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TMS and its Effect on Chronic Pain

Chronic Pain
Signs and Symptoms
Causes and Triggers
Conventional Treatments
TMS Therapy for Chronic Pain

 

Chronic or severe pain can range from mild to excruciating, felt in brief moments, be gradual in pain, or reside in a continuous manner or in episodic attacks. This pain can usually last more than 6 months, depending on its cause. Also, chronic pain can physically affect a person, their mood, performance at work or school, and even their intellectual and cognitive functions.

 

Chronic Pain

Chronic pain is one of many medical mysteries known to man. Doctors have their own limitations in treating this chronic pain, its effective treatment and different kinds of dilemmas. Chronic pain can result in other different disorders like anxieties, worries, depression and poor cognitive performance.

Pain is one harsh sensation that can happen to a person. Commonly experience inside body tissues, but most studies revealed that chronic pain affects the lower back pain, neck pain, stomach, head, pelvic and other areas of the body.  But with a proper psycho-physiological assessment, pain can significantly improve even be eliminated.

Unfortunately, many people suffering from chronic pain don’t have any idea how to address their suffering. Not all conventional treatment to chronic pain can benefit everyone. Prescription medications that contain opioids commonly lead to drug addiction.

 

Signs and Symptoms of Chronic Pain

Signs and symptoms of chronic pain vary for everyone. Chronic pain has certain kinds of severity and source which makes it difficult to diagnose and treat. However, some signs and manifestations are as follows: continuous pain, from cute to chronic pain, an electrical sensation, aches, intellectual disorders like low self-confidence, easy to anger, stress, worries, anxieties and many more.

 

Causes or Triggers of Chronic pain

There is no single specific factor that cause chronic pain. But there are certain factors that can trigger the disorder such as cases of infection, injury, and different illnesses.

 

Conventional Treatments

Treating chronic pain includes taking medicines for the routine relief; doctors for surgery or operation can prescribe medications for a certain medical procedure. Some include alternative therapies like acupuncture and other traditional practices. But chronic pain treatment will depend to a certain extent on its cause.

Sadly, long-term use of these conventional treatments often leads to drug tolerance and drug addiction. As the rise of chronic pain disorders among people across the globe, the need for a safe and alternative treatment increases.

 

TMS for Chronic Pain

About 20 years ago, scientists develop Transcranial Magnetic Stimulation as a safe and alternative treatment for major depression. Due to its success, experts continue to stretch its parameters for treating other kinds of disorders.

Today, TMS could offer patients suffering from chronic pain their long waited relief from the discomfort.  TMS can work directly on regions of the brain associated with pain. It can provide a non-invasive and non-systemic approach, avoiding adverse side effects associated with pain medication drugs.

Some painful sensation responds accordingly to antidepressants, anticonvulsants, and opioid agonists. But these drugs also carry deadly side effects. So there is still a growing need for a safe and effective therapeutic option.

Fortunately, TMS provides effective and fast relief of chronic pain using electromagnetic waves targeting the brain cells associated with pain. It’s an affordable and simple procedure and it gives no dangerous side effects to the body. TMS uses magnetic stimulation of brain nerve cells that are related to chronic pain. These waves can modulate cortical excitability and at the same time inhibit pain perception in the brain. This method can significantly improve symptoms of chronic pain in patients.

The TMS machine uses a coil placed near on top of the head to stimulate the cortical regions of the brain. This strategic location along with the correct threshold can effectively stimulate brain cells. The procedure is safe and does not elicit adverse effects. Some TMS clinics use H-coils and used to stimulate the lower-limb motor cortex, an area in the brain tucked deep within the medial longitudinal fissure that controls motor skills. One study shows that deep TMS has significant results to patients suffering from diabetic neuropathic pain. Experts saw improvement in relieving chronic pain symptoms in these patients.

As a non-invasive procedure, it does not need any hospitalization or anesthesia. Most of its side effects are well tolerated and diminishes over time as treatment session continues. Treatments usually take place inside the doctor’s office and patients are kept wide awake. TMS does not require any anesthesia or similar drugs; patients can easily go back to their normal daily routine after each session. This makes TMS as an ideal treatment option for patients with a strict schedule to follow.

 

How was TMS First Done?
Brain Stimulation Research
Uses of TMS

The first known brain stimulation attempts using electromagnetic stimulation goes as early as 1896 when Jacques-Arsene d”Arsonval of Paris and Silvanus P. Thompson showed the first ever prototype in London. However, it was not until 1985 when Anthony Barker and his team showed the first successful demonstration of Transcranial Magnetic Stimulation at the Royal Hallamshire Hospital in Sheffield, England.

 

How Was it Done?

Barker and his team essentially took a leaf out of Michael Faraday’s book. They made a single Faraday coil and place it above the left prefrontal cortex using a motor strip and saw the right hand moved. Barker’s team first did the experiment on themselves. This single yet monumental experiment created ripples within the medical community. The result created excitement and interest in the international research community about using TMS for various medical usages. Because of such feat producing concrete proof that electromagnetic stimulation of the brain showed a direct tissue response, the medical community credited Anthony Barker as the inventor of TMS.

 

Brain Stimulation Research Studies

Since its discovery, there was an exponential growth of different international studies on brain stimulation. Majority of these studies focuses on the use of TMS in treating different mental disorders, side effects, and most importantly – its efficacy. Today the field has garnered enough topics to have its own called Brain Stimulation.

 

TMS Uses

Health Canada was the first government body to approve the use of TMS in 1997. Soon after, it got its first official use in treating resistant depression in 2002. The US Food and Drug Administration approved TMS therapy in 2008 after taking into consideration its risk and efficacy.  

Today, TMS machine uses electromagnetic wave pulses similar to an MRI machine; it’s generally safe for everyone. Medical providers placed the coil near the prefrontal cortex of the brain associated with depression symptoms. The electromagnetic waves suppress overacting brain regions while activating inactive brain cells. This creates a new chemical balance within the brain structures thus relieving the patients with the depressive symptoms. It’s a simple procedure that does not require any hospitalization, anesthesia, or surgeries. Patients undergoing TMS therapy are kept fully awake and can immediately resume their daily routine following the session.

Some studies even show that lasting effect of TMS without relapse and even without taking antidepressant medications. Numerous research studies have been published since its approval and TMS therapy consistently show great promise of treating resistant major depressive disorder and other mental health diseases.

Just recently, the 2nd International Conference on Brain Stimulation Conference in Barcelona, Spain held on March 6, 2017, awarded Anthony Barker, Ph.D. the International Brain Stimulation award. About a thousand or more people from across the globe attended the conference with professionals from a myriad of disciplines such as neurosurgeons, neurologists, biomedical engineers, psychiatrists, and researchers.

The conference was a great platform for speakers from the international community to present their data and research about the different types of brain stimulation topics. For several days, topics like TMS, deep TMS, ECT, vagus nerve stimulation, effects of ultrasound on brain tissue, and other invasive brain stimulation were presented to the public.

But the highlights of the studies include topics of the potential uses and indications for TMS therapy. Some experts showed different types of research about the future use of TMS for treating addictions such as cocaine, opiates, alcohol, nicotine and even obsessive-compulsive disorder. There was even a research that shows great promise for the potential benefits of TMS in treating pain sufferers and for stroke rehabilitation.

With its success of treating major depressive disorders with no or minimal side effects, TMS therapy is the focus of widespread research studies. TMS providers continue to seek and explore its uses in treating various disorders.

 

Transcranial Magnetic Stimulation or TMS is far from being a miracle, but the procedure has opened new ways to understand the brain. These ways are different from functional MRIs which view the activity of the brain in real time. TMS allows us to see the deeper and more subtle result of stimulating our brain cells. It allows us to identify what part of the brain does what, more accurately.

 

If you break the process down to its simplest steps, it’s basically putting an electromagnet on top of your head. The magnet activates in pulses using a machine that controls both the strength and the frequency. The electromagnet’s activation causes a somewhat loud “tick” sound akin to the sparks of electricity when inserting an electric plug into a socket. The machine generates high voltage bursts that deliver powerful electromagnetic waves. But despite the raw power fed to the magnets, it’s harmless to the receiver.

 

TMS Parts in General

There are two kinds of TMS. There’s the original TMS where there’s a large electromagnetic coil positioned on a certain part of your head to deliver single pulses. The other one is called Repetitive Transcranial Magnetic Stimulation or rTMS. It’s often a smaller pair of the electromagnet that delivers repetitive weaker bursts of electromagnetism over a period of time. Both of them have the same general parts.

 

The Electromagnets or Conductors

While it can be explained as simply aiming the magnets, how it actually works is a bit more complex. The magnets are composed of two coils that deliver a “beam” of electromagnetism. The two beams on their own are weak and won’t affect the brain that much. When they cross, however, the combined energy is enough to properly stimulate whichever part they land on. This is how TMS can stimulate specific parts of the brain.

 

The Pulse Generator

Basically, the machine that generates electricity to activate the electromagnets. The machine comes with a control panel that allows the user to alter the amount of electricity that flows to the electromagnet. They can also control the frequency of the pulses. The pulse generators are relatively large and heavy. But recent advancement in technology allowed development of smaller, semi-portable machines.

 

All in One TMS Machines

Since machines are getting smaller these days, so are TMS pulse generators. There are commercially released products where the magnet and the pulse generators come as one device. These relatively lightweight devices can be placed on your head to deliver pre-programmed frequencies.

 

The key to getting the right effect is to conduct the therapy continuously. TMS clinics offer programs that have 40-60 minute sessions every day for 5-7 days a week, lasting for 20-30 days. On average, people experience improvements in their depression and anxiety. What concerns most first-time users are the lack of sensations during the first few rounds of stimulation. Proof that it affects the brain is shown through the muscle twitches caused when the magnet is aimed at the motor part of the brain which controls your muscles. The procedure is indeed slow, which is important as so to avoid causing stress or damage.

 

The brain is perhaps the most complicated organ in the world. Millions of neurons communicating in countless ways. They work millions of times per second, all ensuring that you live longer than 2 minutes. Complicated systems also have complicated problems, which often need complicated solutions. Yet as we discover more about our brain and how we can affect it, solutions for problems such as depression, tend to get simpler.

So simple that it involves putting a magnet over your head for an hour or less, every day for a month.

 

What is TMS?

TMS is short for Transcranial Magnetic Stimulation. As the name states, it’s using electromagnets to stimulate areas beyond the skull, specifically, certain parts of the brain. The TMS machine consists of the electromagnetic coils that deliver the magnetic pulses and the pulse generator. This is a machine that delivers precise amounts of electric current to the magnet.

 

What is Depression?

It’s feeling sad, but not the everyday sadness you feel when you, for example, dropped your cold ice cream on hot, stressful day. Depression is an intense kind of sadness that can last for days, even weeks. It can affect your way of thinking, making it progressively worse. It can resolve itself into Clinical Depression, a treatable medical condition.

How Does it Work?

It works by activating a pair of electromagnetic coils about half an inch above your scalp. The two coils deliver a relatively weak pulse of electromagnetism, not enough to affect your brain in any significant way. Where the two waves meet, however, causes a significant electromagnetic effect. The effect is strong enough to make your hand or foot twitch when the coil is aimed at the motor area of the brain. Yet, weak enough that it doesn’t cause any significant damage, even after an daily, one-hour exposure over a month.

 

Using this targeted method, TMS can stimulate certain parts of the brain. People suffering from depression have decreased activity in certain parts of their brain. Specifically, these are the areas that create or govern the creation of Dopamine, a brain chemical that causes happiness. TMS can stimulate these areas to help restore normal function. Think of it as physical therapy on an arm or leg that has been cast for 4 months. TMS “flexes” and “massages” the problem areas, allowing these parts to work normally when they need to.

 

The full therapy varies depending on the severity of the depression. According to many clinical trials and anonymous patient data, 4-6 weeks of therapy caused improvements about 95% of the patients. The 5% are those unfortunate to have developed adverse effects. This is either through pre-existing conditions or could not handle the therapy due to side effects such as dizziness and nausea.

 

Continued therapy is encouraged well after the month-long procedure to minimize remission. Though there are still a number of patients who went into remission after stopping the procedure, TMS still holds a candle when it comes to non-invasive or drug therapies for depression.

 

Migraines are not your ordinary headaches. Sometimes, a headache is caused by a simple lack of sleep. Other times, it’s caused by stress. But what separates migraines from headaches is that they are severely painful and recurring.

 

Migraine Buildup

An important factor that separates them is that Migraines often come with warning signs. In some people, their vision gets distorted somehow, becoming sensitive to light and sounds, or feeling intense nausea eventually leads to vomiting.

There’s no known single trigger for a migraine, but there are plenty of identifiable reasons that lead to migraine triggering. A majority of the “leads” are stress, food and drink, and sleep (specifically, lack thereof), which could also cause common headaches in some people. In some cases, it could even be feeling a certain emotion, such as feeling sad. There is no one cause, but there’s a whole range of solutions.

 

Medication

Medications works against migraines, but not everyone can tolerate meds and there are patients who get no benefit from those meds. Though the medication can be as simple as over-the-counter drugs, recurring pain can get in the way of normal life. The drugs don’t work 100% and in some cases only work briefly to “take the edge off”.

 

Transcranial Magnetic Stimulation for Migraines

That’s where TMS -Transcranial Magnetic Stimulation- is used for migraine treatment. The procedure is literally putting a magnet on your head. The statement alone can raise speculation, but it’s a bit more complicated than that.

Your brain triggers signals by using electricity. It’s been recorded that your brain uses around 20 volts electricity on average. Electromagnetism can deliver a harmless charge that activates neurons. By using the TMS machine to activate your neurons, it can “massage” parts of your brain that do not function correctly into functioning correctly.

Though there’s no clear trigger when it comes to migraine episodes. Research into brain activity during a migraine points out over-activity in one or more regions of the brain. TMS will stimulate the occipital cortex, which can suppress a migraine by calming brain activity. It may not treat a migraine when it’s already there but could reduce the intensity of the next attacks, or halt it from happening altogether.

 

TMS Accessibility

TMS therapy for a migraine doesn’t even have to happen in a clinic anymore. Portable versions of the TMS machine is now available, so you can do the therapy in the comforts of your own home. The devices, just like the TMS machine, deliver short but precise bursts of electromagnetism. They are to be placed on the back of your head and used for about 20-30 minutes.

As far as success goes, it was enough for the Food and Drug Association (FDA) to approve TMS as a treatment for a migraine. People who use TMS therapy either found themselves relieved of a migraine for the whole day. The continued use resulted in many patients finding themselves pain-free, even without daily TMS sessions.

TMS technology is moving forward every passing day. First, it was initially used to study the brain and map it out. As our understanding of the brain advanced further, we come up with more ways to use electromagnetism as a way to treat imbalances in our brain. Put it simply, it’s only going to improve as research goes deeper.

To make an appointment with TMS of the Palm Beaches, please contact us at your earliest convenience. We are also here to answer any questions you might have, including about the applicability of your insurance for undergoing TMS treatment.

 

The idea of placing magnets on your head may seem odd as a medical procedure. But, nowadays, it is a method used to treat many mental conditions. This treatment, like any other therapies looking to treat mental illnesses, doesn’t offer an absolute guarantee for success. So, how successful is Transcranial Magnetic Stimulation?

 

How TMS Works

Transcranial Magnetic Stimulation is exactly that. They place a high power electromagnet on key places on your scalp or forehead. This is to deliver magnetic pulses that affect your brain cells. There is no surgery, needles, cutting, or any other invasive procedures involved other than maybe a little adhesive. TMS stimulates certain areas of the brain, targeted to treat depression. According to some research, it also has potential to treat autism or Asperger’s.

 

An Alternative to Pills

People who seek alternatives to dangerous mood-controlling medications can now turn to Transcranial Magnetic Stimulation. In some cases, people who suffer depression do not respond to psychiatric drugs. Some cannot tolerate the drugs or find other holistic methods ineffective. In other cases, patients cannot use drugs to treat their conditions. An example would be pilots or other people who need to be functional while under treatment and cannot take psychoactive drugs.

Depression is a gripping condition. It cannot easily be detected due to a person’s inclination to isolate themselves. The condition can go undetected due to ignorance and misinformation of people around the affected person. This is often the case for adolescents who cannot tell depression from the normal roller-coaster emotions of puberty. If left unattended, depression can lead to further damages to the person quality of life. In severe cases, it can end in suicide or other permanent damage.

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TMS Success Rate

According to most clinics that offer TMS, the success rate of treating persistent depression with TMS range between 70% to 80%. In severe cases of depression, the full treatment has a 60% to 75% success rate. This is to fully treat or significantly reduce the symptoms. The treatment involves numerous sessions, lasting 25 or more procedures. The effect is gradual and may come with some side effects, but all can be managed. Once a patient reaches about half the recommended treatment cycles, dramatic improvements can be seen.

The success rates are not just from the treatment alone. Like all manner of conditions such as addiction, maintenance is key. The success rate is solid, but maintenance is what keeps remission at bay.

Nearly 20% of patients who undergo this treatment do not produce successful results. But for those who did find the treatment effective, their lives have been changed for the better. Their days in the dark have brightened to a colorful new perspective. They are given hope for better living that everyone else experiences naturally. This chance of a better life reflects how TMS can offer a positive impact.

Still, TMS is still a young technology. Further clinical trials are done every day to see how else TMS can improve and affect the brain. There are clinical trials already set to try TMS treatment on people suffering from constant migraines. Further research can only tell how we can benefit from TMS and how the therapy can be used more effectively.

To set up an appointment for TMS in Florida or to simply ask any questions you might have about the procedure, feel free to contact us anytime.

 

Before modern techniques, electrodes were surgically implanted in the brain to treat pain. But this invasive procedure has many drawbacks. Nowadays, a non-invasive treatment for pain holds promise for patients. This popular treatment is called Transcranial Magnetic Stimulation (TMS).

Before we delve into TMS, let us dig deeper into the mechanism of pain.

 

What Is Chronic Pain?

Chronic pain refers to the pain that lasts more than 6 months. This painful experience can range from mild to excruciating degrees. It may also be continuous or episodic. When the pain is both continuous and excruciating, patients are often left unable to complete daily tasks. It leads to both physical and emotional problems. This, in turn, leads to negativity at work, home, business, relationships, and mental health.

Chronic pain is usually caused by trauma (e.g. injury, accidents). It can also be caused by an illness or infection. Signs and symptoms of chronic pain include the following:

  • Recurring or ongoing pain that does not go away
  • Mild to excruciatingly severe pain
  • Sensations of shooting, aching, burning
  • Stiffness, soreness, discomfort, and tightness
  • Mental health issues such as depression, anxiety, irritability, stress, and low self-esteem

 

TMS For Pain Management And Treatment

TMS is used to treat chronic pain and major depression. The brain’s circuit activity is altered by the magnetic field produced by TMS. This method has a huge advantage over pain prescription medications. Drugs usually get inside the body causing a large number of side effects. On the other hand, TMS produces minor side effects since the therapy is directly delivered to the brain.

 

Evidence Of TMS Efficiency In Treating Pain

A study has found out that the repetitive implementation of TMS to patients resulted in a consistent reduction of pain scores.  The results showed that pain scores were reduced by 15% for a week. But, scientists encourage more research in regard to TMS. This is to improve its efficiency in managing and treating pain.   

 

How Is TMS Applied?

Clinical studies found out that the motor cortex is the best target for TMS and its treatment of pain. Repetitive TMS (rTMS) is also given to patients. In this method, series of pulses are targeted to the brain and is delivered in rapid succession. This is all done in a single session. But, different techniques are applied to different people. This is due to the fact that people vary in their reactions to TMS treatments.  

To provide a long-lasting pain treatment, multiple sessions of repetitive TMS (rTMS) is delivered to the patient. Multiple sessions affects the connectivity of the brain. It can alter the circuits responsible for pain thus reducing it. Some treatments are required to be administered daily during the early phases. Then, it is reduced to weekly therapies and monthly therapies. Treatments can last for months or even year.

 

In Conclusion

TMS is best used to treat pain and depression. It is recommended for those who experience debilitating side effects from prescription medications. TMS is used to alter brain activity. Doing this non-invasive procedure also results in a few side effects, making it a great alternative for those who don’t respond well to medication.

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TMS of the Palm Beaches

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