The Effectiveness of High-Frequency Repetitive Transcranial Magnetic Stimulation on Patients with Neuropathic Orofacial Pain: A Systematic Review of Randomized Controlled Trials

Abstract

Background. Repetitive transcranial magnetic stimulation (rTMS) has been widely used in the treatment of neuropathic orofacial pain (NOP). The consistency of its therapeutic efficacy with the optimal protocol is highly debatable. Objective. To assess the effectiveness of rTMS on pain intensity, psychological conditions, and quality of life (QOL) in individuals with NOP based on randomized controlled trials (RCTs). Methods. We carefully screened and browsed 5 medical databases from inception to January 1, 2022. The study will be included that use of rTMS as the intervention for patients with NOP. Two researchers independently completed record retrieval, data processing, and evaluation of methodological quality. Quality and evidence were assessed using the PEDro scores and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results. Six RCTs with 214 participants were included in this systematic review: 2 studies were considered level 1 evidence, and 4 were considered level 2 evidence. Six studies found that high-frequency rTMS had a pain-relieving effect, while 4 studies found no improvement in psychological conditions and QOL. Quality of evidence (GRADE system) ranged from moderate to high. No significant side effects were found. Conclusions. There is moderate-to-high evidence to prove that high-frequency rTMS is effective in reducing pain in individuals with NOP, but it has no significant positive effect on psychological conditions and QOL. High-frequency rTMS can be used as an alternative treatment for pain in individuals with NOP, but further studies will be conducted to unify treatment parameters, and the sample size will be expanded to explore its influence on psychological conditions and QOL.

Repetitive transcranial magnetic stimulation use in neuropathic pain with comorbid depression: a review of efficient treatment protocols’ parameters

“…Y. Diao и соавт. (2022) также сообщают, что высокочастотная рТМС уменьшает боль у пациентов с орофациальной НБ [16]. Некоторые исследования показали эффективность протоколов рТМС в облегчении НБ при центральном постинсультном болевом синдроме, 2 из которых также продемонстрировали снижение баллов КД [17][18][19].…”

“…Только в 5 исследованиях рекомендованный протокол рТМС оказался эффективным для лечения как НБ, так и КД [14,15,17,18,24], остальные работы не показали снижения баллов по шкалам оценки депрессии (см. таблицу) [16,[19][20][21][22][23][25][26][27][28][29][30][31][32][33][34][35]. В проведенном метаанализе также не обнаружено снижения сопутствующих симптомов КД при НБ [25].…”

“…Однако в некоторых исследованиях сообщалось об эффективном применении рТМС области S2 [19]. Больше половины проанализированных исследований не показали снижения баллов по психометрическим шкалам для оценки депрессии [16,[19][20][21][22][23][25][26][27][28][29][30][31][32][33][34][35].…”