Repetitive Transcranial Magnetic Stimulation (rTMS) uses magnetism to stimulate small, targeted areas of the brain in the treatment of a host of medical conditions.
The device applies a brief magnetic pulse or train of pulses to the scalp using a coil of wire connected to a pulse generator. When the magnetic field of the pulse alternates rapidly enough, a secondary electric current is created. This second electric current alters the local electric field near the targeted cells in the brain, which are thereby stimulated.
rTMS has been around for many years and was largely developed as a treatment for depression. However, its benefits in the treatment of chronic neuropathic pain have also been recognised. There have been a number of studies, some inconclusive, but others extremely positive in terms of the level of pain relief achieved. Indeed, some of the trials described the level of pain relief achieved as “significant”.
Treatment with rTMS in itself does not cause pain, but some people who have undergone the treatment have found it uncomfortable, with each pulse generating a sensation likened to a knocking or tapping, as well as a tingling around the face, scalp and jaw. Whilst the treatment is non-invasive and does not involve medication, there are some possible side effects, including feelings of lightheadedness, mild headaches and temporary hearing problems. There is also a small risk of seizures.
Because of the use of magnetism, it is also not recommended for those fitted with spinal cord stimulators, pacemakers and stents, among others.
In the UK, in 2015 the National Institute for Clinical Excellence (NICE) approved rTMS as a safe form of treatment for depression and the Smart TMS Clinic in London was the first clinic in the UK to offer rTMS for chronic pain.
The treatment is now available at a number of centres, including Northampton and Birmingham.
Therein lies the problem. rTMS is extremely expensive. We understand that a four week course of treatment costs in the region of £8,000.
Clearly, as with any new form of treatment, as time goes by and with increasing competition, the cost will reduce. In the meantime, however, we have only been able to identify two NHS trusts offering the treatment, but in each case for depression only, not for chronic pain.
For those in litigation, those representing you should consider discussing with the pain medicine and psychiatric experts in your claim, rTMS as a possible treatment option. If appropriate, funding may then be sought through the claim.