Efficacy of repetitive transcranial magnetic stimulation for post-stroke shoulder pain: a systematic review and meta-analysis

Post-stroke shoulder pain (PSSP) is a common complication of stroke survivors, substantially impeding upper-limb functional recovery and diminishing quality of life. Conventional treatments usually target peripheral symptoms and only yield limited or transient benefits. Repetitive transcranial magnetic stimulation (rTMS) has shown analgesic potential in various neuropathic pain conditions, yet its efficacy in PSSP lacks systematic evaluation. Eight databases were systematically searched to identify randomized controlled trials evaluating rTMS interventions for PSSP. The primary outcome was pain intensity measured by the visual analog scale or numeric rating scale. Secondary outcomes included Fugl-Meyer Assessment, Modified Barthel Index, and shoulder range of motion. Risk assessment and data analysis were performed using Review Manager 5.4.1, with heterogeneity quantified by the I² statistic and subgroup analyses conducted to explore its potential sources. 12 RCTs involving over 500 participants met the inclusion criteria. Results revealed that rTMS significantly reduced pain intensity compared to control (WMD: −1.62; 95% CI: −2.00, −1.24; <i>p</i> &lt; 0.00001). Additionally, rTMS significantly improved the FMA, MBI scores and shoulder ROM. rTMS appears to be a promising intervention for reducing PSSP and enhancing upper-limb motor function. These findings support incorporating rTMS into stroke rehabilitation protocols. In the future, high-quality, multi-center RCTs with extended follow-up are warranted to optimize stimulation parameters and validate long-term benefits.