Evidence map›Paper›PMID 39404833›Full record

SynthesisPain medicine (Malden, Mass.)2025

Noninvasive brain stimulation beyond the motor cortex: a systematic review and meta-analysis exploring effects on quantitative sensory testing in clinical pain.

Andrew Flood, Rocco Cavaleri, We-Ju Chang, Jason Kutch, Constantino Toufexis, Simon J Summers

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Pain medicine (Malden, Mass.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Andrew FloodResearch Institute of Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory 2617, Australia.ORCID 0000-0001-7295-4901
Rocco CavaleriBrain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, School of Health Sciences, Sydney, New South Wales 2560, Australia.ORCID 0000-0001-9499-1703
We-Ju ChangCollege of Health Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales 2308, Australia.
Jason KutchDivision of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90007, United States.
Constantino ToufexisResearch Institute of Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory 2617, Australia.
Simon J SummersBrain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, School of Health Sciences, Sydney, New South Wales 2560, Australia.ORCID 0000-0001-9080-4202

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNoninvasive brain stimulation (NIBS) has been investigated increasingly as a means of treating pain. The effectiveness of NIBS in the treatment of pain has traditionally focused on protocols targeting the primary motor cortex (M1). However, over time, the effectiveness of M1 NIBS has been attributed to effects on interconnected cortical and subcortical sites rather than on M1 itself. Although previous reviews have demonstrated the effectiveness of non-M1 NIBS in improving subjective reports of pain intensity, the neurophysiological mechanisms underlying these effects remain incompletely understood. As chronic pain is associated with pain hypersensitivity and impaired endogenous descending pain modulation, it is plausible that non-M1 NIBS promotes analgesic effects by influencing these processes.

objectiveThe aim of this systematic review and meta-analysis was therefore to evaluate the effect of NIBS over non-M1 sites on quantitative sensory testing measures in clinical pain populations.

methodsA systematic search of electronic databases was conducted from inception to January 2024. Included articles (13 trials, n = 565 participants) were appraised with the Physiotherapy Evidence Database (PEDro) scale and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a random-effects model was used to meta-analyze outcomes where possible.

resultsA small number of studies found that NIBS applied to the dorsolateral prefrontal cortex might improve pain modulation in patients with fibromyalgia and that stimulation of the posterior superior insula and prefrontal cortex could improve pain sensitivity in chronic neuropathic and osteoarthritic pain, respectively. However, findings varied among studies, and there remains a paucity of primary research.

conclusionThis review indicates that current literature does not provide clear evidence that NIBS over non-M1 sites influences pain processing. STUDY REGISTRATION: PROSPERO (CRD42020201076).

Indexed as

Chronic PainMotor CortexPain ManagementTranscranial Direct Current StimulationTranscranial Magnetic StimulationHumansPain Measurementendogenous pain modulationnoninvasive brain stimulationpain sensitivity

Identifiers

PMID39404833
PMCPMC11789781

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.