Repetitive transspinal magnetic stimulation in the treatment of chronic low back pain. A meta-analysis (Part II)

Abstract

The aim of this review was to analyze results of studies on the effectiveness of repetitive transcranial and transspinal magnetic stimulation (rTMS and rTsMS) in the treatment of low back pain. Chronic low back pain (CLBP) is prevalent over other types of pain and, beyond the nosological scope of musculoskeletal diseases, affects about 80-84% of the population in a lifetime. Neuroplasticity underlying the pathogenesis of CLBP is driven by stimuli, and stimuli can be mediated by processes from «top to bottom», i.e. from the overlying to the underlying hierarchical structures of the nervous system, and vice versa, i.e. from peripheral to the central. This is reflected in the increased interest of the professional community of regenerative medicine in implementing high-tech methods of neuromodulation by repetitive electromagnetic pulses in CLBP. In this second part of the review, we present a meta-analysis of the literature data accumulated by the time of its publication. It completes our previously published information stating that both rTMS and rTsMS are viable pathogenetic therapeutic modalities for patients with CLBP, based on experimental and clinical positive effects on impaired sensory transmission, changes in proprioception, motor control, and psychological modulation. Both methods have proven successful in providing short-term relief for chronic dorsalgia, while the long-term effects of rTsMS (>1 month) require further investigation. Various factors associated with the unification of the still heterogeneous stimulation protocols, including pulse delivery form, frequency, application location, periodicity and treatment duration, may further improve proper result interpretation. The combination of rTMS and rTsMS in CLBP, which is evident to the authors of this review but has not been described in the literature yet, could have more impact on the pain management processes of the investigated pathology than each of them separately.