Efficacy and safety of repetitive transcranial magnetic stimulation with different frequencies on neuropathic orofacial pain: a systematic literature review and meta-analysis

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique used to treat neuropathic orofacial pain (NOP). This study aimed to evaluate the efficacy and safety of rTMS in managing NOP and reducing health risks. A comprehensive literature search was conducted in various databases, including PubMed, Physiotherapy Evidence Database (PEDro), the Cochrane Library, Web of Science, Embase and Clinical Trials.gov. Thirteen relevant articles were identified and assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Risk of Bias assessment tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was utilized to evaluate the evidence rating for the studies. The analysis of the thirteen randomized controlled trials, involving 355 eligible patients, demonstrated moderate evidence supporting the significant effect of rTMS in reducing pain intensity (Mean Difference (MD): -1.01, 95% Confidence Interval (CI) -2.39 to -1.48, p < 0.001) and improving the quality of life (QOL) based on various instruments (MD: -9.23, 95% CI -11.91 to -6.54, p < 0.001; MD: -2.1, 95% CI -3.74 to -0.45, p <0.05). Patients also reported favorable improvements in global impression (MD: -0.54, 95% CI -1.02 to -0.07, p < 0.05) and sensory status (Standardized Mean Difference (SMD): -1.30, 95% CI -1.74 to -0.87, p < 0.001). However, there were no significant improvements in sleep quality (MD: -1.72, 95% CI -4.13 to 0.68, p > 0.05) or psychological status (p> 0.05). Overall, the study demonstrated that rTMS is an effective and safe way to reduce pain, improve QOL, enhance sensory status, and create a positive clinical impression in patients with NOP. Further research is needed to investigate the effects of rTMS on sleep and psychological well-being in individuals with NOP.