Herrero Babiloni A, Guay S, Nixdorf DR, et al. Non-invasive brain stimulation in chronic orofacial pain: a systematic review. J Pain Res. 2018 Aug 1;11:1445-1457. doi: 10.2147/JPR.S168705. eCollection 2018. (Systematic review)

Background: Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are non-invasive brain stimulation techniques that are being explored as therapeutic alternatives for the management of various chronic pain conditions.

Objective: The primary objective of this systematic review is to assess the efficacy of TMS and tDCS in reducing clinical pain intensity in chronic orofacial pain (OFP) disorders. The secondary objectives are to describe adverse effects, duration of relief, and TMS/tDCS methodologies used in chronic OFP disorders.

Methods: A search was performed in MEDLINE, Embase, Web of Science, Scopus, and Google Scholar. Inclusion criteria were 1) population: adults diagnosed with chronic OFP including neuropathic and non-neuropathic disorders; 2) intervention: active TMS or tDCS stimulation regardless of the used protocol; 3) comparison: sham TMS or tDCS stimulation; and 4) outcome: primary outcome was patient reported pain intensity. Secondary outcomes were duration of pain relief, adverse effects, and methodological parameters. Risk of bias and quality of study reporting were also assessed.

Results: A total of 556 individual citations were identified by the search strategy, with 14 articles meeting selection criteria (TMS=11; tDCS=3). Data were obtained for a total of 228 patients. Included OFP disorders were trigeminal neuralgia, trigeminal neuropathy, burning mouth syndrome, atypical facial pain, and temporomandibular disorders. Significant pain reductions were obtained in both techniques. More number of sessions yielded to more durable effects. Overall, high risk of bias and poor study quality were found.

Conclusion: TMS and tDCS appear to be safe and promising alternatives to reduce pain intensity in different chronic OFP disorders. Additional research effort is needed to reduce bias, improve quality, and characterize optimal brain stimulation parameters to promote their efficacy.

Discipline Area Score
Physician 4 / 7
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Comments from MORE raters

Physician rater

The studies included in this review are plagued by poor quality, small numbers and significant heterogeneity in patient populations and treatment parameters. There is not enough evidence to change clinical practice but hopefully it spurs better research of transcranial stimulation for pain.

Physician rater

This article discusses transcraneal magnetic brain stimulation for chronic facial pain syndromes and describes multiple poorly done studies which promote this modality but base this on biased and weak studies. The jury is still out but it is not promising.
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