Summary of findings for the main comparison.

Repetitive transcranial magnetic stimulation (rTMS) compared with sham for chronic pain

rTMS compared with sham for chronic pain
Patient or population: adults with chronic pain Settings: laboratory/ clinic Intervention: active rTMS Comparison: sham rTMS
Outcomes	Effect size	Relative and absolute effect (average % improvement (reduction) in pain (95% CIs) in relation to post‐treatment score from sham group)* *Where 95%CIs do not cross the line of no effect.	No of participants (studies)	Quality of the evidence (GRADE)
Pain intensity (0 to < 1 week postintervention) measured using visual analogue scales or numerical rating scales	SMD ‐0.22 (‐0.29 to ‐0.16)	This equates to a 7% (95% CI 5% to 9%) reduction in pain intensity, or a 0.40 (95% CI 0.53 to 0.32) point reduction on a 0 to 10 pain intensity scale.	655 (27)	⊕⊕⊝⊝ low1
Disability (0 to < 1 week postintervention) measured using self‐reported disability/pain interference scales	SMD ‐0.29, 95% CI ‐0.87 to 0.29	‐	119 (5)	⊕⊝⊝⊝ very low2
Quality of life (0 to < 1 week postintervention) measured using Fibromyalgia Impact Questionnaire	MD ‐10.80, 95% CI ‐15.04 to ‐6.55	‐	105 (4)	⊕⊕⊝⊝ low3
CI: confidence interval; MD: mean difference; rTMS: repetitive transcranial magnetic stimulation; SMD: standardised mean difference
GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect; Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different; Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect; Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

¹Downgraded once for study limitations due to high or unclear risk of bias and once for inconsistency due to heterogeneity. ²Downgraded once for study limitations due to high or unclear risk of bias, once for inconsistency due to heterogeneity and once for imprecision due to low participant numbers. ³Downgraded once for study limitations due to high or unclear risk of bias and once for imprecision due to low participant numbers.