Dosage and safety of transcranial magnetic stimulation and transcranial direct current stimulation for managing patients with chronic musculoskeletal pain: a scoping review protocol.

Abstract

Although emerging evidence supports the short-term efficacy of transcranial magnetic stimulation (TMS), including repetitive TMS (rTMS) and theta-burst transcranial magnetic stimulation (TBS-TMS), and transcranial direct current stimulation (tDCS) for managing patients with chronic musculoskeletal pain (CMP), their clinical utility in managing CMP remains inconclusive. This uncertainty may arise from methodological limitations, including heterogeneity in treatment parameters such as stimulation targets and dosages. Additionally, safety profiles for these non-invasive brain stimulation interventions in patients with CMP remain insufficiently reported, with limited data on adverse events, cumulative risks and long-term safety outcomes. Hence, in this scoping review protocol, we aim to systematically (1) identify and map the stimulation targets and dosages of TMS and tDCS used in previous studies to treat patients with CMP; (2) summarise the rationale for using the stimulation targets and dosages of TMS and tDCS; and (3) summarise the reports on the safety of TMS and tDCS in managing patients with CMP, including whether safety was reported and how it was described. We will adopt Arksey and O'Malley's methodological framework and report findings according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Two authors will independently screen articles and extract data from PubMed, Scopus, Web of Science and Embase, including publications from inception to 1 August 2025. Discrepancies regarding study inclusion will be resolved through consultation with a third author. We will synthesise results using descriptive statistical methods. This scoping review does not require ethical approval. The findings will be disseminated through presentation at national or international conferences and peer-reviewed publication. Open Science Framework (Registration DOI: https://doi.org/10.17605/OSF.IO/8HFBZ).