- Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation in Postherpetic Neuralgia: A Systematic Review and Meta-Analysis
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Abdallah Abbas, Basant Lashin, Mohamed Abouzid, Hadir Mustafa Mohamed, Mohamed El-Moslemani, Mohamed A. Zanaty, Haneen Sabet, Dina Essam Abo-elnour, Ahmed Ibrahim Ghonimy Shedid, Mohamed Salah Mohamed Syed, Amna Hussein, Hoda Awad, Ahmed M. Raslan
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Received December 6, 2024 Accepted January 10, 2025 Published online January 24, 2025
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DOI: https://doi.org/10.62087/hpr.2024.0032
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 Abstract
- The aim of this study was to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in managing pain in postherpetic neuralgia (PHN) patients. A comprehensive literature search was conducted through May 2024, across four databases: Scopus, PubMed, Web of Science, and Cochrane Library. The eligibility criteria included clinical trials, observational studies, and case-control studies focusing on rTMS in PHN. Two reviewers independently screened the studies and extracted data. The risk of bias was assessed using the RoB 2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. A meta-analysis was performed using Review Manager v.5.3, and heterogeneity was evaluated using the chi-square and I2 tests. Subgroup and sensitivity analyses were conducted. Five studies (245 patients) were included. The number of rTMS sessions in the included studies ranged from 10 to 28. The meta-analysis demonstrated that rTMS significantly reduced pain compared to sham treatments. At 2 weeks post-treatment, the mean difference in pain scores (visual analogue scale) was –1.44 (95% confidence interval: –2.12 to –0.77; p<0.0001). This pain reduction remained significant at 1 month and 3 months. However, no significant differences were observed between the rTMS and sham groups regarding the Patient’s Global Impression of Change scale, sleep quality, quality of life (QoL), medication regulation, or the incidence of adverse events. rTMS exerted a consistent pain relief effect of rTMS, but its impact on broader aspects of patient well-being was less clear. rTMS reduces pain in PHN patients for up to 3 months, but its effects on QoL and secondary outcomes warrant further investigation.
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