Chronic Pain

Condition

Chronic pain is defined as pain that lasts longer than 6 months.

The pain can range from mild to excruciating and may be either episodic or continuous. A condition of continuous, excruciating pain is completely debilitating and patients feel unable to do anything normal. It can take a heavy toll both physically and emotionally, affecting work, home life and mental health too.

Signs and Symptoms of Chronic Pain

  • Ongoing or recurring pain that does not go away
  • Mild to severe pain
  • Shooting, burning, aching, or electrical sensations
  • Discomfort, soreness, tightness, or stiffness
  • Mental health issues including low esteem, depression, irritability, anxiety, stress

Causes/Triggers

There is no one specific or exact cause of chronic pain – factors may include:

  • Trauma – an injury or accident  which triggers ongoing chronic pain
  • Illness/infection

Sometimes there is no identifiable cause.

Conventional Treatments

Treatment for chronic pain will depend to a certain extent on its cause. Options may include:

  • Medication – to deal with the pain on a daily basis
  • Surgery – where there is a specific source to the pain and surgery is appropriate e.g. back
  • Alternative therapies – therapies such as acupuncture, hypnotherapy or meditation may be considered

rTMS at The Smart Clinics in London

Transcranial Magnetic Stimulation therapy treatment is available at Smart TMS, based at The Smart Clinics, Brompton Cross, London. Smart TMS was the first UK clinic to offer rTMS treatments for chronic pain.

On the basis of research, we believe that rTMS – Repetitive Transcranial Magnetic Stimulation could offer sufferers of chronic pain an alternative treatment option using transcranial magnetic stimulation to work directly on the associated areas of the brain. It would also offer the benefit of being a non-medication approach, avoiding potentially unpleasant side-effects associated with drugs.

To discuss this further, please contact us.

Chronic Pain and TMS Treatment

Evidence, Research and Studies

There is evidence from research that rTMS reduces pain in chronic facial pain, chronic neuropathic pain and chronic post herpetic (shingles) pain.

Research Studies

Fifty five with chronic facial pain were given rTMS (19 with cluster headaches,; 21 with trigeminal neuropathic pain, and 15 with atypical facial pain).  rTMS was given for 5 days per week for two consecutive weeks, followed by a “maintenance phase” of two sessions during one week, then one session in weeks 4 and 6, and a monthly session for the next five months.  All the pain scores significantly decreased from day 1 to day 15: the intensity of permanent pain reduced from a score of 5.2 to 3.2 and paroxysmal pain reduced from 8.6 to 4.5, and the daily number of painful attacks reduced from 5.6 to 2.3.  The percentage of responders (defined as a pain score decrease of more than or equal to 30%) was 73% at day 15 and this dropped to 40% at day 180.  The analgesic effect was similar regardless of the type of pain (Hodaj et al, 2015).

A meta-analysis of the analgesic effect of high frequency rTMS on neuropathic pain patients was conducted.  Twenty-five studies (including 32 trials and 589 patients) were selected for the meta-analysis.   The results showed that all types of high frequency rTMS treatments produced pain reduction, with the maximal pain reduction found after 5 sessions of rTMS treatment.  Further, this significant analgesic effect remained for one month after 1 to 5 sessions of rTMS treatment.  It was concluded that rTMS stimulation is effective in relieving pain in neuropathic pain patients.  Five sessions of rTMS treatment produced a maximal analgesic effect and may be maintained for at least one month. (Jin et al, 2015),

In a randomised controlled study 17 patients patients with neuropathic pain due to lumbosacral radiculopathy were given rTMS.  This was found to be superior to the control group in terms of reducing pain intensity.  rTMS also lowered induced pain thresholds   It was concluded that rTMS is effective in patients with neuropathic pain due to lumbosacral radiculopathy (Attal, et al, 2016).

Twenty patients, with post-herpetic neuralgia pain, of over 6 months duration were given 10 sessions of rTMS and compared to a control group.  The real rTMS group demonstrated greater reduction of self reported pain scores than the control group.  The mean reduction in the pain scores in the rTMS group was 17%.  These analgesic effects were associated with long-term improvements in the quality of life.  The results suggest that rTMS is an effective and safe therapy in patients with post-herpetic neuralgia (Ma et al, 2015).

If you would like to discuss the use of rTMS in the treatment of chronic pain please contact Dr Neal oninfo@smartrtms.co.uk.

References

  • Attal et al (2016) Repetitive transcranial magnetic stimulation and transcranial direct current stimulation in neuropathic pain due to radiculopathy : a randomized sham controlled comparative study.  Pain.  Epub ahead of print. 
  • Hodaj et al . (2015) Treatment of Chronic Facial Pain Including Cluster Headache by Repetitive Transcranial Magnetic Stimulation of the Motor Cortex With Maintenance Sessions:  A Naturalistic Study. Brain Stimul (4):801-7.
  • Jin et al (2015) High Frequency Repetitive Transcranial Magnetic Stimulation Therapy For Chronic Neuropathic Pain: A Meta-analysis. Pain Physician. 18(6):E1029-46.
  • Ma et a(2015) l High-Frequency Repetitive Transcranial Magnetic Stimulation Reduces Pain in Postherpetic Neuralgia Pain Med16(11):2162-70.