Repetitive transcranial magnetic stimulation is a non-invasive and safe treatment option for reducing pain compared to other treatments for chronic phantom pain.

To examine the available therapies for the management of chronic pain in individuals with limb amputations i.e. chronic phantom pain.

An extensive database search on Medline, EMBASE, Scopus by Elsevier, Cumulative Index of Nursing and Allied Health Literature (CINAHL), EBSCO (Elton B. Stephens CO) and Cochrane CENTRAL was done. It focused on randomized controlled trials that included treatments, such as neuromodulation, neural blockades, pharmacological methods and alternate therapies for chronic phantom pain. Network meta-analysis was accomplished considering the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Improvement in the pain score was the main outcome measure and adverse events were secondary outcome measures.

The use of neuromodulation, particularly repetitive transcranial magnetic stimulation (repetitive TMS) was most effective for significant pain improvement compared with placebo (mean difference=-2.9 points, 95% CI=-4.62 to -1.18; moderate quality of evidence) as per the Network meta-analysis of ten randomized trials. Morphine was linked with a substantial increase in the rate of adverse events (OR=6.04, 95% CI=2.26 to 16.12; low quality of evidence).

Repetitive TMS therapy may be associated with significantly superior pain control for chronic PLP. There is a need for comprehensive, large-scale trials given the lack of studies, different patient characteristics through each trial, and shortage of long-term results.