That particular one seems to reappear on a regular basis for some reason.
From the Walton Centre
“Although the exact cause of chronic pain is not known, there is good evidence to show that with it the nervous system undergoes many changes. Pain signals are spontaneously generated in the nerves which the brain interprets as real pain. It is as if a burglar alarm had gone off on its own without an intruder in the house. Many treatments are used to reduce these false alarm signals but they do not always work. Another curious change that happens is that the body’s ability to control pain is weakened when chronic pain sets in. Our ability to withstand pain, or distract from it, is reduced. In such a situation, a long distance runner who in a race can withstand enormous pain may find simple walking impossible because of a similar pain.”
How do you determine the precise brain location for TMS treatment?
This requires a separate ‘mapping session’ which we always do at the start. The critical aspect of the mapping is to make sure that the target muscle chosen by your doctor can be activated by TMS. We will place small (1 cm in diameter) recording electrodes on your hand, stuck on to the skin and are painless. We will then give several single pulses strong enough to cause a small movement (twitch) in your hand, leg, neck or head (depending on where your pain is), lasting a fraction of a second. The mapping session usually involves 20-25 pulses given every 5-15 seconds. We usually identify two separate targets, a ‘hotspot’ at which a TMS pulse gives the strongest response, and an alternative site where the response is slightly less. This information is saved on the system, so that at any subsequent session we will be able to identify it with no need for repeated mapping.
What is the current Walton Centre experience of TMS in the management of chronic pain?
Since 2011 we have provided TMS treatment for chronic pain, although only as part of research projects. All research has involved patients with chronic neuropathic pain who have not benefit from other treatments. We rate some 30% of patients as responders who show clinically meaningful improvement of their pain and are motivated to have long-term TMS treatment. We have treated around 200 people in over 3000 sessions. Some patients have received over 100 treatment sessions and continue to have a stable response and tolerate the treatment well. In some cases, people have complained of an increase in their existing tinnitus but specialist investigations have not shown a connection with TMS. We have seen one epileptic fit in one of our patients, which self-terminated and did not cause any problems except the inability to drive for 6 months.
Who can I contact if I have a question about TMS?
Your primary contact is the Walton Centre TMS Specialist Operator, Ms Anna Mavrianou, tel. 0151 529 5834/0151 556 3255, E-mail address anna.mavrianou@nhs.net. The office hours in general are Monday to Friday 10.00 – 16.30. She will be able to deal with your query or contact your Pain Consultants if required. At the moment we do not provide an out of hours service.