Non‐Invasive Brain Stimulation in Chronic Pain: Current Evidence, Network Perspectives and Paths to Personalization

ABSTRACT Chronic pain is increasingly conceptualized as a network‐level neuroplasticity disorder involving maladaptive interactions among sensory, affective‐salience, and descending modulatory pathways. This narrative review synthesizes evidence for non‐invasive brain stimulation (NIBS) in chronic pain—transcranial magnetic stimulation (TMS), transcranial electrical stimulation (tES), and low‐intensity transcranial focused ultrasound (LITUS)—and outlines systems neuroscience‐grounded routes to personalization. High‐frequency motor cortex rTMS shows the most consistent, though modest, short‐term analgesic effects, especially in neuropathic pain and fibromyalgia, and currently has the strongest guideline support. tES, particularly tDCS, produces small, heterogeneous benefits with low‐certainty evidence, whereas tACS and tRNS remain largely experimental. LITUS provides millimeter‐scale focality and access to deep pain‐relevant structures, with early preclinical and human studies suggesting promising but preliminary analgesic effects. Across modalities, responses are highly variable and usually short‐lived, reflecting reliance on population‐derived targets and protocol‐based dosing that disregard individual network organization. We highlight emerging strategies for target and parameter personalization, including graph‐theoretical targeting, individualized electric/acoustic field modeling, and closed‐loop neuromodulation guided by electrophysiological and imaging biomarkers, to enable more mechanism‐ and network‐informed, phenotype‐sensitive NIBS for chronic pain.