Dosage and safety of non-invasive brain stimulation for chronic musculoskeletal pain management: a scoping review
7 affiliations
- 1School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- 2Clinical Research Centre, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
- 3Department of Rehabilitation, Seventh People�s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
- 4School of Intelligent Medical and Health Engineering, Shanghai Polytechnic University, Shanghai, China
- 5Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, & Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
- 6Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- 7Department of Anatomy, Faculty of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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.
Design: 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.
Data sources: MEDLINE (PubMed), Scopus, Web of Science and Embase were searched from their inception to 16 October 2025.
Eligibility 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.
Data 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.
Results: 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.
Conclusion: 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.
Trial registration number: DOI: http://doi.org/10.17605/OSF.IO/8HFBZ.
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BibTeX
@article{wang2026dosage,
title = {{Dosage and safety of non-invasive brain stimulation for chronic musculoskeletal pain management: a scoping review}},
author = {Sizhong Wang and Jianqing Su and Bingxia Ding and Zeyu Shen and Ramakrishnan Mani and Kun Yang and Tianzhong Zi and Senlin Qian and Divya Bharatkumar Adhia and Jerin Mathew and Liming Jiang},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-125498},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125498},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Dosage and safety of non-invasive brain stimulation for chronic musculoskeletal pain management: a scoping review
AU - Sizhong Wang
AU - Jianqing Su
AU - Bingxia Ding
AU - Zeyu Shen
AU - Ramakrishnan Mani
AU - Kun Yang
AU - Tianzhong Zi
AU - Senlin Qian
AU - Divya Bharatkumar Adhia
AU - Jerin Mathew
AU - Liming Jiang
PY - 2026
DA - 2026/10/30
JO - BMJ Open
DO - 10.1136/bmjopen-2026-125498
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125498
AB - 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. Design: 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. Data sources: MEDLINE (PubMed), Scopus, Web of Science and Embase were searched from their inception to 16 October 2025. Eligibility 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. Data 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. Results: 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. Conclusion: 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. Trial registration number: DOI: http://doi.org/10.17605/OSF.IO/8HFBZ.
SN - 2044-6055
SN - 2044-6055
ER -