Repetitive transcranial magnetic stimulation for pain after spinal cord injury: a systematic review and meta-analysis.
BACKGROUND
The evidence regarding efficiency of repetitive transcranial magnetic stimulation (rTMS) on relief of neuropathic pain (NP) in patients with prior spinal cord injury (SCI) is controversial. The current meta-analysis aimed to assess the efficacy of rTMS in pain relieve in patients suffering from SCI associated NP.


METHODS
Medline, PubMed, Cochrane Database, EMBASE, Google Scholar databases were searched for clinical studies on effects of rTMS treatment on NP caused by prior SCI published before March 14th, 2016 with various combinations of following key words: "transcranial magnetic stimulation," "spinal injury," "pain." Standardized difference in means with 95% confidence interval was calculated for the change of pain scores after rTMS or sham rTMS treatments.


RESULTS
A total of two randomized controlled studies (RCTs) and 4 crossover RCTs were included in the present meta-analysis. The RCTs recruited a total of 27 patients. The crossover RCTs recruited a total of 100 patients. The combined standardized difference in means indicated that patients who received rTMS intervention had better pain relief than those who received sham rTMS intervention, however, the results did not reach statistical significance (standardized mean difference -0.607, 95% CI: -1.29 to 0.075, P=0.081).


CONCLUSIONS
rTMS might reduce SCI associated neuropathic pain; however, further studies are required to support our conclusions.
Center for Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.|School of Rehabilitation, Capital Medical University, Beijing, China.|Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China.
Feng
F
Gao
Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.|School of Rehabilitation, Capital Medical University, Beijing, China.
Hongyu
H
Chu
Center for Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China - crrclei100@sina.com.|Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.|School of Rehabilitation, Capital Medical University, Beijing, China.|Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China.
Jianjun
J
Li
Center for Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.|School of Rehabilitation, Capital Medical University, Beijing, China.|Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China.
Mingliang
M
Yang
Center for Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.|School of Rehabilitation, Capital Medical University, Beijing, China.|Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China.
Liangjie
L
DU
Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.|School of Rehabilitation, Capital Medical University, Beijing, China.
Jun
J
Li
Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.|School of Rehabilitation, Capital Medical University, Beijing, China.
Liang
L
Chen
Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.|School of Rehabilitation, Capital Medical University, Beijing, China.
Degang
D
Yang
Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.|School of Rehabilitation, Capital Medical University, Beijing, China.
Hong
H
Zhang
Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Chetwyn
C
Chan
D006801:Humans; D009437:Neuralgia / Q000209:etiology / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D013119:Spinal Cord Injuries / Q000150:complications*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*