André‐Obadia 2008

Methods	Cross‐over RCT; 3 conditions
Participants	Country of study: France Setting: laboratory‐based Condition: neuropathic pain (mixed central, peripheral and facial) Prior management details: refractory to drug management, candidates for invasive MCS n = 30 Age: 31‐72 years, mean 55 (SD 10.5) Duration of symptoms: mean 5 years (SD 3.9) Gender distribution: 23 M, 7 F
Interventions	Stimulation type: rTMS, figure‐of‐8 coil Stimulation parameters: Condition 1: frequency 20 Hz; coil orientation posteroanterior; 90% RMT; number of trains 20; duration of trains 4 s; ITI 84 s; total number of pulses 1600 Condition 2: frequency 20 Hz, coil orientation lateromedial; number of trains 20; duration of trains 4 s; ITI 84 s; total number of pulses 1600 Condition 3: sham ‐ same as for active conditions with coil angled away perpendicular to scalp Stimulation location: M1 contralateral to painful side Number of treatments: 1 for each condition
Outcomes	Primary: 0‐10 NRS (anchors "no pain" to "unbearable pain") When taken: daily for 2 weeks poststimulation Secondary: none
Notes	Data requested from study authors Sources of support: supported in part by a Grant from the Fondation pour la Recherche Médicale (FRM), France COI: study authors declared no COI
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "the order of sessions was randomised (by computerized random‐number generation)"
Adequate blinding of participants?	Unclear risk	Comments: sham credibility assessment ‐ suboptimal. Coil angled away from scalp and not in contact in sham condition. Did not control for sensory characteristics of active stimulation and was visually distinguishable
Adequate blinding of assessors?	Low risk	Quote: "The physician who applied the procedure received from a research assistant one sealed envelope containing the order of the rTMS sessions for a given patient. The order remained unknown to the physician collecting clinical data."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: 2 participants apparently lost to follow‐up and not obviously accounted for in the analysis. However, this is less than 10% and is unlikely to have strongly influenced the results
Selective reporting (reporting bias)	Low risk	Comment: medial‐lateral coil orientation condition data not presented but provided by study authors on request
Free from carry‐over effects?	Low risk	Comment: a 2‐week washout period was observed between stimulation conditions and possible carry‐over effects were checked and ruled out in the analysis
Study Size	High risk	Comment: < 50 participants per treatment arm
Study duration	Unclear risk	Comment: ≥ 2 weeks but < 8 weeks' follow‐up
Other bias	Low risk	Comment: no significant other bias detected