Chronic pain affects millions of people in the U.S., with more than 20% of adults (over 51 million individuals) struggling with ongoing pain in 2021 alone. Of these, nearly 7% experienced high-impact chronic pain that limited their daily activities, making everyday tasks feel challenging. With traditional pain management treatments sometimes falling short, many people are turning towards new options like Transcranial Magnetic Stimulation (TMS) for pain relief.
What is Chronic Pain?
Chronic pain is a persistent form of pain that lasts for months or even years beyond the expected period of healing. Unlike acute pain which is a temporary response to inflammation, injury, or illness and typically resolves within a short time frame, chronic pain continues despite treatment. It can be intermittent or continuous. Those affected may struggle with daily routines, suffer from a reduced quality of life, or face difficulties in working, eating, or enjoying physical activities.
Causes of Chronic Pain
The onset of chronic pain can be caused by several factors and sometimes persists long after the original injury or illness has healed. Common causes of chronic pain include:
- Aging
- Nerve damage and injuries
- Poor posture
- Diseases like arthritis, cancer, ulcers, or gallbladder disease
- Unknown sources where pain continues without a clear origin
Types of Chronic Pain
Chronic pain can come in many different forms. The way it feels depends on where it’s coming from, whether it’s due to an injury, a medical condition, or something going wrong in the body’s systems. Here are the three main types of chronic pain and what sets them apart.
Musculoskeletal Pain
Musculoskeletal pain affects the bones, muscles, ligaments, tendons, and nerves. It can be either acute or chronic and can lead to high rates or drug use, sick leave, and disability. Musculoskeletal pain can lower the quality of life due to ongoing discomfort and functional limitations.
Neuropathic Pain
Neuropathic pain happens when the nervous system malfunctions or sustains damage. It can originate from the peripheral nerves, spinal cord, or brain and causes sensations like burning, tingling, or numbness. It is commonly linked to conditions like diabetes, nerve injuries, or infections.
Central Pain
Central pain occurs from damage to or dysfunction of the central nervous system, which includes the brain and spinal cord. It can result from conditions like stroke, multiple sclerosis (MS), brain or spinal cord trauma, epilepsy, tumors, or Parkinson’s disease. Central pain may present as:
- Persistent feelings of “pins and needles”
- Pressing, aching, or lacerating sensations
- Sharp bursts of pain resembling the discomfort caused by a dental probe on an exposed nerve
Symptoms may affect large portions of the body or be confined to certain areas like the hands or feet. This can make everyday tasks challenging for those who suffer from central pain.
How TMS Works
TMS uses magnetic pulses to influence the brain’s activity, particularly in areas linked to mood and pain perception. The process starts with placing an electromagnetic coil against the scalp near the forehead. This coil delivers repeated magnetic pulses which create electrical currents in targeted brain regions. These currents stimulate nerve cells to improve the communication between different parts of the brain.
For pain relief, TMS focuses on areas involved in processing pain signals like the motor cortex or the prefrontal cortex. By modulating the activity in these regions, TMS can help reduce the intensity of pain or change the way the brain interprets pain signals. It’s a non-invasive procedure, meaning it doesn’t involve surgery or long recovery periods, and most sessions last around 30 to 40 minutes. Typically, people undergo TMS therapy several times a week for four to six weeks depending on their condition and response.
TMS for Different Chronic Pain Conditions
TMS is currently being explored for conditions such as central pain syndromes, fibromyalgia, neuropathic pain, and sciatica. Here’s how TMS is being used for these chronic pain conditions.
Central Pain Syndromes
Central pain syndromes result from damage to the central nervous system (CNS), including conditions like MS, Parkinson’s disease, and epilepsy. These conditions often cause persistent pain that is difficult to manage with standard treatments. TMS may alleviate symptoms by influencing brain activity and promoting neuroprotective effects. Research shows:
- In Parkinson’s disease, TMS may stimulate neurogenesis and release neuroprotective chemicals.
- For MS, TMS has been used to manage symptoms like fatigue, spasticity, and gait abnormalities, potentially improving neuronal transmission in the brain.
- In epilepsy, TMS may help reduce the frequency of seizures in patients resistant to antiepileptic drugs by inhibiting cortical excitability.
Fibromyalgia
Fibromyalgia is a condition that causes widespread musculoskeletal pain and is often accompanied by fatigue, sleep disturbances, and cognitive difficulties. TMS may help reduce pain and improve daily functioning for those with fibromyalgia. A recent study showed:
- Repetitive TMS (rTMS) can alleviate pain and enhance quality of life.
- Although TMS has shown potential in treating fibromyalgia pain, its effects on symptoms like anxiety and depression are less clear.
- Pain relief from TMS may be due to its ability to modulate neural pathways involved in pain perception.
Neuropathic Pain
Affecting 6.9% to 10% of the general population, neuropathic pain comes from damage to the nervous system and can manifest as shooting or burning sensations. It can affect the spinal cord, peripheral nerves, or brain. TMS may be beneficial for managing neuropathic pain by modulating neural activity and increasing the brain’s natural pain threshold. Evidence supports:
- Using high-frequency TMS (10 Hz) to target the primary motor cortex for neuropathic pain relief.
- Conditions such as diabetic neuropathy, spinal cord injury (SCI), and post herpetic neuralgia have shown positive responses to TMS therapy.
- TMS may help alleviate neuropathic pain by upregulating pain thresholds, inhibiting pain impulses, and increasing the production of endogenous opioids.
Sciatica and Lower Back Pain
Chronic lower back pain and sciatic, which is pain radiating along the sciatic nerve, can be debilitating and difficult to treat. TMS may be beneficial for those experiencing refractory pain after conventional treatments have failed. Here’s what research shows:
- Studies indicate improvement in pain scores for patients undergoing TMS compared to sham treatments (placebo) and physical therapy.
- The most common TMS target for lower back pain is the left primary motor cortex, with some studies also targeting the primary sensory-motor cortex.
- Animal studies suggest that rTMS can reduce inflammation, improve sciatic nerve function, and restore nerve tissue integrity.
Challenges in Treating Chronic Pain with TMS
While TMS has shown promise in treating chronic pain, there are obstacles that still limit its widespread use and effectiveness. These challenges not only affect how well TMS works for patients but also how easily it can be accessed. Here are some of the main challenges that need to be addressed:
- Lack of large, randomized controlled trials for chronic pain
- Difficulty for patients with chronic pain to sit for long sessions
- Limited availability of FDA-approved, portable TMS devices for home use
- No standardized protocols for TMS in chronic pain management
- Inconsistent results due to varied stimulation targets and treatment methods
Manage Your Chronic Pain with TMS
While more research is still needed for TMS and its efficacy in pain management, it may still be a viable option if you’ve tried other options without success. If you’re living with persistent pain and looking for an alternative approach, consider exploring TMS for pain relief. Reach out today to discuss whether TMS might be right for you.
Sources:
- Chronic Pain Among Adults — United States, 2019–2021 – CDC
- Chronic Pain – Johns Hopkins Medicine
- What Causes Chronic Pain? – WebMD
- Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain – Pain and Therapy
- Neuropathic Pain – Cleveland Clinic
- Central Pain Syndrome – National Institute of Neurological Disorders and Stroke
- Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases – Frontiers in Neurology
- Repetitive Transcranial Magnetic Stimulation for Patients with Fibromyalgia: A Systematic Review with Meta-Analysis – Pain Medicine
- Application of Repetitive Transcranial Magnetic Stimulation in Neuropathic Pain: A Narrative Review – Life (Basel)
- Transcranial magnetic stimulation for the treatment of chronic low back pain: a narrative review – Frontiers in Pain Research
- Repetitive transcranial magnetic stimulation regulates neuroinflammation in neuropathic pain – Frontiers in in Immunology
