Defrin 2007

Methods	Parallel RCT
Participants	Country of study: Israel Setting: outpatient department Condition: post‐SCI central neuropathic pain Prior management details: refractory to drug, physical therapy and complementary therapy management n = 12 Age: 44‐60 years; mean 54 (SD 6) Duration of symptoms: > 12 months Gender distribution: 7 M, 4 F
Interventions	Stimulation type: rTMS, figure‐of‐8 coil Stimulation parameters: frequency 5 Hz; coil orientation not specified; 115% RMT; number of trains 500; duration of trains 10 s; ITI 30 s; total number of pulses 500 reported, likely to have been 25,000 judging by these parameters Stimulation location: M1 ‐ midline Number of treatments: x 10, x 1 daily on consecutive days Control type: sham coil ‐ visually the same and makes similar background noise
Outcomes	Primary: 15 cm 0‐10 VAS pain intensity, anchors "no pain sensation" to "most intense pain sensation" When taken: pre and post each stimulation session Secondary: McGill pain questionnaire When taken: 2‐ and 6‐week follow‐up period
Notes	AEs: not reported Sources of support: supported by the National Association of the insurance companies. COI: study authors declared no COI
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: method of randomisation not specified Quote: "Patients were randomised into 2 groups that received either real or sham rTMS"
Allocation concealment (selection bias)	Unclear risk	Comment: allocation concealment not specified
Adequate blinding of participants?	Unclear risk	Quote: "Two coils were used; real and sham, both of which were identical in shape and produced a similar background noise." Comment: sham credibility assessment ‐ suboptimal. Sham coil controlled for auditory cues and was visually indistinguishable from active stimulation, but did not control for sensory characteristics of active stimulation over the scalp. Given that stimulation was delivered at 110% RMT active stimulation, but not sham, it is likely to have elicited muscle twitches in peripheral muscles
Adequate blinding of assessors?	Low risk	Quote: "The patients as well as the person conducting the outcome measurements were blind to the type of treatment received."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: only 1 participant withdrew for "logistic reasons". Unlikely to have strongly influenced the findings
Selective reporting (reporting bias)	Low risk	Comment: while group means/SD were not presented in the study report, the study authors provided the requested data
Study Size	High risk	Comment: < 50 participants per treatment arm
Study duration	Unclear risk	Comment: ≥ 2 weeks but < 8 weeks' follow‐up
Other bias	Unclear risk	Comment: baseline differences observed in pain intensity levels (higher in active group)