Background: Chronic pain is closely associated with dysregulation of the autonomic nervous system, often reflected by reduced heart rate variability (HRV). While observational studies have demonstrated this association, the extent to which pain interventions modulate HRV and the impact of individual factors on HRV changes remain unclear. Objective: To evaluate the impact of pain interventions on HRV parameters through meta-analysis of randomized controlled trials (RCTs), and to examine whether intervention type and individual factors such as body mass index (BMI) moderate HRV responses. Methods: We conducted a systematic review of 23 RCTs and a meta-analysis of 21 RCTs (1262 subjects) involving patients with acute and chronic pain. HRV outcomes were extracted pre- and post-intervention. Both between-group (active vs. sham/control) and one-group (pre-post within active group) analyses were performed for time-domain indices—standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), and percentage of successive normal-to-normal intervals > 50 ms (pNN50)—and frequency-domain indices—high-frequency (HF) and low-frequency (LF) components. Meta-regressions tested moderators including BMI, age, and pain phenotype. The protocol was registered in PROSPERO (CRD42023448264). Results: Twenty-three RCTs involving 1262 participants with a wide range of pain conditions were included. Meta-analysis of time-domain HRV parameters showed a trend toward improvement: SDNN (g = 0.435, p = 0.059) approached significance, while RMSSD (g = 0.361, p = 0.099) and pNN50 (g = 0.222, p = 0.548) showed smaller, non-significant effects. Frequency-domain analysis revealed a significant moderate reduction in the LF/HF ratio (g = −0.378, p = 0.003), suggesting a shift toward parasympathetic dominance. HF and LF showed small, non-significant changes. One-group meta-analysis confirmed significant improvements in vagally mediated HRV, with large effects for RMSSD (g = 1.084, p < 0.001) and HF (g = 0.622, p < 0.001), and a moderate effect for SDNN (g = 0.455, p = 0.004). Meta-regression identified BMI as a significant moderator: higher BMI was associated with attenuated improvements in HF and RMSSD and a slight shift toward sympathetic predominance. Conclusions: Pain interventions can significantly modulate autonomic function, as reflected in HRV improvements, particularly in vagally mediated indices. These effects are influenced by patient characteristics such as BMI. HRV may serve as a valuable biomarker for both treatment efficacy and autonomic recovery in pain management. In this context, HRV highlights its role as a biomarker for pain dysregulation and compensatory failure, reflecting shared top-down modulation between nociception and autonomic regulation.

Introduction: Multiple sclerosis (MS) can trigger difficulties in communication. Transcranial magnetic stimulation (TMS) is a treatment option. Objectives: To analyze the self-reported communicative ability of people with MS undergoing TMS. Methods: The protocol consisted of 10 interventions by TMS (primary motor cortex, left dorsolateral pre-frontal cortex). The domain 1 of the self-administered WHODAS 2.0 Disability Rating Scale was used before and after (30 days) TMS to identify patient’s opinion of communication. Scores ranged from 0 = minimum difficulty to 100 = maximum. Results: The study comprised 30 people with MS: 22 women, 8 men, age 33– 68 years (mean = 50.0, standard deviation [SD] = 10.6), EDSS 0-6.5 (mean = 4.6, SD = 1.9), time diagnostic 1–24 years (mean = 10.0, SD = 7.2). All patients mentioned preserved ability for general understanding of the interlocutors’ speech. Prior to TMS, n = 18/60% had moderate difficulty concentrating (including speech content/subject), moderate/severe to n = 24/80% in recent memory, n = 10/33%) in problem solving, and n = 10/33% in learning, fundamental mental and reasoning activities for communication, activity reported with a moderate degree of difficult in n = 18/60% to start and maintain conversations due to inability to recall words (language disorder) or impairment in speech intelligibility (dysarthria). Self-reports pointed to a decrease in difficulties after TMS. Conclusion: We observed that WHODAS 2.0 seems to be a favorable both to identify the patient-reported outcome measures about the communicative difficulties, and to analyze the effects of TMS, which, in turn, showed potential to improve verbal communication and requires longitudinal investigation.

Introduction: Multiple sclerosis (MS) causes various cognitive symptoms. Transcranial magnetic stimulation (TMS) is a resource used for stimulation. Objectives: To evaluate the effects of TMS on the working memory of people with MS. Methods: A double-blind crossover study was carried out with 29 people diagnosed with MS (18 relapsing-remitting, 6 primary progressive and 5 secondary progressive), aged between 29 and 68 years (mean = 47.2, standard deviation [SD] = 10.9 years), 9 men (31%) and 20 women (69%), with EDSS from 0 to 6.5 (mean = 4.3 and SD = 1.85) and diagnosis time between 1 and 24 years (mean = 9.5 and SD = 6.57 years). The active group received 10 TMS interventions (primary motor cortex (Cz): 10Hz, 50 pulses per time, 30 trains, 20 seconds apart, totaling 1,500 pulses at 90% of the resting motor threshold and pre -left dorsolateral front (F3): 10 Hz, 50 pulses per train, 40 trains, 20 second interval, totaling 2,000 pulses at 110% of resting threshold) for 10 consecutive working days. The sham group received the inactive TMS and participated in the physical activities. After 30 days, there was an inversion of the active and sham groups for a new sequence of 10 days. For evaluation, an interview was conducted for data collection and the subtest Digits of the Wechsler Intelligence Scale (WAIS-III) was applied at the beginning and end of the stimulations. The chi-square test was used for statistical analysis. Results: 55.2% of people who received active TMS improved, against only 27.6% of people who received sham TMS. This difference was significant with P = 0.033. Conclusion: TMS appears to be an important resource for treating the working memory of people with MS. This result may encourage further research.