Fregni 2011

Methods	Parallel RCT
Participants	Country of study: USA Setting: laboratory Condition: chronic visceral pain (chronic pancreatitis) Prior management details: most on continuous opioid therapy, most had received surgery for their pain n = 17, 9 in active group, 8 in sham group Age mean (SD): active group 41.11 (11.27) years, sham group 46.71 (13.03) years Duration of symptoms: > 2 years Gender distribution: 14 F, 3 M
Interventions	Stimulation type: rTMS Stimulation parameters:frequency 1 Hz; coil orientation not specified, number of trains 1; duration of trains not specified; intensity 70% maximum stimulator output, total number of pulses 1600 Stimulation location: SII Number of treatments: 10, x 1 daily (weekdays only) Control type: sham rTMS coil
Outcomes	Primary: pain VAS; 0 = no pain, 10 = most intense pain imaginable When taken: daily pain logs for 3 weeks pre‐intervention, daily post‐stimulation during intervention period and at 3‐week follow‐up Secondary: none relevant
Notes	COI: no declaration made Sources of support: support from Harvard Thorndike Clinical Research Center/ NIH
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Patients were randomised (using a computer generated list with blocks of 4)"
Allocation concealment (selection bias)	Unclear risk	Comment: allocation concealment not specified
Adequate blinding of participants?	Low risk	Quote "The sham and real TMS coils looked identical and were matched for weight and acoustic artefact. This sham coil induces a similar tapping sensation and generates the same clicking noise as the real TMS coil, but without induction of a significant magnetic field and secondary current." Comment: sham appears optimal
Adequate blinding of assessors?	Low risk	Quote: "The pain evaluation was carried out by a blinded assessor"
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Comment: dropout/withdrawal not reported
Selective reporting (reporting bias)	High risk	Comment: reporting of pain scores incomplete across all time points
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 values not presented by group for key outcome variables