What is Transcranial Magnetic Stimulation (TMS) therapy?
TMS is an effective and validated treatment for depression, however, its role in the management of other non-psychiatric conditions is only beginning to reveal itself. TMS can be considered a neuromodulation technique that serves to normalise the connectivity of damaged brain networks. Neuromodulation is a process of modulating nervous system signals. By implication, any condition that has issue with neurological information processing could be a source of TMS application. In fact, research is showing TMS’ potential benefit in the treatment of multiple nervous system conditions including multiple sclerosis, tinnitus, traumatic brain injury, stroke related disability, Alzheimer’s disease, Parkinson’s disease, autism, amyotrophic lateral sclerosis, obsessive compulsive disorder, post traumatic stress disorder and schizophrenia to name a few. Neuropathic pain, that is nerve related pain, is one area leading the charge of TMS’ treatment application.
TMS as a neuromodulation technique
Neuromodulation as a treatment for pain can be traced as far back as Ancient Greece when electric stingrays were used to treat the pain of childbirth and gout. Our improved modern understanding of the mechanism behind this was born out of Melzack and Wall’s gate theory of pain in 1965. The gate theory of pain tells us that non-painful stimulation of our nervous system will close so called nerve ‘gates’ to painful stimuli. This prevents pain signals travelling to our nervous system so we don’t feel pain. In 1967 Wall, Sweet and Avery took advantage of this ‘gate’ and created the first implantable stimulator. By stimulating non-painful nervous system pathways (for example the areas responsible for touch signals) they were able to gate off the painful pathways so that pain was not felt. In place of pain was the sensation of touch. This was the start of our modern-day usage of spinal cord stimulators.
Spinal cord stimulation works at the level of the spinal cord, but we know pain signals travel to a much higher centre of processing: the brain. It wasn’t until 1991 that Tsubokawa showed us that stimulating the brain could also benefit pain. But this was intrusive and subject to complication. Could we do this without any direct brain contact? Just 4 years later Migita reported the first case of magnetic brain stimulation successfully treating a patient with neuropathic pain. Through use of magnetic energy, we could modulate the painful signals occurring in the brain, but without the intrusiveness of direct brain contact. TMS for pain management was born!
Jean-Pascal Lefaucheur subsequently led the way in TMS pain therapy. Ultimately concluding in 2020 that “high frequency stimulation of the motor cortex has level A evidence for analgesic efficacy in neuropathic pain.” Put simply: magnetically stimulating the part of the brain that controls our movement can relieve nerve related pain. While neuropathic pain was shown to have the largest evidence base to support this claim, TMS’ potential treatment benefit was seen in numerous other pain conditions including migraine, complex regional pain syndrome, fibromyalgia, phantom limb and bladder pain syndromes.
How does TMS work?
The mechanism behind TMS’ success in treating pain is complex. The modulation of brain system networks occurs across multiple areas. Targeting not only the physical aspects, but also the emotional and thinking targets of pain processing. In this network of brain areas we know as the ‘pain matrix’ TMS enhances the body’s own release of pain relieving chemicals.
Why choose TMS?
The advantages of TMS are extensive. With the ever-increasing problem and failure of pain-relieving medications, TMS could be a viable and safer alternative. In fact, it could potentially assist in stopping harmful medications. TMS has few if any side effects, with scalp tenderness and headache being the most commonly reported problems that typically resolve by the 3rd treatment. As a non-invasive and non-medication treatment it has no known problems of interacting with existing medical therapies. It is convenient and time effective, with each session lasting no longer than 20 minutes. You could potentially drive in for your treatment and be back at work before your 30minute lunch break ends!
Are there any problems with TMS?
At least 10 sessions are needed before any analgesic benefit is likely to be seen. If there is a history of epilepsy care needs to be taken, but the risk is less than the use of an opioid medication and there are some studies that suggest TMS could help epilepsy! The exact means of sustaining the pain reduction is not yet clear, but regular maintenance sessions may be able to maintain the benefit seen. If you have any metalware above the level of your neck then TMS may not be right for you.
How can I get TMS?
Transcranial Magnetic Stimulation (TMS) can be considered an emerging treatment in the field of pain management. TMS is a non-invasive and safe alternative to medications and where other more conventional pain treatments have failed. TMS may be particularly effective for patients who also have other mental health conditions. At present Modalis is the only known service in Australia offering TMS for pain management.
Disclaimer
Anodyne is a multidisciplinary medical centre in Perth Western Australia. With a focus on patient centred approaches for pain and mental health recovery.
Any advice posted on our blog, website, or app is of a general nature and for informational purposes only. It is not intended to replace or substitute for any medical or other advice.
Anodyne makes no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical practitioner.
Want to know more?
Please visit www.modalis.com.au for more information or contact us at Anodyne on how to get involved in this exciting new treatment for pain.