Does repetitive transcranial magnetic stimulation help neuropathic pain after spinal cord injury?

Neuropathic pain after spinal cord injury (SCI-NP) is common and often hard to treat with medications alone. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that may offer pain relief. Research shows that rTMS, especially when applied to the motor cortex, can significantly reduce pain intensity in people with SCI-NP.

What the research says

A 2025 meta-analysis of 7 randomized controlled trials involving 159 spinal cord injury patients found that rTMS effectively improved neuropathic pain compared to sham stimulation, with a large effect size (SMD = -1.41) ². Another broader meta-analysis of 14 studies on neuropathic pain (not limited to SCI) also reported significant reductions in pain scores measured by VAS and SF-MPQ, though not by NRS ¹. Clinical guidelines from 2020 give Level A evidence (definite efficacy) for high-frequency rTMS of the primary motor cortex for neuropathic pain ⁶. The analgesic effect may involve reducing inflammation: rTMS decreases pro-inflammatory cytokines like IL-1β, IL-6, and TNF-α, and increases anti-inflammatory factors like IL-10 and BDNF ⁷. A 2021 multicenter trial in patients with peripheral neuropathic pain found that active rTMS to the motor cortex or dorsolateral prefrontal cortex did not significantly outperform sham over 25 weeks on the primary outcome, but secondary analyses suggested some benefit ⁸. Overall, the evidence supports rTMS as a helpful option for SCI-NP, though individual responses vary.

What to ask your doctor

• Could rTMS be a treatment option for my neuropathic pain after spinal cord injury?
• What is the typical rTMS protocol (frequency, number of sessions, target brain area) used for this condition?
• Are there any side effects or risks I should be aware of?
• How long does pain relief typically last after a course of rTMS?
• Would rTMS be covered by my insurance or available at a nearby clinic?