Neuropathic pain is a chronic and often debilitating condition caused by injury or dysfunction in the nervous system. Affecting approximately 7–10% of the population, it can result from stroke, diabetes, spinal cord injury, herpes zoster infection, or nerve damage, and severely impacts a patient’s quality of life. Traditional pharmacological treatments, including anticonvulsants, antidepressants, and opioids, offer only partial relief and are often associated with side effects. This has led to the exploration of Repetitive Transcranial Magnetic Stimulation (rTMS)—a safe, non-invasive neuromodulation therapy—as a promising alternative.

Repetitive Transcranial Magnetic Stimulation (rTMS) uses magnetic pulses to stimulate specific regions of the brain, particularly the primary motor cortex (M1). In patients with neuropathic pain, brain imaging studies reveal maladaptive reorganization of motor and sensory circuits, including abnormal functional connectivity and cortical excitability. rTMS helps normalize this dysregulation, thereby reducing pain.

• High-frequency rTMS (≥5 Hz) is generally excitatory and can upregulate pain thresholds, stimulate the release of endogenous opioids and anti-inflammatory cytokines, and modulate cortical and subcortical circuits involved in pain perception.
• rTMS has been shown to affect neuroplasticity, improving pain tolerance and potentially reversing some of the central sensitization that underlies chronic neuropathic pain.

Multiple studies and meta-analyses support the efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) in various neuropathic conditions:

• A 2023 review confirms that 10 Hz rTMS applied to the primary motor cortex leads to significant pain relief in conditions such as diabetic neuropathy, post-stroke pain, and spinal cord injury, especially when sessions are repeated over multiple weeks.
• A meta-analysis of 25 studies showed that 5 to 10 sessions of high-frequency rTMS can produce lasting pain reduction for up to a month in chronic neuropathic pain patients.
• In phantom limb pain, daily rTMS sessions resulted in pain reduction lasting up to 2 months. Similar long-term improvements were seen in post-herpetic neuralgia and brachial plexus injury.

Repetitive Transcranial Magnetic Stimulation (rTMS) has shown efficacy in treating:

• Central neuropathic pain (e.g., after stroke, spinal cord injury, phantom limb pain)
• Peripheral neuropathic pain (e.g., diabetic neuropathy, radiculopathy, post-herpetic neuralgia, trigeminal neuralgia)

The most common target site is the primary motor cortex, but some studies also explore stimulation of the dorsolateral prefrontal cortex (DLPFC) and secondary somatosensory cortex, depending on the source and type of pain.

Repetitive Transcranial Magnetic Stimulation (rTMS) is well-tolerated, with no serious adverse events reported across large studies. Most patients experience only mild, temporary side effects such as scalp discomfort, fatigue, mild headache

Sessions are conducted in an outpatient setting, last 20–30 minutes, and typically occur daily over 2–4 weeks, with optional maintenance sessions.

Repetitive Transcranial Magnetic Stimulation (rTMS) may be especially beneficial for:

• Patients with chronic, treatment-resistant neuropathic pain
• Individuals with intolerable side effects from pain medications
• Those not eligible for invasive interventions like spinal cord stimulation
• Patients seeking a non-pharmacological, brain-based therapy

Repetitive Transcranial Magnetic Stimulation (rTMS) offers a safe, evidence-based, and non-invasive solution for managing neuropathic pain, especially in cases unresponsive to conventional treatments. By targeting and rebalancing dysfunctional brain circuits, Repetitive Transcranial Magnetic Stimulation (rTMS) can significantly reduce pain intensity, improve function, and enhance overall quality of life. As research grows, rTMS is becoming an essential tool in the personalized care of patients with neuropathic pain.