FAQs About TMS Treatment
What is TMS?
Transcranial Magnetic Stimulation (TMS) is a non-invasive, medication-free treatment option that is currently being used to treat many conditions, including depression, anxiety, migraines and chronic pain. It works by stimulating neurons in a patient’s brain, and does this through the creation of a magnetic field inside of a coil that is placed on top of the head. People with Fibromyalgia and other chronic pain conditions have been shown to have increased activity in specific regions of the brain, and our treatment aims to target these areas and inhibit this over activity. There are currently no licensed medications available for Fibromyalgia, so this novel approach is much needed and very exciting!
Is it safe?
Generally, TMS is very well tolerated by most people, with an excellent safety record. The most serious side effect that has been reported are seizures, although the rate of occurrence is reported to be 0.003%. For context, our colleagues at the London Psychiatry Centre have never reported a seizure in over 8 years of delivering TMS. At TMS London your safety is our main priority, and our expert team will screen you thoroughly before treatment to ensure that any risk to you is minimized as much as possible. A first aid trained TMS expert will be with you throughout the procedure to further ensure your safety.
Does it work for everyone?
As with all medical treatments, not everybody responds the same to TMS. While research has shown TMS to be effective for reducing pain and improving quality of life in many people suffering from Fibromyalgia, it has also shown that certain people are what we call “non-responders”. Most people who are going to respond will have shown improvement within 2 weeks, and with this in mind we offer a flexible weekly payment option, giving you more flexibility and control over your treatment.
Is it painful?
Most people will experience a tapping sensation at the treatment site, and although this can feel strange at first, it is not usually reported as being painful. We will do our best to make sure that you are comfortable throughout your treatment, and we will work with you to help ensure this.
How many sessions will I need?
Our standard protocol is to offer a total of 20 sessions, with two sessions per day spaced over 10 days. Although there is flexibility within this depending on your availability.
Does the effect last?
The most recent study into the use of TMS for Fibromyalgia included a six-month follow up of the participants, and showed that the positive effects were maintained over this period. No longer term studies have been completed so beyond this time we are not yet able to say, although there is no reason to believe that the changes would not last.
We also offer our patients the option of monthly maintenance TMS booster treatments. Our colleagues at the London Psychiatry Centre have found this to be an effective way to ensure the continued effect of the intervention.
What are the side effects?
TMS is generally well tolerated and only a small percentage of people decide to discontinue treatment because of side effects. The most common side effect is a headache, which is experienced by up to 10% of people, although this usually responds well to over-the-counter pain medication and resolves quickly. Another potential side effect is hearing sensitivity due to the clicking sound that the TMS machine produces, although at TMS London you will be given earplugs to mitigate this risk. The most serious side effect is seizure, although this is very rare (0.003% of cases), and has never occurred in 8 years of TMS at the London Psychiatry Centre.
What happens during the treatment?
For every session, you will be brought into a specially equipped room, asked to lie down on a treatment bed and given earplugs for your comfort and safety. The procedure does not require any anaesthesia, so you will be awake during each session. The insulated magnetic coil will be gently placed over the top of your head, and the TMS technician will then adjust the device by delivering a series of pulses until it gives just enough energy to produce a small twitch in your hand. This is called the “motor threshold”. This number will be different for everyone, and will be taken at several points during your treatment block, as this number can vary over time within individuals. Once your motor threshold has been determined, the magnetic coil will be moved to the front right side of your head, over a region of the brain called the Dorsolateral Pre-Frontal Cortex (DLPFC), that research suggests may be responsible for regulating the brain’s integration and modulation of pain signals. Each treatment will consist of a series of “pulses” at regular, one-second intervals. Sessions typically last twenty to thirty minutes. A trained member of staff will be monitoring you during the entire treatment, and you are free to ask them to stop the procedure at any time.
What should I do before/after each session?
Due to the non-invasive nature of the treatment, there is not much that you need to do to prepare. The only things that we ask are that you avoid having too much caffeine prior to your treatment – as this can affect the excitability of your nervous system. We also encourage you to stay well hydrated, as this has been shown to affect the brain’s response to treatment. After each day of treatment, we suggest that you take some time to relax and avoid doing anything too strenuous in the evening.
Can I drive afterwards?
Most people are fine to drive immediately after treatment; however, this will depend on your reaction to the TMS so it may be best to make other arrangements on your first day of treatment.
What can I do between treatments?
We recommend at least an hour between sessions, and this time should be spent relaxing. You may wish to visit nearby Regent’s Park, stop at one of Marylebone’s many excellent cafes and restaurants, or even pay a visit to our on-site therapies team, who offer treatments such as reflexology, aromatherapy, massage and hydrotherapy.
Am I suitable for treatment?
Although TMS is very safe, some people may not be suitable for the treatment. These include people with epilepsy, people with cochlear implants or any other metalwork in their skull, and people with mental health disorders which have not been optimally stabilised. Please feel free to contact us if you are unsure about whether or not you may be suitable.
I can’t make six sessions per week. Will it still work?
Although six sessions per week is our standard protocol, there is flexibility within this in order to allow patients to fit treatment around their busy lives. We do not recommend however, that patients spread out their treatment too much, as most of the evidence suggests that a more intensive treatment protocol is associated with superior outcomes.
Is TMS covered on my insurance?
We do not deal directly with insurance companies. However, as a NICE recommended treatment for depression, it may be possible to claim back the cost of treatment from some insurance companies.
What payment options do you offer?
Unlike many other places who offer TMS, we at TMS London do not require full payment for the entire 20 sessions up front. Instead, we ask for payment in advance for each week of treatment, with the aim of allowing people more flexibility and control over their treatment.
However, appointments with our medically specialised consultants, and investigations (including blood tests and scans) required to get to the bottom of your musculoskeletal pain, are generally all covered by insurance. Please speak to our staff first before speaking to the insurance company as it is important to receive the correct guidance with regards to terminology and codes for procedures.
TMS is a non-invasive procedure which can Treat the symptoms of fibromyalgia in adult patients.
Does TMS really work?
In a recent, in-depth study of 90 fibromyalgia patients the average pain ratings and associated symptoms showed significant improvement post rTMS. The beneficial effects of rTMS lasted up to 6 months.
Make a booking for TMS treatment
TMS London we offer you the option of a reduced six session introductory trial in order for you to experience the treatment and decide whether it is right for you.
Who is Dr Stephanie Barrett
Dr Stephanie Barrett is one of the UK’s leading consultant physicians and rheumatologists.
Consultant Physician and Rheumatologist
MB ChB MD FRCP
President of the Royal Society of Medicine, Rheumatology Division, 2017-18
Member of Council and Trustee at the Royal Society of Medicine
Member of Council, Rheumatology Section of the Royal Society of Medicine
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