{ "abstract": "Objectives: To map stimulation targets and dosage parameters used in non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS), theta-burst stimulation (TBS) and transcranial direct current stimulation (tDCS) for chronic musculoskeletal pain (CMP), and to synthesise rationale for dosage selection, safety monitoring and adverse event reporting.\n\nDesign: The scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute guidance, using the Arksey and O'Malley framework.\n\nData sources: MEDLINE (PubMed), Scopus, Web of Science and Embase were searched from their inception to 16 October 2025.\n\nEligibility criteria: Studies involving adults with CMP receiving rTMS, TBS or tDCS were eligible if they reported at least one of the following outcomes: stimulation targets, dosage parameters or safety. All study designs were eligible.\n\nData extraction and synthesis: Two reviewers independently screened and extracted data. Findings were synthesised descriptively by modality, target, dosage characteristics, rationale for parameter selection and safety monitoring.\n\nResults: A total of 123 studies were included, predominantly randomised controlled trials (RCTs) involving fibromyalgia, knee osteoarthritis and chronic low back pain. The primary motor cortex (M1) and dorsolateral prefrontal cortex were the most frequently targeted regions for stimulation. Common protocols used 10 Hz rTMS at 80–120% rest motor threshold and tDCS at 1–2 mA for 20–30 min. Treatment schedule varied substantially, ranging from 1 to 60 sessions, and most delivered at five sessions per week over 2 to 4 weeks. Stimulation targets were justified in 63% of studies, whereas rationales for frequency, intensity and number of sessions were reported inconsistently. The method used for adverse events monitoring was not clearly described in 62% of studies. Among the 113 studies in which participants actually received NIBS, reported adverse events were predominantly mild and transient. However, adverse event ascertainment and reporting were inconsistent and the reported percentages represented the proportion of studies reporting each adverse event rather than participant-level incidence. Therefore, these data do not permit reliable estimation of adverse event frequency.\n\nConclusion: Current NIBS dosage for management of CMP remains heterogeneous and driven by empirical experience. Safety reporting is inadequate. Although reported adverse events were predominantly mild and transient, inconsistent adverse event ascertainment and reporting preclude reliable conclusion about the safety profile of NIBS. Greater emphasis on brain network theory-informed targets in people with CMP, systematic and personalised dosage optimisation, and standardised safety reporting is needed to support evidence-based clinical implementation.\n\nTrial registration number: DOI: http://doi.org/10.17605/OSF.IO/8HFBZ.", "abstract_shown": true, "affiliations": [ "School of Exercise and Health, Shanghai University of Sport, Shanghai, China", "Clinical Research Centre, The Second Rehabilitation Hospital of Shanghai, Shanghai, China", "Department of Rehabilitation, Seventh People�s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China", "School of Intelligent Medical and Health Engineering, Shanghai Polytechnic University, Shanghai, China", "Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, & Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand", "Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand", "Department of Anatomy, Faculty of Biomedical Sciences, University of Otago, Dunedin, New Zealand" ], "article_type": "research article", "arxiv": null, "author_total": 11, "authors": [ { "affs": [ 0 ], "name": "Sizhong Wang", "orcid": "0000-0002-9274-3447" }, { "affs": [ 1 ], "name": "Jianqing Su" }, { "affs": [ 0 ], "name": "Bingxia Ding" }, { "affs": [ 2, 3 ], "name": "Zeyu Shen" }, { "affs": [ 4 ], "name": "Ramakrishnan Mani" }, { "affs": [ 2 ], "name": "Kun Yang" }, { "affs": [ 2 ], "name": "Tianzhong Zi" }, { "affs": [ 2 ], "name": "Senlin Qian" }, { "affs": [ 5 ], "name": "Divya Bharatkumar Adhia", "orcid": "0000-0002-2505-4916" }, { "affs": [ 6 ], "name": "Jerin Mathew", "orcid": "0000-0001-6002-9815" }, { "affs": [ 1, 2 ], "name": "Liming Jiang", "orcid": "0000-0001-7773-0149" } ], "bibtex": "https://research.draconitic.com/paper/5r4fhteam3bnn.bib", "cited_by": 0, "doi": "10.1136/bmjopen-2026-125498", "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13723872/", "id": "5r4fhteam3bnn", "issns": [ "2044-6055", "2044-6055" ], "landing_url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125498", "language": "en", "licence": "CC-BY-NC-4.0", "licence_label": "CC BY-NC 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "1506" ], [ "heading", "1727" ], [ "heading", "Original Research" ], [ "heading", "Rehabilitation Medicine" ] ], "openalex": null, "pdf_url": null, "pmcid": "PMC13723872", "pmid": "42963090", "published": "2026-10-30", "publisher": "BMJ", "ris": "https://research.draconitic.com/paper/5r4fhteam3bnn.ris", "sources": [ { "first_seen": "2026-11-01T00:21:00Z", "native_id": "10.1136/bmjopen-2026-125498", "source": "crossref", "url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125498" }, { "first_seen": "2026-11-04T12:22:25Z", "native_id": "PMC13723872", "source": "pmc", "url": "https://doi.org/10.1136/bmjopen-2026-125498" } ], "subjects": [ { "field": "medicine", "origin": "journal-openalex:F27", "subfield": "general" } ], "title": "Dosage and safety of non-invasive brain stimulation for chronic musculoskeletal pain management: a scoping review", "title_text": "Dosage and safety of non-invasive brain stimulation for chronic musculoskeletal pain management: a scoping review", "type": "peer-reviewed", "updated_at": "2026-11-05T12:20:36Z", "url": "https://research.draconitic.com/paper/5r4fhteam3bnn", "venue": "BMJ Open", "versions": [] }