title: High Frequency Repetitive Transcranial Magnetic Stimulation Therapy For Chronic Neuropathic Pain: A Meta-analysis.
abstract: BACKGROUND
  Increasing evidence supports an analgesic effect of repetitive transcranial magnetic stimulation (rTMS) for neuropathic pain (NP). However, the optimal parameters of rTMS (stimulation frequency and treatment sessions) for achieving long-term analgesic effects remain unknown. This study analyzed the current findings in the literature.
  
  
  OBJECTIVE
  The aim of this study was to assess the optimal parameters of rTMS for NP, including the rTMS sessions needed for inducing acute as well as long-term analgesic effects.
  
  
  METHODS
  A meta-analysis of the analgesic effect of high frequency rTMS (HF- rTMS) for neuropathic patients.
  
  
  METHODS
  This meta-analysis examined all studies involving the analgesic efficacy of HF-rTMS for NP.
  
  
  METHODS
  PubMed, Embase, and the Cochrane library were searched for clinical studies of rTMS treatment on NP published before December 31, 2014. Crude standardized mean differences (SMD) with 95% confidence interval (CI) were calculated for pain intensity after different treatment sessions (from 1 to 10) and follow-up of one or 2 months after rTMS treatment using random effect models.
  
  
  RESULTS
  Twenty-five studies (including 32 trials and 589 patients) were selected for the meta-analysis according to the inclusion and exclusion criteria. All 3 HF-rTMS treatments (5, 10, and 20 Hz) produced pain reduction, while there were no differences between them, with the maximal pain reduction found after one and 5 sessions of rTMS treatment. Further, this significant analgesic effect remained forone month after 5 sessions of rTMS treatment.
  
  
  CONCLUSIONS
  There are limitations of this meta-analysis. For example, the long-term analgesic effects of different HF-rTMS and low frequency (LF) rTMS sessions, including the single session of rTMS on different NP of varying origins have yet not been evaluated; the full degree of pain relief is still unclear for many rTMS studies.
  
  
  CONCLUSIONS
  HF-rTMS stimulation on primary motor cortex is effective in relieving pain in NP patients. Although 5 sessions of rTMS treatment produced a maximal analgesic effect and may be maintained for at least one month, further large-scale and well-controlled trials are needed to determine if this enhanced effect is specific to certain types of NP such as post-stroke related central NP.
authors.affiliation: Luzhou Medical College, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Lotus Biotech.com LLC, John Hopkins University-MCC, Rockville, MD.
authors.forename: Guoqiang
authors.initials: G
authors.lastname: Xing
authors.affiliation: Imaging Institute of Rehabilitation and Development of Brain Function, the Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, China.
authors.forename: Guangming
authors.initials: G
authors.lastname: Li
authors.affiliation: Imaging Institute of Rehabilitation and Development of Brain Function, the Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, China.
authors.forename: Anguo
authors.initials: A
authors.lastname: Wang
authors.affiliation: Imaging Institute of Rehabilitation and Development of Brain Function, the Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, China.
authors.forename: Shenggang
authors.initials: S
authors.lastname: Feng
authors.affiliation: Imaging Institute of Rehabilitation and Development of Brain Function, the Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Tang
authors.affiliation: Imaging Institute of Rehabilitation and Development of Brain Function, the Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Liao
authors.affiliation: Imaging Institute of Rehabilitation and Development of Brain Function, the Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Guo
authors.affiliation: Lotus Biotech.com LLC, John Hopkins University-MCC, Rockville, MD.
authors.forename: Morgan A
authors.initials: MA
authors.lastname: McClure
authors.affiliation: Luzhou Medical College, China; Imaging Institute of Rehabilitation and Development of Brain Function, the Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, China; Peking University Third Hospital, Beijing, China.
authors.forename: Qiwen
authors.initials: Q
authors.lastname: Mu
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D050781:Transcranial Magnetic Stimulation / Q000379:methods*