Toto's Take: Transcranial Magnetic Stimulation - a series in using TMS to heal pain

what it is, the motor threshold, how it feels after seven sessions, butterflies...

Dear Companions,

I have dreams that Transcranial Magnetic Stimulation (TMS) in the future will be able to counter the effects of AI on shrinking our prefrontal cortex. I imagine it could eventually be used to probe a fertilized egg to attach to a uterus, help a man or woman decide if they should marry a particular person, or help someone decide if they should go to college. For now, it’s used/cleared for depression, anxiety, OCD, PTSD, bi-polar, and other more difficult cases. Then there are the occasional lab rats like me who use it for chronic pain, although I’ll take the mood effects too. So please do share this with anyone who is seeking non-pharmacological interventions.

I have a longer post already in draft, as I have so much to say, so much to still learn, and still so many sessions to do, that I just keep pushing off. That is counterproductive. Away Message is meant to share my insight and experience on techniques that are helping in the Healingvrse. Nobody is coming here for a medical treatise. So, I have time-boxed myself today to write something to you before my toddler arrives and I use some new-found energy.

In the next part of my series, I’m going to address the part of the brains that I’m zapping, as well as the functional MRI that showed where my individual weak parts are for those interested in a bit of neuroscience.

First, we’ve all probably heard about Transcranial Magnetic Stimulation (TMS), and thus obviously intuit that it involves magnets. But then it gets murky. My memory of magnets is that of horse shaped red toy on the refrigerators, not a therapeutic device. TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. How it works:

1. Magnetic Coil Placement: A magnetic coil is placed against the scalp near the forehead.

2. Magnetic Pulses: The coil generates brief magnetic pulses, which pass through the skull and induce electric currents in the brain.

3. Stimulation of Nerve Cells: These electric currents stimulate nerve cells in the targeted brain region.

How that actually feels is like a mild to moderate electrocution, like I’m a bug getting swatted, hard. (Although I know what real electrocution feels like, having touched an electrified fence on a farm, and TMS is much, much more localized). The "zapping" feeling is due to a phenomenon known as magnetic induction. When you move a magnet near a conductive material (such as metal or certain parts of your body that conduct electricity), it can induce small electric currents in that material. The human body has a complex network of nerves that can detect electric currents. If a magnet induces a current, it might stimulate these nerves, leading to the sensation of a zap.

My script consists of two kinds of pulsing sequences which differ by frequency and duration of pulse. The first set as explained to me is intended to wake up the neurons, the second set, called high frequency, is intended to get them to rewire. This then guides my meditation during the process: Wake up, bitches, I’ll say to my neurons. And then, rewire. And yes, that’s my Buddhist approach. Actually, that’s my other TMS approach.

John Sarno’s TMS, also uses neuroscience to approach chronic ailments by rewiring the mind through effective thinking strategies. Here’s my first post on that, and a list of TMS resources. Thus, both these TMS’s go hand in hand.

The reason for my mantra is that I asked the doctor what the best thing to do during the session was. I was curious if I should not think about my pain. He said quite the opposite. He told me its best to keep the brain working during the session, and if I could focus on the pain, that it would be even better because I would be stimulating those areas. I’m assuming actively thinking about pain spots can increase neural activity in the corresponding brain regions which are weak. TMS relies on neural activation to induce changes, so heightened activity can make the stimulation more effective. He quoted a specific study out of Stamford, but I don’t have it on hand now. I will get it for one of the next posts. But once the session is over I go back to the John Sarno model, and reduce focus as much as possible on symptoms.

The sessions started at 30-40 minutes, but now take about an hour as I'm doing 4 spots on my brain. I think about the pain, or talk to the technician, or ask a bazillion questions, or just grumble. A lot of the time is spent on positioning the equipment on the exact right spot. The zapping itself is about 20 minutes.

TMS of the magnetic variety is supposed to be uncomfortably intense to trigger the results. The way they decide what intensity you are supposed to get to is by measuring your Motor Threshold Testing, as follows: gradually increase the intensity of the pulses on the motor cortex, in the area just above your temples, until they observe a physical response, such as the involuntary twitching of the thumb. This indicates the intensity required to activate the neurons in the motor cortex. Voila! From there you can apply the same threshold to the rest of the regions in the brain where one cannot observe such obvious physical responses, like the occipital cortex where I had the biggest “weakness” on my functional MRI imaging.

And really there’s a lot of twitching during all this. Twitching off my eye, twitching of my jaw. Actually, the most uncomfortable sensation is when my optical nerve gets implicated when I am being zapped in the dorsolateral prefrontal cortex (DLPFC). And that’s about the time I start imagining myself as the character of Alex from Clockwork Orange who is forcibly subjected to a series of disturbing and violent images while being administered drugs that induce a feeling of intense nausea in order to change his behavior.

TMS may sound new and dangerous, but I was assured by a couple of good doctors that it is incredibly safe. One told me that he has a colleague who administers this for years, and never had a patient seizure, which is what the internet will say is the most likely danger. Rarely I will think about this risk, but mostly I’ve put it out of my mind. This is another point of the threshold test. You want to achieve neuron activation personalized to your brain, but not much higher than that. Therefore, you will only try to hit 100% of your load, or 110%, but not much more. It’s safe enough that it has been cleared for treatment in pregnant women, and that is pretty much a gold standard if you think about it. Of course, there are some horror stories on Reddit, but so be it.

Regarding that threshold, I started out at only being able to get to 50% of my threshold. It was simply too painful, and my doctor was very encouraging that we should be titrating up. To be patient. First of all, zapping an already existing migraine is not fun. And the optical nerve in particular hurt. If I don’t get enough sleep either, that very clearly lowers my pain tolerance. But after 7 sessions, I’ve been able to grow my tolerance steadily, and am now anywhere between 70% to 100% of where I need to be. In short, you become less sensitive. Now it doesn't bother me too much at all although it’s still a bit intense. And there are moments where I even enjoy it. Like eating my magnet Wheaties. I expect to see better results in the next seven sessions as a result.

In the meantime, I can report that out of the first 7 sessions, I have seen an improvement in my condition and a quality of life increase. This could be in part because my brain is generating less pain, or that one of the centers we are targeting is the mood center too (the aforementioned DFLP). More on that next time, but regardless life is a bit more manageable. I am more resilient. Any percentage improvement is like describing the sensation of 1000 butterflies. It makes the air around me more bendable. It makes people less terrifying. It makes me more formidable.

Here’s a butterfly I saw after my third session, when I was able to meet my family in the park for my sister’s birthday after missing them the last two years.

It’s interesting to me how light they are. But rooted in the breeze. And only one person ever gets to see a butterfly at a time. And I’m glad that some days now, it’s me.

With much love form the Healingvrse,

Rebecca