Evidence-Based Complementary and Alternative Medicine

Review Article

Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews

Table 2

PICOs included in systematic reviews.
PICOs numberPICOs in bubble chartStimulation siteFrequency (Hz)Session scheduleComparisonPopulationOutcomesSystematic reviews includedIndividual studies included in the systematic review Conclusion
Controlled trial (parallel)Controlled trial (cross)Number of studiesNumber of SRs involving the Quality (high/moderate/low/critically low) of Individual studies:
1DLPFC, 20 Hz, long sessions vs. sham rTMSLeft DLPFC20 Hz12 sessionsShamMigraineHeadache indexYang [29], Stilling [35], Feng [37], Lan [38], Shirahige [41]Brighina 2004 10/0/0/1Mixed
2DLPFC, 10 Hz, long sessions vs. sham rTMSLeft DLPFC10 Hz23 sessionsShamMigraineMIDASStilling [35]Conforto 2014 10/0/0/1Potentially worse: immediately
  Left DLPFC10 Hz23 sessionsShamMigraineMIDASYang [29], Stilling [35], Hamid [36], Feng [37], Lan [38], Shirahige [41]Conforto 2014 10/0/0/1No difference: follow-up at 8 weeks
  Left DLPFC10 Hz15 sessionsShamChronic widespread painNRSHamid et al. [36], O'Connell [23]Avery 2015  11/0/0/1Mixed
  Left DLPFC10 Hz12 sessionsStandard pharmacotherapyMigraineVASYang [29], Stilling [35], Feng [37]Rapinesi 2016 10/0/0/1Potentially better
3DLPFC, 10 Hz, medium sessions vs. sham rTMSLeft DLPFC10 Hz10 sessionsShamBMSVASYang [29], O'Connell [23] , Herrero Babiloni [27] &Umezaki 2016 & 11/0/1/1Mixed
4DLPFC, 10 Hz, short sessions vs. sham rTMSLeft DLPFC10 Hz4 sessionsShamMild traumatic brain injury related headacheNRSYang [29], Stilling [35]Leung 2018 10/0/0/1Potentially better: at 1 and 4 weeks
  Left DLPFC10 Hz2 rTMS sessions, 1 rTMS + 1 shamShamPostsurgical painVAS, morphine useYang [29]Borckardt 2014 10/0/0/1No difference
5DLPFC, 5 Hz, medium sessions vs. sham rTMSLeft DLPFC5 Hz10 sessions MigraineMIDASYang [29], Moisset [31] Sahu 201910/0/0/1Potentially better
6DLPFC, 5 Hz, short sessions vs. sham rTMSLeft DLPFC5 Hz5 sessionsShamEpisodic migraineAttack frequencyMoisset [31]Amin 2020 10/0/0/1Potentially better
7S2,1 Hz, medium sessions vs. sham rTMSS21 Hz10 sessionsShamChronic visceral pain (visceral pain due to chronic pancreatitis)VASYang [29], Hamid [36], O'Connell [23], Galhardoni [45]Fregni 2011  11/0/0/1Mixed
8S2,1 Hz or 20 Hz, short sessions vs. sham rTMSS21 Hz or 20 Hz1 sessionShamChronic pancreatitis painVASO'Connell [23] Fregni 200511/0/0/0Unclear
9Vertex,10 Hz, medium sessions vs. sham rTMSVertex10 Hz10 sessionsShamSCI Galhardoni et al. [45]Yılmaz 2014 10/0/0/1No difference
10Vertex,1 Hz, short sessions vs. sham rTMSVertex1 Hz5 sessionsShamMigraineNRSYang [29], Stilling [35], Moisset [31], Feng [37], Shirahige [41]Teepker 2010 10/0/0/1No difference
11PFC, 10 Hz, short sessions vs. sham rTMSLeft PFC10 Hz3 sessionsShamIntractable neuropathic pain of various originsNRSYang [29], Hamid [36], O'Connell [23], Herrero Babiloni&, Kumru [39] Borckardt 2009,&21/0/1/2Mixed
  Left PFC10 Hz1 sessionShamPostsurgical painVASYang [29], Goudra [40], Galhardoni [45]Borckardt 2006   Mixed
  Left PFC10 Hz1 sessionShamPostsurgical painVASYang [29]Borckardt 2008 10/0/0/1Potentially better
12S2 vs. S1/M1 vs. sham rTMS, 10 Hz, short sessionsRight S210 Hz3 sessionsS1/M1 and shamNon-specified orofacial pain, trigeminal neuropathic painNRSYang [29] Herrero Babiloni [27]&, Kumru [39] Lindholm 2015&10/0/1/1Potentially better (S2)
13PMC/DLPFC vs. sham rTMS, 10 Hz, medium sessionsLeft PMC/DLPFC10 Hz10 sessionsShamSCIPain intensity: VASYu [28], Yang [29], O'Connell [23]Nardone 2017  21/0/0/2Potentially better (immediate effect)
  Left PMC/DLPFC10 Hz10 sessionsShamCPSPVASXu [30]de Oliveira 2014   Potentially better (immediate effect)
  Left PMC/DLPFC10 Hz10 sessionsShamSCIPain intensity: VASYu [28]Nardone 2017 21/0/1/2No difference (follow-up)
  Left PMC/DLPFC10 Hz10 sessionsShamCPSPVASYang [29], Xu [30], Moisset and Bouhassira [30], Liampas [33], Ramger [26]&, O'Connell [23], Kumru [39], Cragg [42], Chen [43]de Oliveira 2014, &   No difference (from D1 to W4)
14Left frontal cortex vs. sham rTMS, 10 Hz, short sessionsLeft frontal cortex10 Hz3 sessionsShamMigraineVASYang [29], Lan [38]Misra 2013 10/0/0/1Potentially better
15Over the superior trapezius muscle vs. sham rTMS, 3 Hz/15 Hz, 10 sessionsOver the superior trapezius muscle3 Hz/15 Hz10 sessionsShamBrachial plexopathyVASAamir [34], Kumru [39]Khedr 2012 10/0/0/1Potentially better(1 month)
16ACC vs. PSI vs. sham rTMS, 10 Hz, 16 sessionsACC vs. PSI10 Hz16 sessionsShamCPSP or SCINRSYang [29], Moisset and Bouhassira [32]Galhardoni 2019 10/0/0/1No difference
17S1, SMA, preM vs. M1 vs. sham rTMS, 5 Hz, short sessionsS1, SMA, preM5 Hz4 sessionsM1 and shamNPVASYang [29], Gatzinsky [22], O'Connell [23], Kumru [39], Chen [43], Jin [44], Galhardoni [45], Leung [46] Hirayama 200611/0/0/1Mixed
  S1, SMA, preM5 Hz2 sessionsM1 and shamCPSP, SCI, TGNI, PNI, RAVAS, SF-MPQKumru [39]Saitoh 2006 10/0/0/1Potentially better (M1, maintained 3 hours)
PICO: population, intervention, control group, outcome; rTMS: repetitive transcranial magnetic stimulation; DLPFC: dorsolateral prefrontal cortex; S2: secondary somatosensory cortex; PFC: prefrontal cortex; PMC: premotor cortex; ACC: anterior cingulate cortex; PSI: posterior superior insula; S1: postcentral gyrus; SMA: supplementary motor area; preM: premotor area. BMS: burning mouth syndrome; SCI: spinal cord injury; CPSP: central poststroke pain; NP: neuropathic pain; TGNI: trigeminal neuropathic pain; PNI: peripheral nerve injury; RA: root avulsion. MIDAS: migraine disability assessment; NRS: numerical rating scale; VAS: visual analog scale; and SF-MPQ: short form of the McGill pain questionnaire. Note: (i) short: 1–5 sessions, medium: 5–10 sessions, and long: >10 sessions. (ii) In the included SRs: high-quality SRs are marked as ; &low-quality SRs; and the rest are critically low-quality SRs; (iii) in the primary studies included in SRs: included by high- and critically low-quality SRs, and included by low- and critically low-quality SRs; (iv) in the number of SRs involving the quality (high/moderate/low/critically low) of primary studies): taking the 13th PICO (PMC/DLPFC vs. sham rTMS, 10 Hz, medium sessions), as an example, a total of 2 primary studies were involved. The meaning of 1/0/0/2 and 1/0/1/2 is shown below in Figure 4.