Chronic Pain

TMS has been shown to have a rapid therapeutic onset for treating various neural disorders with extremely mild or no side effects. TMS is a safe, effective and rapid-acting treatment modality that works by using electromagnetism to stimulate specific parts of the brain.
The human brain is an electrical organ that functions through transmitting electrical signals from one nerve cell to another. Transcranial Magnetic Stimulation therapy can stimulate neurons to restore them back to normal functioning.

A recent study found that as little as 20 minutes of repetitive TMS over the left forward-most region of the brain – the prefrontal cortex – was associated with a 40% reduction in post-op morphine use. As with any scientific finding, replication is paramount. The study was replicated, and results were found to be the same as the original finding. Overall, patients who received real TMS (as opposed to a sham placebo TMS) used 36% less morphine and had remarkably lower ratings of overall post-operative pain than the patients receiving the sham (Borckardt et. al, 2008).

“Non-invasive unilateral repetitive transcranial magnetic stimulation (rTMS) of the motor cortex induces analgesic effects in focal chronic pain syndromes, probably by modifying central pain modulatory systems. Neuroimaging studies have shown bilateral activation of a large number of structures, including some of those involved in pain processing, suggesting that such stimulation may induce generalized analgesic effects.” (Passard et. al, 2007)

“All the various components of pain were relieved by rTMS: mostly the spontaneous pain, but also paroxysms and allodynia were concomitantly alleviated. Therefore, the use of rTMS alone is devoid of interest to manage patients with chronic pain in long term, but it could allow these patients to wait for surgical implantation with a good level of pain control, which could not be offered by analgesic drugs. Moreover, rTMS response could be a useful indicator of the success of the subsequent surgical procedure…In conclusion, motor cortex rTMS may be clinically useful in the management of chronic, drug-resistant pain to maintain a satisfactory level of pain relief in selected patients until the implantation of a cortical stimulator.” (Lefaucher et. al, 2004)

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Reflex Sympathetic Dystrophy

Short video on the use of TMS for RSD from SoCal TMS

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Fibromyalgia

“Fibromyalgia syndrome is a widespread musculoskeletal pain and fatigue disorder. Fibromyalgia means pain in the muscles, ligaments, and tendons—the soft fibrous tissues in the body. Most patients say that they ache all over. Their muscles may feel like they were pulled or overworked. Sometimes the muscles twitch and other times they burn.” (Fibromyalgia Network, 2007)

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Facts

• Approximately 3% to 6% of the population suffers from fibromyalgia.
• More women than men are afflicted with fibromyalgia (75% versus 25%) and it shows up in people of all ages.

Causes

• Persons suffering from fibromyalgia may be genetically predisposed to the syndrome
• Signs of symptoms can be traced back to childhood for most sufferers
• May be linked to myofascial pain syndrome, irritable bowel syndrome, hypoglycemia and various genitourinary symptoms

Signs and Symptoms

• Individuals afflicted with fibromyalgia experience “flare-ups” and symptom variation from day to day
• Persons may experience extended periods of remission, followed by short or long-term flares
• Patients may suffer from a mild, idiopathic form of the disease or a more somatoform type resulting from depression
• Signs of fibromyalgia include:
  • Increased sensitivity to touch
  • Overall pain and tenderness
  • Tingling and aching sensations
  • Muscle spasms, nerve pain and weak limbs
  • Sleep disruptions
  • Cognitive “fog” or overload

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Selected References

• Short EB, Borckardt JJ, Anderson BS, Frohman H, Beam W, Reeves ST, George MS. Ten sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: a randomized, controlled pilot study. Pain. 2011 Nov;152(11):2477-84.
• Mhalla A, Baudic S, Ciampi de Andrade D, Gautron M, Perrot S, Teixeira MJ, Attal N, Bouhassira D. Long-term maintenance of the analgesic effects of transcranial magnetic stimulation in fibromyalgia. Pain. 2011 Jul;152(7):1478-85. Epub 2011 Mar 11.
• Borckardt JJ, Smith AR, Reeves ST, Madan A, Shelley N, Branham R, Nahas Z, George MS. A pilot study investigating the effects of fast left prefrontal rTMS on chronic neuropathic pain. Pain Med. 2009 Jul-Aug;10(5):840-9. Epub 2009 Jul 6.
• Defrin R, Grunhaus L, Zamir D, Zeilig G. The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury. Arch Phys Med Rehabil. 2007 Dec;88(12):1574-80.
• Khedr EM, Kotb H, Kamel NF, Ahmed MA, Sadek R, Rothwell JC. Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J Neurol Neurosurg Psychiatry. 2005 Jun;76(6):833-8.
• Borckardt, J., Reeves, S., Weinstein, M., Smith, A., Shelley, N., Kozel, F., . . . George, M. (2008). Significant analgesic effects of one session of postoperative left prefrontal cortex repetitive transcranial magnetic stimulation: A replication study. Brain Stimulation, 122-127.

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*At this time, TMS is not FDA-approved for the treatment of acute or chronic pain, which would be considered an off-label application.