Chronic pain has aspects that are both physical and mental, and it comes in many forms. Sometimes when somatic approaches have failed, a top down approach that attacks the brain’s perception of pain can be useful. Of course depression is highly co-morbid with pain, treating mood areas with TMS also seems to affect the pain threshold. In one study, a single TMS treatment was given post-operatively to patients while they were in the recovery room, and TMS treated patients used 50% less self administered pain medicine than those given a sham treatment.
We also use TMS targeted at pain pathways themselves in the motor and sensory cortex of the brain. This technique has been very useful in treating phantom limb pain where there is no bodily target to treat. We have also had great success treating Fibromyalgia, Chronic Regional Pain Syndrome (CRPS, also known as RSD) and other types of neuropathic pain.
Use in clinical practice at SoCal TMS has shown positive results.
Beyond Major Depression, Bipolar Disorder is an obvious target for TMS treatment. We use the same treatment protocols targeting the Dorsal Lateral Prefrontal Cortex in treating the depressed phase of Bipolar Disorder and have had excellent clinical success with many patients. Insurance coverage is currently lacking however as the strict FDA indication for TMS is Major Depression. TMS can cause a switch into mania in Bipolar Disorder, just as with antidepressants.
There are several protocols being investigated for treatment of the manic phase of Bipolar Disorder, but consensus is lacking on what the optimum treatment is.