The Use of Non-Invasive Brain Stimulation for the Management of Chronic Musculoskeletal Pain: Fad or Future?

Abstract

This article aims to offer a broad perspective on the use of non-invasive brain stimulation (NIBS) techniques in the context of chronic musculoskeletal pain (CMP) conditions. While NIBS has demonstrated promising efficacy in certain chronic pain populations, its application in the management of CMP remains limited. This paper examines the current evidence supporting the use of NIBS for pain relief in CMP, the rationale and proposed mechanisms of action, the importance of patient selection, common methodological limitations in the existing literature, and the potential adverse effects of these techniques. The authors argue that the current evidence is insufficient to support widespread clinical adoption of NIBS for CMP. Advancing the field will require more rigorous study designs, with adequately powered and properly blinded randomized controlled trials. Additionally, future research should address the identification of potential responders to brain stimulation, conduct economic evaluations, and carefully assess the benefit-risk ratio before NIBS can be integrated into routine clinical practice.

Keywords: brain stimulation; chronic musculoskeletal pain; review.

Figure 1

Evolution of the number of articles published in the field of non-invasive brain stimulation and pain in the last 20 years.

Figure 2

Number of original RCTs that reported a power calculation, a blinding assessment, and a prospective registration. Note that this was performed only for papers not included in meta-analyses, except for one meta-analysis that reported blinding assessment in the text. Therefore, the percentages are not exhaustive but are intended to show trends.