title: Repetitive transcranial magnetic stimulation in chronic pain: a review of the literature.
abstract: OBJECTIVE
  To review the literature on the analgesic effects of repetitive transcranial magnetic stimulation (rTMS) in chronic pain according to different pain syndromes and stimulation parameters.
  
  
  METHODS
  Publications 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.
  
  
  METHODS
  This 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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  rTMS 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.
authors.affiliation: Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Galhardoni
authors.affiliation: Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
authors.forename: Guilherme S
authors.initials: GS
authors.lastname: Correia
authors.affiliation: Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
authors.forename: Haniel
authors.initials: H
authors.lastname: Araujo
authors.affiliation: Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
authors.forename: Lin T
authors.initials: LT
authors.lastname: Yeng
authors.affiliation: Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
authors.forename: Diego T
authors.initials: DT
authors.lastname: Fernandes
authors.affiliation: Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
authors.forename: Helena H
authors.initials: HH
authors.lastname: Kaziyama
authors.affiliation: Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Marcolin
authors.affiliation: INSERM U-987, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Bouhassira
authors.affiliation: Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Pain Center, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Pain Center, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil. Electronic address: ciampi@usp.br.
authors.forename: Daniel Ciampi
authors.initials: DC
authors.lastname: de Andrade
mesh_terms: D059350:Chronic Pain / Q000534:rehabilitation*; D020918:Complex Regional Pain Syndromes / Q000534:rehabilitation; D005356:Fibromyalgia / Q000534:rehabilitation; D006801:Humans; D009044:Motor Cortex; D009437:Neuralgia / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Analgesia; Chronic pain; Complex regional pain syndromes; Fibromyalgia; Low back pain; Neuropathic pain; Rehabilitation; Transcranial magnetic stimulation