Keywords
Transcranial direct current stimulation
Pain
How to Cite
Abstract
Chronic neuropathic pain, characterized by impaired endogenous pain modulation mechanisms, represents a major therapeutic challenge. Among the investigated strategies, non-invasive brain stimulation (NIBS) techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have emerged as promising alternatives in clinical management.
Objective: to analyze the available evidence on the efficacy and safety of different transcranial stimulation modalities for neuropathic pain treatment, with emphasis on rTMS and tDCS.
Methodology: a systematic review was conducted in the PubMed database contemplating studies between 2014 - 2024. Eligible articles included randomized controlled trials and comparative clinical studies applying transcranial stimulation interventions in patients diagnosed with neuropathic pain. After a two-step screening process, 24 studies were selected and analyzed. Extracted data included type of stimulation, parameters, cortical targets, sample profile, pain etiology, and clinical outcomes such as pain intensity, quality of life, and adverse events.
Results: high-frequency rTMS applied over the primary motor cortex (M1) consistently demonstrated significant analgesic effects, as well as improvements in secondary outcomes such as quality of life and emotional symptoms. Stimulation over the dorsolateral prefrontal cortex (DLPFC) showed additional impact on cognitive and affective aspects of pain. tDCS presented more modest effects, though with therapeutic potential in specific subgroups and greater feasibility for home-based use. Other modalities, such as iTBS and HD-tDCS, also showed beneficial outcomes, while tRNS displayed limited results. Reported adverse events were mild and transient, not compromising adherence.
Conclusion: transcranial stimulation, particularly high-frequency rTMS applied over M1, represents an effective, safe, and promising approach for chronic neuropathic pain management. Despite methodological heterogeneity among studies, the findings support its integration with pharmacological and behavioral strategies, highlighting the need for standardized protocols and long-term investigations to consolidate its clinical applicability.
Keywords: Transcranial magnetic stimulation; Transcranial direct current stimulation; Pain.
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Copyright (c) 2025 Anny Caroliny Marion Piovesan, Heloisa Zanetta Borba, Isabela Dala Pedra Cadan, Geovana da silva Barrozo Nogueira, Taisa Colombo Vilhena, Laura Ramalho de Rosse, Sofia Carraro Mathias, Eloisa da silva Barrozo Nogueira, Nathalye Fernanda Pedroso Dircksen
