele M, Frasca V, Pichiorri F, Giacomelli E, Cambieri C, et al. Pain relief by deep repetitive transcranial magnetic stimulation applied with the H‐coil. Clinical Neurophysiology 2011;122:S144.
Palm 2016 {published data only}
    1. Palm U, Chalah MA, Padberg F, Al‐Ani T, Abdellaoui M, Sorel M, et al. Effects of transcranial random noise stimulation (tRNS) on affect, pain and attention in multiple sclerosis. Restorative Neurology and Neuroscience 2016;34(2):189‐99.
Passard 2007 {published and unpublished data}
    1. Passard A, Attal N, Benadhira R, Brasseur L, Saba G, Sichere P, et al. Effects of unilateral repetitive transcranial magnetic stimulation of the motor cortex on chronic widespread pain in fibromyalgia. Brain 2007;130:2661‐70.
Picarelli 2010 {published data only (unpublished sought but not used)}
    1. Picarelli H. [Os efeitos da estimulação magnética transcraniana repetitiva (EMTr) aplicada sobre o córtex motor de pacientes com síndrome complexa de dor regional]. The effects of repetitive transcranial magnetic stimulation (rTMS) over the motor cortex on complex regional pain syndrome patients [PhD thesis]. Sao Paolo: Universidade de São Paulo, 2009.
    1. Picarelli H, Teixeira MJ, Andra DC, Myczkowski ML, Luvisotto TB, Yeng LT, et al. Repetitive transcranial magnetic stimulation is efficacious as an add‐on to pharmacological therapy in complex regional pain syndrome (CRPS) type I. Journal of Pain 2010;11(11):1203‐10.
Pleger 2004 {published and unpublished data}
    1. Pleger B, Janssen F, Schwenkreis P, Volker B, Maier C, Tegenthoff M. Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I. Neuroscience Letters 2004;356(2):87‐90.
Portilla 2013 {published data only (unpublished sought but not used)}
    1. Portilla AS, Bravo GL, Miraval FK, Villamar MF, Schneider JC, Ryan CM, et al. A feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury. Journal of Burn Care & Research 2013;34(1):e48‐52.
Riberto 2011 {published and unpublished data}
    1. Riberto M, Alfieri FM, Benedetto Pacheco, Leite VD, Kaihami HN, Fregni F, et al. Efficacy of transcranial direct current stimulation coupled with a multidisciplinary rehabilitation program for the treatment of fibromyalgia. Open Rheumatology Journal 2011;5(1):45‐50.
Rintala 2010 {published data only}
    1. Rintala DH, Tan G, Willson P, Bryant MS, Lai ECH. Feasibility of using cranial electrotherapy stimulation for pain in persons with Parkinson's disease. Parkinson's Disease 2010;2010:569154.
Rollnik 2002 {published and unpublished data}
    1. Rollnik JD, Wustefeld S, Dauper J, Karst M, Fink M, Kossev A, et al. Repetitive transcranial magnetic stimulation for the treatment of chronic pain ‐ a pilot study. European Neurology 2002;48(1):6‐10.
Saitoh 2007 {published and unpublished data}
    1. Saitoh Y, Hirayama A, Kishima H, Shimokawa T, Oshino S, Hirata M, et al. Reduction of intractable deafferentation pain due to spinal cord or peripheral lesion by high‐frequency repetitive transcranial magnetic stimulation of the primary motor cortex. Journal of Neurosurgery 2007;107(3):555‐9.
Sakrajai 2014 {published and unpublished data}
    1. Sakrajai P, Janyacharoen T, Jensen MP, Sawanyawisuth K, Auvichayapat N, Tunkamnerdthai O, et al. Pain reduction in myofascial pain syndrome by anodal transcranial direct current stimulation combined with standard treatment: a randomized controlled study. Clinical Journal of Pain 2014;30(12):1076‐83.
Short 2011 {published data only}
    1. Short EB, Borckardt J, Beam W, Anderson B, Nahas Z, George MS. Transcranial magnetic stimulation for fibromyalgia. Biological Psychiatry 2010;1:151S.
    1. Short EB, Borckardt JJ, Anderson BS, Frohman H, Beam W, Reeves S, et al. 10 sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: a randomized controlled trial. Biological Psychiatry 2011;1:136S.
Soler 2010 {published data only}
    1. Soler D, Kumru H, Vidal J, Fregni F, Tormos JM, Navarro X, et al. Transcranial direct current stimulation (TDCS) and virtual reality (VR) techniques for treatment neuropathic central pain in spinal cord injury (NP‐SCI). European Journal of Pain Supplements 2010;4(1):105‐6.
    1. Soler D, Kumru H, Vidal J, Fregni F, Tormos JM, Navarro X, et al. Transcranial direct current stimulation (TDCS) and virtual reality (VR) techniques for treatment neuropathic central pain in spinal cord injury (NP‐SCI). European Journal of Pain Supplements 2010;41(1):105‐6.
Souto 2014 {published data only}
    1. Souto G, Borges IC, Goes BT, Mendonça ME, Gonçalves RG, Garcia LB, et al. Effects of tDCS‐induced motor cortex modulation on pain in HTLV‐1: a blind randomized clinical trial. Clinical Journal of Pain 2014;30(9):809‐15.
Tan 2000 {published data only}
    1. Tan G, Monga T, Thornby J. Efficacy of microcurrent electrical stimulation on pain severity, psychological distress, and disability. American Journal of Pain Management 2000;10(1):35‐44.
Tan 2006 {published data only}
    1. Tan G, Rintala DH, Thornby JI, Yang J, Wade W, Vasilev C. Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury. Journal of Rehabilitation Research and Development 2006;43(4):461‐74.
Tan 2011 {published data only}
    1. Tan G, Rintala DH, Jensen MP, Richards JS, Holmes SA, Parachuri R, et al. Efficacy of cranial electrotherapy stimulation for neuropathic pain following spinal cord injury: a multi‐site randomized controlled trial with a secondary 6‐month open‐label phase. Journal of Spinal Cord Medicine 2011;34(3):285‐95.
Taylor 2013 {published and unpublished data}
    1. Taylor AG, Anderson JG, Riedel SL, Lewis E, Kinser PA, Bourguignon C. Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia. Pain Management Nursing 2013;14(4):327‐35.
    1. Taylor AG, Anderson JG, Riedel SL, Lewis JE, Bourguignon C. A randomized, controlled, double‐blind pilot study of the effects of cranial electrical stimulation on activity in brain pain processing regions in individuals with fibromyalgia. Explore: The Journal of Science and Healing 2013;9(1):32‐40.
Tekin 2014 {published data only}
    1. Tekin A, Ozdil E, Guleken MD, Iliser R, Bakim B, Oncu J, et al. Efficacy of high frequency [10 Hz] repetitive transcranial magnetic stimulation of the primary motor cortex in patients with fibromyalgia syndrome: a randomized, double blind, sham‐controlled trial. Journal of Musculoskeletal Pain 2014;22(1):20‐6.
Thibaut 2017 {published data only}
    1. Thibaut A, Carvalho S, Morse LR, Zafonte R, Fregni F. Delayed pain decrease following M1 tDCS in spinal cord injury: a randomized controlled clinical trial. Neuroscience Letters 2017; Vol. 658:19‐26.
Tzabazis 2013 {published data only (unpublished sought but not used)}
    1. Schneider MB, Yang S, Aparici CM, Brocklin H, Seo Y, Etkin A, et al. Steerable electrical currents using multi‐coil RTMS: clinical effects of modifying current direction. Biological Psychiatry 2012;1:282S.
    1. Tzabazis A, Aparici CM, Rowbotham MC, Schneider MB, Etkin A, Yeomans DC. Shaped magnetic field pulses by multi‐coil repetitive transcranial magnetic stimulation (rTMS) differentially modulate anterior cingulate cortex responses and pain in volunteers and fibromyalgia patients. Molecular Pain 2013;9:33.
Umezaki 2016 {published data only}
    1. Umezaki Y, Badran BW, Devries WH, Moss J, Gonzales T, George MS. The efficacy of daily prefrontal repetitive transcranial magnetic stimulation (rTMS) for burning mouth syndrome (BMS): a randomized controlled single‐blind study. Brain Stimulation 2016;9(2):234‐42.
Valle 2009 {published data only (unpublished sought but not used)}
    1. Valle A, Roizenblatt S, Botte S, Zaghi S, Riberto M, Tufik S, et al. Efficacy of anodal transcranial direct current stimulation (tDCS) for the treatment of fibromyalgia: results of a randomized, sham‐controlled longitudinal clinical trial. Journal of Pain Management 2009;2(3):353‐62.
Villamar 2013 {published data only}
    1. Villamar MF, Wivatvongvana P, Patumanond J, Bikson M, Truong DQ, Datta A, et al. Focal modulation of the primary motor cortex in fibromyalgia using 4x1‐ring high‐definition transcranial direct current stimulation (HD‐tDCS): immediate and delayed analgesic effects of cathodal and anodal stimulation. Journal of Pain 2013;14(4):371‐83.
Volz 2016 {published data only}
    1. Volz MS, Farmer A, Siegmund B. Reduction of chronic abdominal pain in patients with inflammatory bowel disease through transcranial direct current stimulation: a randomized controlled trial. Pain 2016;157(2):429‐37.
Wrigley 2014 {published data only}
    1. Wrigley PJ, Gustin SM, McIndoe LN, Chakiath RJ, Henderson LA, Siddall PJ. Long standing neuropathic pain following spinal cord injury is refractory to transcranial direct current stimulation: a randomized controlled trial. Pain 2014;154(10):2178‐84.
Yagci 2014 {published data only}
    1. Yagci I, Agirman M, Ozturk D, Eren B. Is the transcranial magnetic stimulation an adjunctive treatment in fibromyalgia patients?. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2014;60(3):206‐11.
    1. Yaĝci I, Atirman M, Ozturk D, Eren B. Effect of low‐frequency transcranial magnetic stimulation of the motor cortex area in fibromyalgia patients [Fibromiyalji hastalarinda motor kortekse dusuk frekansli transkraniyal magnetik stimulasyonun etkinlitinin arastirilmasi]. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2013;59(232):[CRSREF: 2710974].
Yilmaz 2014 {published data only}
    1. Yilmaz B, Kesikburun S, Yasar E, Tan AK. The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury. Journal of Spinal Cord Medicine 2014;37(4):397‐400.
References to studies excluded from this review Avery 2007 {published data only}
    1. Avery DH, Holtzheimer PE, Fawaz W, Russo J, Neumaier J, Dunner DL, et al. Transcranial magnetic stimulation reduces pain in patients with major depression: a sham‐controlled study. Journal of Nervous and Mental Disease 2007;195(5):378‐81.
Belci 2004 {published data only}
    1. Belci M, Catley M, Husain M, Frankel HL, Davey NJ. Magnetic brain stimulation can improve clinical outcome in incomplete spinal cord injured patients. Spinal Cord 2004;42(7):417‐9.
Bolognini 2013 {published data only}
    1. Bolognini N, Olgiati E, Maravita A, Ferraro F, Fregni F. Motor and parietal cortex stimulation for phantom limb pain and sensations. Pain 2013;154(8):1274‐80.
Bolognini 2015 {published data only}
    1. Bolognini N, Spandri V, Ferraro F, Salmaggi A, Molinari ACL, Fregni F, et al. Immediate and sustained effects of 5‐day transcranial direct current stimulation of the motor cortex in phantom limb pain. Journal of Pain 2015;16(7):657‐65.
Carraro 2010 {published data only}
    1. Carraro ER de O, Frazao ACDD, Soares KVB de C, Silva VF. Cerebral stimulation by photo and auditory synthesis associated to imagery and muscle therapy: reducing pain in women with fibromyalgia [Estimulação cerebral por sintetização fótica e auditiva associada àimagética e massoterapia: minimização de dor em mulheres portadoras de fibromialgia]. Motriz, Rio Claro 2010;16(2):359‐69.
Choi 2012a {published data only}
    1. Choi YH, Lee SU. The effect of transcranial direct current stimulation on myofascial trigger pain syndrome. Journal of Bodywork & Movement Therapies 2012;16(3):401.
Choi 2012b {published data only}
    1. Choi YH. Synergistic effects of transcranial direct current stimulation and trigger point injection for treatment of myofascial pain syndrome. Journal of Rehabilitation Medicine 2012;Suppl 52:0521FP34.
Choi 2014 {published data only}
    1. Choi Yoon‐Hee, Jung Sung‐Jin, Lee Chang Han, Lee Shi‐Uk. Additional effects of transcranial direct‐current stimulation and trigger‐point injection for treatment of myofascial pain syndrome: a pilot study with randomized, single‐blinded trial. Journal of Alternative & Complementary Medicine 2014;20(9):698‐704.
    1. Lee SU, Lee CH, Choi YH. Synergistic effects of transcranial direct current stimulation and trigger point injection for treatment of myofascial pain syndrome: a pilot study with randomized, single‐blinded trial. Arthritis and Rheumatism. 2013; Vol. 65:S464.
Cummiford 2016 {published data only}
    1. Cummiford CM, Nascimento TD, Foerster BR, Clauw DJ, Zubieta JK, Harris RE, et al. Changes in resting state functional connectivity after repetitive transcranial direct current stimulation applied to motor cortex in fibromyalgia patients. Arthritis Research and Therapy 2016;18(1):40.
Evtiukhin 1998 {published data only}
    1. Evtiukhin AI, Dunaevskii IV, Shabut AM, Aleksandrov VA. The use of transcranial electrostimulation for pain relief in cancer patients. Voprosy Onkologii 1998;44:229‐33.
Frentzel 1989 {published data only}
    1. Frentzel N, Kleditzsch J, Konrad B. A comparative assessment of pain alleviating therapy using middle frequency currents. Voprosy Kurortologii, Fizioterapii 1989;26(1):23‐7.
Hargrove 2012b {published data only}
    1. Hargrove JB, Bennett RM, Clauw DJ. Long‐term outcomes in fibromyalgia patients treated with noninvasive cortical electrostimulation. Archives of Physical Medicine & Rehabilitation 2012;93(10):1868‐71.
Johnson 2006 {published data only}
    1. Johnson S, Summers J, Pridmore S. Changes to somatosensory detection and pain thresholds following high frequency repetitive TMS of the motor cortex in individuals suffering from chronic pain. Pain 2006;123(1‐2):187‐92.
Katz 1991 {published data only}
    1. Katz J, Melzack R. Auricular transcutaneous electrical nerve stimulation (TENS) reduces phantom limb pain. Journal of Pain & Symptom Management 1991;6(2):73‐84.
Khedr 2015 {published data only}
    1. Khedr EM, Kotb HI, Mostafa MG, Mohamad MF, Amr SA, Ahmed MA, et al. Repetitive transcranial magnetic stimulation in neuropathic pain secondary to malignancy: a randomized clinical trial. European Journal of Pain 2015;19(4):519‐27.
Lindholm 2015 {published data only}
    1. Jaeaeskelaeinen S, Lindholm P, Lamusuo S, Lahti A, Pesonen U, Taiminen T, et al. S2 cortex‐a promising novel target for the treatment of neuropathic pain with rTMS. Clinical Neurophysiology 2014;125:S229.
    1. Lindholm P, Lamusuo S, Lahti A, Pesonen U, Taiminen T, Virtanen A, et al. Right S2 cortex: an effective target for the treatment of neuropathic pain with transcranial magnetic stimulation. Journal of Neurology 2013;260:S200‐1.
    1. Lindholm P, Lamusuo S, Taiminen T, Pesonen U, Lahti A, Virtanen A, et al. Right secondary somatosensory cortex‐a promising novel target for the treatment of drug‐resistant neuropathic orofacial pain with repetitive transcranial magnetic stimulation. Pain 2015;156(7):1276‐83.
Longobardi 1989 {published data only}
    1. Longobardi AG, Clelland JA, Knowles CJ, Jackson JR. Effects of auricular transcutaneous electrical nerve stimulation on distal extremity pain: a pilot study. Physical Therapy 1989;69(1):10‐8.
Ma 2015 {published data only}
    1. Ma SM, Ni JX, Li XY, Yang LQ, Guo YN, Tang YZ. High‐frequency repetitive transcranial magnetic stimulation reduces pain in postherpetic neuralgia. Pain Medicine 2015;16(11):2162‐70.
Maestu 2013 {published data only}
    1. Maestu C, Blanco M, Nevado A, Romero J, Rodriguez‐Rubio P, Galindo J, et al. Reduction of pain thresholds in fibromyalgia after very low‐intensity magnetic stimulation: a double‐blinded, randomized placebo‐controlled clinical trial. Pain Research & Management 2013;18(6):e101‐6.
Morin 2017 {published data only}
    1. Morin A, Léonard G, Gougeon V, Cyr MP, Waddell G, Bureau YA et al. Efficacy of transcranial direct‐current stimulation in women with provoked vestibulodynia. Americal Journal of Obstetrics and Gynecology 2017; Vol. 216, issue 6:e1‐584.e11.
Nelson 2010 {published data only}
    1. Nelson DV, Bennett RM, Barkhuizen A, Sexton GJ, Jones KD, Esty ML, et al. Neurotherapy of fibromyalgia?. Pain Medicine 2010;11(6):912‐9.
O'Connell 2013 {published data only}
    1. O'Connell NE, Cossar J, Marston L, Wand BM, Bunce D, Souza LH, et al. Transcranial direct current stimulation of the motor cortex in the treatment of chronic nonspecific low back pain: a randomized, double‐blind exploratory study. Clinical Journal of Pain 2013;29(1):26‐34.
Pujol 1998 {published data only}
    1. Pujol J, Pascual‐Leone A, Dolz C, Delgado E, Dolz JL, Aldomà J. The effect of repetitive magnetic stimulation on localized musculoskeletal pain. Neuroreport 1998;9(8):1745‐8.
Schabrun 2014 {published data only}
    1. Schabrun SM, Jones E, Elgueta Cancino EL, Hodges PW. Targeting chronic recurrent low back pain from the top‐down and the bottom‐up: a combined transcranial direct current stimulation and peripheral electrical stimulation intervention. Brain Stimulation 2014;7(3):451‐9.
Seada 2013 {published data only}
    1. Seada Yi Nofel R, Sayed HM. Comparison between trans‐cranial electromagnetic stimulation and low‐level laser on modulation of trigeminal neuralgia. Journal of Physical Therapy Science 2013;25(8):911‐4.
Sichinava 2012 {published data only}
    1. Sichinava NV, Gorbunov FE, Stel'nikov AV, Lukianova TV. The correction of cognitive and psychological disorders in the patients presenting with vertebrogenic pain syndrome. Vaprosy Kurtortologii, Fizioterapii, i Lechebnoi, Fizicheskoi Kultury 2012;4:307.
Silva 2007 {published data only}
    1. Silva G, Miksad R, Freedman SD, Pascual‐Leone A, Jain S, Gomes DL, et al. Treatment of cancer pain with noninvasive brain stimulation. Journal of Pain and Symptom Management 2007;34(4):342‐5.
Smania 2005 {published data only}
    1. Smania N, Corato E, Fiaschi A, Pietropoli P, Aglioti SM, Tinazzi M. Repetetive magnetic stimulation: a novel therapeutic approach for myofascial pain syndrome. Journal of Neurology 2005;252:307‐14.
Yoon 2014 {published data only}
    1. Yoon EJ, Kim YK, Kim H‐R, Kim SE, Lee Y, Shin HI. Transcranial direct current stimulation to lessen neuropathic pain after spinal cord injury: a mechanistic PET study. Neurorehabilitation & Neural Repair 2014;28(3):250‐9.
Zaghi 2009 {published data only}
    1. Zaghi S, DaSilva AF, Acar M, Lopes M, Fregni F. One‐year rTMS treatment for refractory trigeminal neuralgia. Journal of Pain & Symptom Management 2009;38(4):e1‐5.
References to studies awaiting assessment Acler 2012 {published data only}
    1. Acler M, Valenti D, Tocco P, Monaco S, Bertolasi L. Effects of non‐invasive cortical stimulation on fatigue and quality of life in post‐polio patients: a double blind real sham study. European Journal of Neurology 2012;19(Suppl 1):580.
Albu 2011 {published data only}
    1. Albu S. Effectiveness of transcranial direct current stimulation in the treatment of chronic neuropathic pain in spinal cord injured patients. European Journal of Neurology 2011;18(Suppl 2):199.
Fricova 2009 {published data only}
    1. Fricova J, Klirova M, So P, Tilerova B, Masopust V, Hackel M, et al. Repetitive transcranial stimulation in chronic neurogenic pain. Pain Practice 2009;9(Suppl 1):38.
Fricova 2011 {published data only}
    1. Fricova J. Repetitive transcranial stimulation in chronic orofacial neurogenic pain treatment. Fundamental and Clinical Pharmacology 2011;25(Suppl 1):31.
Fricová 2013 {published data only}
    1. Fricová J, Klírová M, Masopust V, Novák T, Vérebová K, Rokyta R. Repetitive transcranial magnetic stimulation in the treatment of chronic orofacial pain. Physiological Research 2013;62 Suppl 1:S125‐34.
Hwang 2015 {published data only}
    1. Hwang B, Lee S, Paik N. Repetitive transcranial magnetic stimulation in complex regional pain syndrome of stroke patients. Neuromodulation 2015;18(2):e18.
Klirova 2010 {published data only}
    1. Klirova M, Fricova J, Sos P, Novak T, Tislerova B, Haeckel M, et al. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of neuropathic pain. European Neuropsychopharmacology 2010;20(Suppl 3):S227‐8.
Klirova 2011 {published data only}
    1. Klirova M, Fricova J, Sos P, Novak T, Kohutova B, Masopust V, et al. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of medication‐resistant neuropathic pain. European Psychiatry. 2011;26(Suppl 1):549.
Knotkova 2011 {published data only}
    1. Knotkova H, Nafissi A, Sibirceva U, Feldman D, Dvorkin E, Sundaram A, et al. A randomized, sham‐controlled, two‐parallel‐arm study of transcranial direct current stimulation (tDCS for the treatment of neuropathic pain in complex regional pain syndrome‐type I (CRPS/RSD). Pain Medicine 2011;12(3):516.
Mattoo 2017 {published data only}
    1. Mattoo B, Tanwar S, Jain S, Kumar U, Bhatia R. Transcranial magnetic stimulation of dorsolateral prefrontal cortex in chronic pain management. Brain Stimulation. Conference: 2nd International Brain Stimulation Conference. Spain 2017;10(2):434‐5.
Moreno‐Duarte 2013a {published data only}
    1. Moreno‐Duarte I, Doruk D, Bravo G, Miraval F, Moura L, Simis M, et al. Investigation of the mechanisms of transcranial direct current stimulation of motor cortex coupled with visual illusion for the treatment of chronic pain in spinal cord injury. Topics in Spinal Cord Injury Rehabilitation 2013;19(1):9‐10.
Mylius 2013 {published data only}
    1. Mylius V, Ayache SS, Farhat WH, Zouari HG, Passeri E, Aoun‐Sebaiti M, et al. Robotized‐navigated low‐frequency repetitive transcranial magnetic stimulation over the right motor and prefrontal cortex improved pain and fatigue in patients with macrophagic myofasciitis. Clinical Neurophysiology 2013;124(10):e116.
Parhizgar 2011 {published data only}
    1. Parhizgar SE, Ekhtiari H. Modulation of primary motor cortex with transcranial direct current stimulation (tDCS) for reduction of opioid induced hyperalgesia: a double‐blinded, sham‐controlled study. European Journal of Medical Research 2011;16:59.
Pellaprat 2012 {published data only}
    1. Pellaprat J, Gerdelat Mas A, Simonetta Moreau M, Dellapina E, Thalamas C, Ory‐Magne F, et al. Effect of high‐frequency repetitive transcranial magnetic stimulation (rTMS) applied on the primary motor cortex, on pain threshold in patients with Parkinson's disease: a physiopathological study. Movement Disorders 2012;27(Suppl1):S210.
Shklar 1997 {published data only}
    1. Shklar B, Gabis L, Stain A. Transcranial electrostimulation as a treatment of head and back pain: immediate analgesic effect. Presented at the meeting of the International Pain Congress, Barcelona, Spain 1997.
Tanwar 2016 {published data only}
    1. Tanwar S, Mattoo B, Jain S, Kumar U, Dada R, Bhatia R. Transcranial magnetic stimulation in reducing chronic pain and the related symptoms in patients with fibromyalgia. Indian Journal of Physiology and Pharmacology. Conference: 62nd Annual Conference of Physiologists and Pharmacologists of India, APPI 2016. India 2016;60(5 Supplement 1):67‐8.
Vatashsky 1997 {published data only}
    1. Vatashsky E. Transcranial electrical stimulation (TCES) of the brain for neck pain (whiplash injury). Israel Journal of Medical Science 1997;33:5.
Williams 2014 {published data only}
    1. Williams EN, Borckardt JJ, Reeves ST, George MS, Short EB. The effects of daily RTMs on c‐reactive protein in patients with fibromyalgia. Biological Psychiatry 2014;75(9 SUPPL. 1):387S.
References to ongoing studies ACTRN12612001155886 {published data only (unpublished sought but not used)}
    1. ACTRN12612001155886. Investigating the role of transcranial direct current stimulation for pain relief in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome patients. (first received 14 May 2012).
ACTRN12613000561785 {published data only}
    1. ACTRN12613000561785. Repetitive transcranial magnetic stimulation in the treatment of fibromyalgia [The effectiveness of repetitive transcranial magnetic stimulation in the treatment of fibromyalgia]. (first received 13 May 2013).
ACTRN12613001232729 {published data only}
    1. ACTRN12613001232729. Modulation of chronic pain perception with noninvasivecentral and peripheral nervous system stimulation [The effect of transcranial direct current stimulation and transcutaneous electrical nerve stimulation on improving pain intensity, physical functioning, mental health and quality of life in a chronic pain population awaiting pain clinic intervention]. (first received 7 November 2013).
ACTRN12614001247662 {published data only (unpublished sought but not used)}
    1. ACTRN12614001247662. The effects of non‐invasive brain stimulation on chronic arm pain [The effects of non‐invasive brain stimulation on pain and the nociceptive system in people with chronic neuropathic pain]. (first received 12 November 2014).
ACTRN12615000110583 {published data only}
    1. ACTRN12615000110583. The impact of non‐invasive brain stimulation on motor cortex excitability and cognition in chronic lower back pain [In individuals with chronic lower back pain, does anodal transcranial direct current stimulation, compared to sham transcranial direct current stimulation, impact on motor cortex excitability and cognition?]. (first received 27 January 2015).
ACTRN12616000624482 {published data only (unpublished sought but not used)}
    1. ACTRN12616000624482. Combined application of brain stimulation and sensorimotor retraining for low back pain [Safety and feasibility of transcranial direct current stimulation (tDCS) combined with sensorimotor retraining in chronic low back pain: a pilot randomised controlled trial]. (first received 9 May 2016).
Ansari 2013 {published data only}
    1. Ansari A, Mathur R, Jain S, Bhattacharjee M. Study of effect of slow frequency repeated transcranial magnetic field on modulation of pain in fibromyalgia patients. Journal of Pain 2013;1:S67.
    1. Ansari AH, Mathur R, Jain S, Mukherjee K. Repeated transcranial magnetic stimulation relieves pain in fibromyalgia patients: an electrophysiological approach to evaluate pain. Acta Physiologica (Oxford, England) 2014;210:179.
ChiCTR‐INR‐17011706 {published data only (unpublished sought but not used)}
    1. ChiCTR‐INR‐17011706. Transcranial magnetic stimulation induced motor evoked potential in the expression of brain‐derived neurotrophic factor BDNF, pathological pain and quality of life in patients with spinal cord injury [Transcranial magnetic stimulation induced motor evoked potential in the expression of brain‐derived neurotrophic factor BDNF, pathological pain and quality of life in patients with spinal cord injury]. (date of registration 20 June 2017).
CTRI/2013/12/004228 {published data only (unpublished sought but not used)}
    1. CTRI/2013/12/004228. Pain relieving strategies in fibromyalgia patients [Effect of Transcranial Magnetic Stimulation on Pain Modulation Status in Fibromyalgia Patients]. (first received 19 December 2013).
Muniswamy 2016 {published data only}
    1. Muniswamy VK, Powell E, Sloan P, Sawaki L. Modulating neuropathic pain with transcranial direct current stimulation: preliminary findings from an ongoing study (10265). Neuromodulation 2016;19 (3):e4.
NCT00815932 {published data only (unpublished sought but not used)}
    1. NCT00815932. The Effect of Transcranial Direct Current Stimulation (t‐DCS) On the P300 Component of Event‐Related Potentials in Patients With Chronic Neuropathic Pain Due To CRPS or Diabetic Neuropathy. (first received 31 December 2008).
NCT00947622 {published data only (unpublished sought but not used)}
    1. NCT00947622. Occipital Transcranial Direct Current Stimulation in Fibromyalgia. (first received 28 July 2009).
NCT01112774 {published data only (unpublished sought but not used)}
    1. NCT01112774. Application of Transcranial Direct Current Stimulation (tDCS) in Patients With Chronic Pain After Spinal Cord Injury [Investigation of the Mechanisms of Transcranial Direct Current Stimulation of Motor Cortex for the Treatment of Chronic Pain in Spinal Cord Injury]. (first received 20 April 2010).
NCT01220323 {published data only (unpublished sought but not used)}
    1. NCT01220323. Transcranial Direct Current Stimulation for Chronic Pain Relief. (first received 6 October 2010).
NCT01402960 {published data only (unpublished sought but not used)}
    1. NCT01402960. Exploration of Parameters of tDCS in Chronic Pain Patients [Exploration of Parameters of Transcranial Direct Current Stimulation (tDCS) in Chronic Pain]. (first received 29 June 2011).
NCT01404052 {published data only (unpublished sought but not used)}
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NCT01904097 {published data only (unpublished sought but not used)}
    1. NCT01904097. Functional Neuroimaging in Fibromyalgia Patients Receiving tDCS [Study of the Brain With Optic Functional Neuroimaging in Patients With Chronic Pain Using Transcranial Direct Current Stimulation]. (first received 8 July 2013).
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    1. NCT01932905. Deep rTMS in Central Neuropathic Pain Syndromes. (first received 27 August 2017).
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    1. NCT02051959. Long‐term Effects of Transcranial Direct Current Stimulation (tDCS) on Patients With Phantom Limb Pain (PLP) [Long‐Term Treatment of Patients Experiencing Phantom Limb Pain With Transcranial Direct Current Stimulation (tDCS)]. (first received 28 January 2014).
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    1. NCT02161302. The effect of tDCS in the treatment of chronic pelvic pain associated with endometriosis. (first received 10 June 2014).
NCT02277912 {published data only (unpublished sought but not used)}
    1. NCT02277912. Efficacy of Transcranial Magnetic Stimulation (TMS) in Central Post Stroke Pain ( CPSP) [Efficacy of Navigated Repetitive Transcranial Magnetic Stimulation in Treatment of Central Post Stroke Pain]. (first received 22 October 2014).
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    1. NCT02330315. Effects of tDCS and tUS on Pain Perception in OA of the Knee [Effects of Transcranial Direct Current Stimulation (tDCS) and Transcranial Ultrasound (TUS) on the Perception of Pain and Functional Limitations Due to Osteoarthritis of the Knee]. (first received 12 December 2014).
NCT02386969 {published data only}
    1. NCT02386969. Repetitive Transcranial Magnetic Stimulation in Central Neuropathic Pain [Long‐term Efficacy of Repetitive Transcranial Magnetic Stimulation on the Primary Motor Cortex (M1) in Central Neuropathic Pain]. (first received 5 March 2015).
NCT02393391 {published data only (unpublished sought but not used)}
    1. NCT02393391. A Novel Non Invasive Brain Stimulation Based Treatment for Chronic Low Back Pain (CLBP). (first received 8 March 2015).
NCT02483468 {published data only}
    1. NCT02483468. The Effects of Cognitive Behavioral Therapy and Transcranial Current Stimulation (tDCS) on Chronic Lower Back Pain. (first received 12 June 2015).
NCT02487966 {published data only (unpublished sought but not used)}
    1. NCT02487966. Optimizing Rehabilitation for Phantom Limb Pain Using Mirror Therapy and Transcranial Direct Current Stimulation (tDCS). (first received 22 June 2015).
NCT02615418 {published data only (unpublished sought but not used)}
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    1. NCT02665988. Adjunctive Transcranial Direct Current Stimulation [A Single‐Blind, Randomized Control Trial of Adjunctive Transcranial Direct Current Stimulation (tDCS) for Chronic Pain Among Patients Receiving Specialized, Inpatient Multi‐Modal Pain Management]. (first received 22 January 2016).
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    1. NCT02687360. Imaging the Effects of rTMS on Chronic Pain. (first received 23 December 2015).
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NCT02771990 {published data only}
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    1. NCT03015558. Analgesic Effect of Non Invasive Stimulation : Transcranial Direct Current Stimulation of Opercular‐insular Cortex [Transcranial Direct Current Stimulation (tDCS) for Neuropathic Chronic Pain : Study of the Opercular‐insular Cortex Stimulation]. (first received 22 December 2016).
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References to other published versions of this review O'Connell 2010
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