Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC 2 -NIN-CP)

Abrahão Fontes Baptista, Ana Mércia B.L. Fernandes, Katia Nunes Sá, Alexandre Hideki Okano, André Russowsky Brunoni, Argelia Lara-Solares, Aziza Jreige Iskandar, Carlos Guerrero, César Amescua-García, Durval Campos Kraychete, Egas Caparelli-Daquer, Elias Atencio, Fabián Piedimonte, Frantz Colimon, Fuad Ahmed Hazime, João Batista S. Garcia, John Jairo Hernández-Castro, José Alberto Flores Cantisani, Kátia Karina Do Monte-Silva, Luis Claudio Lemos CorreiaManuel Sempértegui Gallegos, Marco Antonio Marcolin, María Antonieta Ricco, María Berenguel Cook, Patricia Bonilla, Pedro Schestatsky, Ricardo Galhardoni, Valquíria Silva, William Delgado Barrera, Wolnei Caumo, Didier Bouhassira, Lucy S. Chipchase, Jean Pascal Lefaucheur, Manoel Jacobsen Teixeira, Daniel Ciampi De Andrade

Research output: Contribution to journalResearch Articlepeer-review

51 Scopus citations


Introduction: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP. Objective: To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice. Methods: Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study. Results: The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain. Conclusion: Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.

Original languageEnglish (US)
Article numbere692
JournalPain Reports
Issue number1
StatePublished - Jan 1 2019

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine


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