Introduction Peripheral neuropathic pain (PNP) is common, disabling and frequently refractory to pharmacotherapy. High-frequency repetitive transcranial magnetic stimulation (rTMS) can reduce neuropathic pain but response rates remain variable.
Personalised target selection based on functional connectivity may improve analgesic efficacy and help elucidate neurobiological mechanisms. Methods and analysis This is a prospective, multicentre, randomised, double-blind, controlled superiority trial recruiting 152 adults with PNP (eg, trigeminal neuralgia, postherpetic neuralgia and diabetic neuropathy) across four hospitals.
Participants will be randomised 1:1 to (1) personalised functional connectivity guided rTMS delivered with MRI-based neuronavigation or (2) conventional rTMS target selection (traditional 'hotspot' approach) with identical procedures to maintain blinding. The intervention consists of 10 sessions over 2 weeks, 18 min per session, 10 Hz and at 90% resting motor threshold.
The primary endpoint is change in pain intensity (visual analogue scale, 0 - 100 mm) from baseline to the day of the 10th session.
BMJ Open published a clinical update in Research Highlights on 24 Jun 2026.
The item focuses on Personalised functional-connectivity-guided neuronavigated high-frequency repetitive transcranial magnetic stimulation for peripheral neuropathic pain: protocol for a multicentre, randomised, double-blind, controlled trial.
Review the original article for the full source wording and details.