Non-Invasive Therapies: rTMS

While some are treated with medications that are mildly effective and carry significant side effects, others are faced with the lack of effective pain management options and diminished quality of life.

Central sensitization and what it means for chronic pain conditions?

For some people, chronic pain conditions can lead to central sensitization, which is defined by changes to the central nervous system due to the development and maintenance of chronic pain. In other words, central sensitization results in the engravement of pain in the brain because specific pain signaling pathways are reinforced over time. The unfortunate irony is that individuals with central sensitization will experience pain much more easily.

Common manifestations of central sensitization include neuropathic pain, complex regional pain syndrome (CRPS), fibromyalgia, trigeminal neuralgia and many other conditions. Patients with such conditions are invited to our Toronto pain management clinic to investigate and explore a therapeutic option known as repetitive transcranial magnetic stimulation (rTMS).

What is repetitive transcranial magnetic stimulation in Toronto?

The realization that electrical stimulation of the motor cortex in the brain could relieve the patient of chronic pain initiated the development of non-invasive technologies, such as rTMS. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has been explored over the recent years in a variety of neurological diseases, including Parkinson’s disease, treatment-resistant depression, fibromyalgia and even schizophrenia.

In Toronto rTMS therapy, electromagnetic coils are placed against the scalp to effectively alter the underlying, pain-causing cortical neuron signaling. Multiple sessions with rTMS have the potential to induce long-lasting, therapeutic brain plasticity with minimal adverse effects. The most common side effects are headaches, and seizures are extremely rare.

Although rTMS neuromodulation therapy is a great alternative treatment for those with chronic pain who do not respond to other solutions, not everyone is a suitable candidate for the procedure. It’s also important to keep in mind that not every candidate for rTMS neuromodulation will respond and experience therapeutic relief from their chronic pain. Thus, our medical team will typically only consider offering rTMS therapy to patients who have been diagnosed with specific chronic pain conditions with central sensitization, have been refractory to traditional treatments and can be treated with electromagnetic stimulation in a safe manner that increases likelihood of success.

Why does Toronto rTMS neuromodulation work?

Through recent work with rTMS, this form of neuromodulation has demonstrated an ability to change neuronal activity in regions of the brain that respond to chronic pain and regulates mood. These brain regions are the motor cortex and the prefrontal cortex.

During rTMS therapy, electromagnetic coils are placed by the motor and prefrontal cortices to deliver magnetic pulses through the skull and into the brain to induce brief activity of the neurons. The frequency of pulse delivery will either increase or decrease brain activity and studies have shown that the best outcomes for treating chronic pain is with higher frequency. When we treat our patients in Toronto with rTMS, we will use the optimal settings deemed appropriate by relevant clinical studies to provide an effective and safe solution for their chronic pain.

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When is rTMS neuromodulation used?

We recommend the use of rTMS therapy when patients fail to achieve adequate pain relief from pain medications and other traditional treatments or when patients are unable to tolerate the side effects associated with the prescribed medications for their chronic pain condition.

What is a rTMS neuromodulation session like?

Before starting any treatment, patients will be instructed to remove all magnetic-sensitive objects including jewelry, since rTMS administers magnetic pulses. Next, patients will be asked to wear earplugs for their own comfort and ear protection because this neuromodulation therapy produces a “click” every time a pulse is produced and transmitted to the brain. To further promote comfort during the therapy session, patients will be seated in a reclined position.

At the initial session, many measurements will be made to ensure that the electromagnetic coils are properly positioned over the motor and prefrontal cortices. This process is known as brain mapping. Once completed, the coils are suspended over the patient’s scalp with an articulation arm. The patient’s baseline or resting motor threshold (RMT) is then measured through the administration of several brief pulses. The RMT is defined by the minimum power intensity that will cause the patient’s thumb to twitch. By measuring the RMT, we can tailor the rTMS neuromodulation settings to determine the most effective amount of energy for controlling the stimulation of target neurons.

After RMT is calculated, rTMS therapy begins. During the treatment session, patients will hear a clicking noise in their ears and feel a tapping sensation underneath the electromagnetic coil as brief pulses are administered.

Who is responsible for administering rTMS neuromodulation?

In our Toronto clinic, the rTMS neuromodulation can only be prescribed by Dr. Dov Weiss. However, during the treatment sessions, we have an experienced rTMS technician who operates and administers the therapy, under the supervision of Dr. Weiss.

While undergoing the treatment, the patient will always be carefully monitored by both our doctor and medical staff members to ensure safety. As a patient, you can also ask to stop the treatment at any moment.

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How long is the procedure?

As in the name, rTMS is repetitive and involves a series of treatment sessions in order to achieve long-lasting results.

Each session can vary in length depending on the coil used and the number of pulses that are necessary. However, a typical session may last approximately 15-40 minutes. Patients who choose to undergo rTMS will receive treatment for 5 days per week. An entire course of neuromodulation is generally 6 weeks long, but this too, will depend on the individual’s response to the therapy.

Is rTMS neuromodulation safe?

Although relatively new to the world of chronic pain management, Toronto rTMS neuromodulation techniques have been used in the clinic for other neurological disorders for almost a decade.

In general, rTMS neuromodulation is a well-tolerated therapy with very few associated side effects and a low discontinuation rate. When side effects do occur, the most common discomfort is a mild headache, which diminishes over the course of the treatment. Some patients may experience painful scalp sensations or facial twitching while pulses are being delivered, but these will also dissipate over time. Finally, the most serious risk associated with rTMS neuromodulation is seizures. In our practice, we diligently follow the appropriate safety guidelines when carrying out rTMS neuromodulation therapies so patients can be assured that their treatment is safe and effective.

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Go Painless

Our team at Painless Medicine and Therapeutics focuses on improving our patient’s pain conditions.

Our goal and philosophy is to make the patient’s therapeutic experience as painless as possible by finding a therapeutic plan that best treats their symptoms and lifestyle. We truly believe in collaboration and working closely with patients so that they have control over their medication, and so that the treatment aligns with our clinic’s values.

In cases where chronic pain cannot be cured, but instead must be effectively managed, our team’s purpose is to limit the complications and to minimize the severity of the symptoms experienced by the patient. We wish to optimize our patients’ control over their pain so they feel enabled to be the best possible version of themselves and enjoy life again.

If you are suffering from a chronic pain condition, we highly suggest that you visit our clinic in Toronto to see what we can do for you.