Repetitive TMS for Chronic Pain: From Clinical Updates to Neurophysiology-based Personalization

Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising non-invasive technique for neuromodulation in the management of chronic pain. Recent clinical guidelines classify rTMS as a third-line treatment for neuropathic pain, with growing evidence supporting its effectiveness, although responses vary among individuals (Soliman et al., Lancet Neurol 2025; 24: 413–28). However, evidence of rTMS effectiveness for other conditions, such as chronic musculoskeletal pain, is still lacking.
This workshop will feature clinical updates, new findings from neuropathic and musculoskeletal pain research, and neurophysiological methods for patient stratification and personalized therapies. It will begin with a brief recorded testimonial from a patient living with chronic pain, illustrating the challenges of treatment failure and the hope provided by new approaches. This story will set the stage for three scientific presentations, grounding the discussion in the patient experience.
Associate Professor Koichi Hosomi (The University of Osaka, Japan), who will chair the session, will open the workshop with an introduction and a brief overview of rTMS in chronic pain.
Following this, the scientific program will include:
Professor Nadine Attal (Université Paris-Saclay, France) will first review the current use of rTMS in the treatment of neuropathic pain and fibromyalgia. Drawing from recent large-scale meta-analyses and consensus guidelines, as well as her own experience conducting clinical trials, she will describe where rTMS fits into treatment plans, which clinical factors predict response, and how these insights are influencing therapeutic decisions.
Associate Professor Hugo Massé-Alarie (Université Laval, Canada) will then present new evidence extending beyond neuropathic pain, with a particular focus on musculoskeletal pain and chronic low back pain. He will present results from a large randomized controlled trial in low back pain and will critically evaluate trials of rTMS in musculoskeletal conditions, where results have been mixed. His talk will highlight methodological challenges, the need for rigorous study designs, and the potential to identify subgroups most likely to benefit.
Post-doc Enrico De Martino (Aalborg University, Denmark) will conclude by presenting a neuroscience-based approach to personalizing rTMS. Using combined transcranial magnetic stimulation and electroencephalography, his research shows that pre-treatment cortical connectivity patterns can predict patient responses to rTMS targeting the primary motor cortex and non-motor regions, including the left dorsolateral prefrontal cortex and the posterior–superior insula. This approach moves beyond a one-size-fits-all protocol and opens opportunities for connectivity-guided interventions.
The workshop will conclude with a panel discussion on translating rTMS research into clinical practice for pain management, with a particular focus on how current evidence should inform routine use. Key questions will include: Can rTMS be applied beyond neuropathic pain to other chronic pain conditions? What are the most promising biomarkers for patient stratification and personalized treatment?
By combining patient perspectives with research spanning clinical, musculoskeletal, and neurophysiological domains, this workshop aims to provide a comprehensive and forward-looking view of rTMS in pain medicine.