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Open Access 11-03-2025 | Repetitive Transcranial Magnetic Stimulation | Review Article

Efficacy of neuromodulation and rehabilitation approaches on pain relief in patients with spinal cord injury: a systematic review and meta-analysis

Authors: Simona Portaro, Angelo Alito, Giulia Leonardi, Nicola Marotta, Adriana Tisano, Daniele Bruschetta, Umile Giuseppe Longo, Antonio Ammendolia, Demetrio Milardi, Alessandro de Sire

Published in: Neurological Sciences

Abstract

Introduction

Spinal cord injury (SCI) is a debilitating neurological condition that causes physical dependency, psychological distress, and financial burden. Pain is a common consequence of SCI, significantly impacting quality of life. Effective pain management in SCI is challenging and requires multifaceted approaches. Among rehabilitation methods, non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS), theta burst stimulation (TBS), transcranial direct current stimulation (tDCS), transcutaneous electrical nerve stimulation (TENS), and virtual reality (VR) have been explored. This study aims to evaluate the efficacy of rehabilitation and non-invasive brain stimulation techniques on pain relief in SCI patients.

Methods

A systematic review of the literature was conducted using PubMed, Scopus, and ScienceDirect with the formula ("spinal cord injury") AND ("pain"). Risk of bias was assessed using the Cochrane Risk of Bias Tool.

Results

Sixteen studies involving 319 patients were included. Patients in the control groups received: rTMS in seven trials, tDCS in seven trials, TBS in one trial, and TENS combined with VR in one trial. The trials analyzed were of poor methodological quality, characterized by small sample sizes, weak power analyses, varying clinical scores, and non-comparable follow-up periods. No major complications or serious adverse events were reported.

Conclusion

Results were inconsistent, with no solid evidence supporting the superiority of rehabilitation techniques over comparator treatments. However, the favorable safety profile and positive outcomes in some measures suggest potential benefits for pain management and quality of life. Further studies are necessary to better understand SCI-related pain and optimize treatment strategies.

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Title: Efficacy of neuromodulation and rehabilitation approaches on pain relief in patients with spinal cord injury: a systematic review and meta-analysis
Authors: Simona Portaro
Angelo Alito
Giulia Leonardi
Nicola Marotta
Adriana Tisano
Daniele Bruschetta
Umile Giuseppe Longo
Antonio Ammendolia
Demetrio Milardi
Alessandro de Sire
Publication date: 11-03-2025
Publisher: Springer International Publishing
Keywords: Repetitive Transcranial Magnetic Stimulation
Neuropathic Pain
Nerve Stimulation
Published in: Neurological Sciences
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-025-08077-y

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