Repetitive transcranial magnetic stimulation for neuropathic pain and neuropsychiatric sequelae in traumatic brain injury: A meta-analysis and trial sequential analysis

Background: Traumatic brain injury (TBI) is a major cause of long-term disability, often leading to chronic neuropathic pain and neuropsychiatric symptoms. These complications significantly impair quality of life and are often resistant to conventional treatments. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has shown promise in treating both neuropathic pain and psychiatric disorders in various neurological conditions. However, its efficacy and safety in the TBI population remain unclear. This study aims to evaluate the effectiveness of rTMS in managing neuropathic pain and neuropsychiatric symptoms in individuals with TBI. Methods: Articles were systematically retrieved from databases using keywords “traumatic brain injury,” “rTMS,” “neuropathic pain,” and “neuropsychiatric symptoms.” Eligible studies included randomized controlled trials involving TBI patients treated with rTMS. The risk of bias (RoB) was evaluated using the RoB 2.0. Trial sequential analysis (TSA) of pooled analysis that is significant and consisted of more than one studies was done. Results: A total of nine studies involving patients with TBI were included. rTMS significantly reduced post-concussive symptoms on Rivermead post-concussion questionnaire (RPQ) 13 (standardized mean difference [SMD] –0.67; P = 0.006) and showed analgesic effects on neuropathic pain (SMD –68; P < 0.03). No significant effects were observed for cognitive function (SMD –0.07; P = 0.80) or depressive symptoms (SMD –0.13 to –0.30; P > 0.05). TSA showed benefit of rTMS for 1-week neuropathic pain relief but not post-concussive symptoms on RPQ 13 at 4 weeks. Conclusion: rTMS may provide short-term benefits in reducing neuropathic pain and potentially for post-concussive symptoms in patients with TBI. More studies are needed to confirm the benefits of using rTMS for post-concussive and neuropsychiatric symptoms.