Frequently Asked Questions About Neuromodulation (rTMS)
Why does Neuromodulation (rTMS) work?
Repetitive Transcranial Magnetic Stimulation (rTMS), a specific form of Neuromodulation, has been shown to produce changes in neuronal activity in regions of the brain implicated in chronic pain and mood regulation. Such areas of the brain include the motor cortex and the prefrontal cortex. As each magnetic pulse passes through the skull and into the brain, this induces brief activity of the brain cells underlying the Neuromodulation (rTMS) treatment coil.
The frequency of pulse delivery also influences whether brain activity is increased or decreased by a session of Neuromodulation (rTMS). Recent studies indicate best outcomes for chronic pain and depression require treatment at higher frequency (greater than 5 Hertz) to respond favorably. At NonSurgical Medical Group, we perform the Neuromodulation (rTMS) procedure at frequencies deemed to be the optimal by nearly all chronic pain clinical studies.
When is Neuromodulation (rTMS) used?
Patients who have failed to achieve an adequate response from pain medications and other traditional forms of chronic pain treatment or who are unable to tolerate medications for their condition, might consider Neuromodulation (rTMS) treatment.
What happens during a Neuromodulation (rTMS) treatment session?
Because Neuromodulation (rTMS) uses magnetic pulses, before beginning a treatment, patients are asked to remove any magnetic-sensitive objects (such as jewelry). Patients are required to wear earplugs during treatment for their comfort and hearing protection, as Neuromodulation (rTMS) produces a clicking sound with each pulse, much like an MRI machine. Patients are seated in a reclined position during each session of Neuromodulation (rTMS).
During the first Neuromodulation (rTMS) session, several measurements are made to ensure that the TMS coil will be properly positioned over the patient’s head. This process is referred to as Brain Mapping. Once the brain mapping is performed, the TMS coil is comfortably suspended over the patient’s scalp using an articulation arm. The TMS physician works with his TMS technician to measure the patient’s resting motor threshold (RMT), by administering several brief pulses. The RMT is the minimum power intensity necessary to make the patient’s thumb twitch, and varies from individual to individual. Measuring the RMT helps the physician personalize the treatment settings and determine the specific amount of energy required for the controlled stimulation of targeted brain cells.
Once the RMT is determined, the TMS coil is then positioned so that it rests above the appropriate region of the patient’s brain. Treatment is then commenced. During the treatment, patients will hear a series of clicking sounds and will feel a tapping sensation under the treatment coil.
RMT is not checked at every treatment but may be reassessed if there is concern it could have changed, for example, because of a change in medication.
Who administers Neuromodulation (rTMS)?
Neuromodulation (rTMS) is always prescribed by a TMS physician and a TMS physician always confirms the initial motor threshold. The treatment itself is administered by an experienced TMS technician under the supervision of the TMS physician or by the TMS physician.
The TMS technician or physician will always be present to monitor the patient during the treatment. The patient can stop a treatment at any time by asking the staff members present.
How long is a Neuromodulation (rTMS) procedure?
Neuromodulation (rTMS) therapy involves a series of treatment sessions. Treatment sessions vary in length depending on the TMS coil used and the number of pulses delivered but typically last around 15 – 37 minutes. Patients receive TMS 5 days per week. A typical course duration of Neuromodulation (rTMS) is 6 weeks. However, this can vary depending on an individual’s response to treatment.
Do I need to be hospitalized for a course of Neuromodulation (rTMS)?
Unlike ECT (Electric Convulsive Therapy), Neuromodulation (rTMS) does not require any sedation or general anesthesia, so patients are fully awake and aware during the treatment. There is no “recovery time”, so patients can drive home afterwards and return to their usual activities.
Is Neuromodulation (rTMS) therapy considered safe?
Yes. Neuromodulation (rTMS) therapy was FDA approved for the treatment of medication resistant major depressive disorder in 2008. The Neuromodulation (rTMS) equipment utilized at NonSurgical Medical Group for the treatment of chronic pain was given FDA 510K Clearance for safety as an equivalent rTMS Class II medical device in December of 2016.
Neuromodulation (rTMS) is well-tolerated, associated with few side-effects and only a small percentage of patients discontinue treatment because of these. The most common side-effect, which is reported in about one-third to half of patients treated with rTMS (about 1 of every 10 sessions), is mild headaches. These generally diminish over the course of treatment. Over-the-counter pain medication can be used to treat these headaches.
About one-third of patients may experience some painful scalp sensations or facial twitching during rTMS pulse delivery. These too tend to diminish over the course of treatment although adjustments can be made immediately in coil positioning and stimulation settings to reduce discomfort.
The Neuromodulation (rTMS) machine produces a clicking noise and because of this, earplugs are given to the patient to use during the treatment. However, some patients may still complain of hearing disturbance immediately following treatment. No evidence suggests these effects are permanent if earplugs are worn during the treatment.
The most serious risk of rTMS is seizures. However, the risk of a seizure is exceedingly low (about 1 in 30,000 treatments). At NonSurgical Medical Group, we follow up-to-date safety guidelines that are designed to minimize the risk of seizures. While Neuromodulation (rTMS) is a safe procedure, it is important to point out that because it is a new treatment, there may be unforeseeable risks that are not currently recognized.
Who cannot get Neuromodulation (rTMS) treatment?
Patients with any type of non-removable magnetic metal in their heads (with the exception of braces or dental fillings) should NOT receive Neuromodulation (rTMS). Failure to follow this rule could cause the object to heat up, move, or malfunction, and result in serious injury or death. The following is a list of metal implants that can prevent a patient from receiving rTMS:
- Aneurysm clips or coils
- Stents in the neck or brain
- Deep brain stimulators
- Electrodes to monitor brain activity
- Metallic implants in your ears and eyes
- Shrapnel or bullet fragments in or near the head
- Facial tattoos with metallic or magnetic-sensitive ink
- Other metal devices or object implanted in or near the head
Who will benefit most from Neuromodulation (rTMS) treatment?
There is much yet to be learned about particular variables that may impact response to Neuromodulation (rTMS). Researchers are presently conducting clinical studies to evaluate who will benefit most from Neuromodulation (rTMS) therapy. For example, there is much interest in evaluating whether Neuromodulation (rTMS) with pain medications is more effective than Neuromodulation (rTMS) alone.
If you have been diagnosed with Neuropathic pain, Fibromyalgia, Complex Regional Pain Syndrome (CRPS Type 1), Trigeminal Neuralgia, or other chronic centralized pain conditions and continue to suffer chronic pain after traditional treatment, you may qualify for our noninvasive, non-pharmaceutical Neuromodulation (rTMS) procedures.
How can I get Neuromodulation (rTMS) treatment?
Neuromodulation (rTMS) is the exclusive brain stimulation therapy offered at NonSurgical Medical Group for the treatment of chronic pain conditions.
Before receiving Neuromodulation (rTMS) treatment, you first meet with our Executive TMS Technician (this is your Preliminary Consultation appointment and it is provided FREE of charge)… and if qualified, you would then be scheduled to consult with our TMS physician to determine if Neuromodulation (rTMS) is safe and appropriate for you.
To be considered for Neuromodulation (rTMS) treatment, patients must have been diagnosed with specific chronic pain conditions and received traditional treatment without success… that is, Neuromodulation (rTMS) is for patients who have experienced inadequate response to pain medications and other standard chronic pain treatment.
Is Neuromodulation (rTMS) treatment covered by my insurance?
No. Neuromodulation (rTMS) treatment for chronic pain conditions is presently not covered by Medicare or general health insurances.
How much does Neuromodulation (rTMS) therapy cost?
We provide this advanced treatment technology for a fee of $250 per session.
Have further questions?
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