Onesti 2013

Methods	Cross‐over RCT
Participants	Country of study: Italy Setting: laboratory n = 25 Condition: neuropathic pain from diabetic neuropathy Prior management details: resistant to standard therapies for at least 1 year Age mean (SD): 70.6 (8.5) years Duration of symptoms (months mean (SD)): not reported Gender distribution: 9 F, 14 M
Interventions	Stimulation type: rTMS using H‐coil Stimulation parameters: frequency 20 Hz; coil orientation H coil, number of trains 30; duration of trains 2.5 s; ITI 30 s, intensity 100% RMT, total number of pulses 1500 Stimulation location: M1 lower limb (deep in central sulcus) Number of treatments: 5 per condition on consecutive days Control type: sham coil, controlled for scalp sensory, auditory and visual cues
Outcomes	Primary: pain VAS 0‐100, no pain to worst possible pain When taken: immediately poststimulation, 3 weeks poststimulation Secondary: none relevant
Notes	COI: 2 authors have links to the manufacturer of the H‐coil Sources of support: no declaration made
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "After enrolment, patients were randomly assigned in a 1:1 ratio to two counterbalanced arms by receiving a sequential number from a computer‐generated random list."
Adequate blinding of participants?	Low risk	Quote: "Sham stimulation was delivered with a sham coil placed in the helmet encasing the active rTMS coil. The sham coil produced a similar acoustic artefact and scalp sensation as the active coil and could also mimic the facial muscle activation induced by the active coil. It induced only a negligible electric field inside the brain because its non‐tangential orientation on the scalp and components cancelling the electric field ensured that it rapidly reduced the field as a function of distance" Comment: controlled for visual auditory and sensory aspects of stimulation
Adequate blinding of assessors?	Unclear risk	Comment: while study described as "double blind" there was no specific mention of blinding assessors
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: only 2 participants lost to follow‐up
Selective reporting (reporting bias)	High risk	Comment: data not presented by stimulation condition ‐ rather they were grouped by the order in which interventions were delivered. No SDs presented. Data requested
Free from carry‐over effects?	Low risk	Comment: 5‐week washout period observed with no difference at T3
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 other bias detected