Estimulación magnética transcraneal para el dolor neuropático de origen oncológico y no oncológico: una revisión sistemática

Objective: Repetitive Transcranial Magnetic Stimulation (rTMS) is a ground-breaking alternative for the treatment of neuropathic pain. rTMS is a brain stimulation technique that is noninvasive and induces electrical currents in the cortex’s nervous tissue. The aim of this study was to assess the effect of rTMS for the treatment of pain, regardless of its non-oncological or oncological origin. Methods: We performed a search in MEDLINE, CENTRAL, Embase, PsycINFO, LILACS and SCOPUS. The inclusion criteria were 1) population: men and women between 18 and 85 years-age, with neuropathic pain (oncological and non-oncological); 2) intervention: treatment with transcranial magnetic stimulation; 3) comparison: inactive control groups and parallel active interventions; and 4) outcome: primary outcome, pain modulation. Secondary outcomes, quality of life and adverse effects. The risk of bias and quality of evidence were assessed as well. Results: The search yielded 1116 articles, of which 21 met the PICO criteria. 12 randomized controlled trials (RCTs) and 9 observational studies. The total sample was 911 patients, the number of sessions varied from one single session to 15, with a mean of 3.5 sessions. Follow-up was performed between day 7 and 311.8 days, with a mean of 45 days. Pain reduction was reported in all 21 reports. Conclusion: rTMS might be an effective therapeutic choice for oncological and nononcological neuropathic pain. Evidence of moderate quality was found for pain modulation; for the quality of life the results are uncertain to determine changes, because the evidence level is very low. Additional research efforts are needed to reduce bias and improve the quality of the studies.