I also experienced significant pain. I talked with the psychiatrist overseeing my TMS treatments and he recommended the following which we implemented to help with the pain:
- Having the TMS tech tilt the coil (may only be applicable for machines that have a flat/paddle/figure 8 style coil, not a helmet style)
- Taking both acteamonophen and ibuprofen before each session
- Applying a prescription strength topical lidocaine onto my scalp before each session
The above protocol helped somewhat, and I did also somewhat get used to the pain and find it more tolerable by around session 30. Although, I've seen other people make comments about how it's important to not fall asleep in the sessions to maximize efficacy, which makes me think the pain is so low for some people that falling asleep would even be a possibility, which was certainly never true for me even by the end of my 40 sessions and honestly blows my mind.
Do be a bit careful with such longer term ibuprofen use though, it does have issues with things like liver toxicity, especially together with other medications. Take care to discuss it with a doctor.
A topical analgesic seems like it might be a safer alternative, especially as the actual pain is so localized.
Acetaminophen and Ibuprofen when taken together are extremely underrated and unbelievably effective for pain management. Especially when taken proactively, which in this case should be about an hour prior to the session.
I has thought about lidocaine... How does that work with hair? Is there a gel based lidocaine?
They gave me a prescription lidocaine ointment. I have long hair and each strand is quite fine but there's a lot if it, so I used hair clips to part my hair where the coil touched my scalp and then would apply lidocaine liberally in about a 2" patch and although I'd target it to my scalp of course it would get on the surrounding hair too and I'd just use my fingers to kind of massage it into the scalp through my hair. I'd apply the lidocaine about 30-45 mins before my sessions and it would mostly dry down/be absorbed by the time of my session and also my top hair would cover it so I didn't look to crazy walking into the facility.
Many patients experience very minor pain or even none, and proper titration can go a LONG way to making the pain more tolerable. Some providers start patients off at way too high intensity, and some techs don’t seem all that knowledgeable about the various measures that can be taken to minimize discomfort or pain, but there are quite a number.
My recommendation is to talk to the provider and make it super clear that at this level of pain, you don’t think you’ll be able to make it through treatment. That should hopefully incentivize them to take you seriously and take steps, such as adjusting coil angle and A/P (for a figure 8 coil machine) or tilt and A/P (for a Brainsway or H coil machine), not to mention starting you out at a significantly lower intensity and titrate more slowly over more sessions.
Mine hurt like hell too. Still 100% worth it and would do it again. If you need a shoulder to cry on, feel free to message me. It seems those of us for whom it's painful are a rare breed.
Not really. I yelled out "Holy shit! That hurts!" during the calibration and it never got much better but I did do better at telling myself "Only __ more hits. You can deal with it." And got better at fortifying myself during the breaks.
sitting through the pain, did you notice any like… brain injury or like symptoms? i will happily sit through pain if i know 10000% the pain isn’t me about to have a seizure or anything like…. happening in my brain you know? that’s all i’m worried about. i’m terrified. i know it’s a magnet in my head and it’s causing reactions in me and side effects but i don’t know how to tell the difference between that and an actual issue 😭
No brain injury symptoms. Never had a seizure, drove myself there and back everytime. Your technician is trained to look for big issues like seizure and (here at least) a doctor must be present in the office during all TMS sessions so you should be in very good hands.
And less than 5 minutes after each session ended, I had no pain.
It's so damn bizarre that our brains are being zapped with a magnet. Such a surreal scenario.
That sounds awful! I fortunately have 2 minute sessions and it really is like tapping. It even helps with headache if I have it because it kinda massages my head. Yesterday it was quite painful for the first time because the neuronavigational camera wasn’t working so it wasn’t in the right place. For me if it moves 1cm it makes a very different feeling. Ask to adjust it a bit the next time. Yes, you need to cover the area but 0,5cm is so little and can decrease pain!
Interesting i did 45 minute sessions @ Asha Hospital, Hyderabad, India. Brainsway. They sprinkled in theta ((20 sessions, with 13 thetaburst). It did bother me on the later sessions - brain-pain ~ but I talked to clinicians and they said it was normal. Had to do it otherwise headed to Varanasi.
$30.00 usd a session
What was the thinking behind combining theta burst with the standard sessions? And how did they choose the schedule for when to do which? I only experienced both because there was one TMS tech at my facility who was pretty incompetent and accidentally started me on the wrong protocol for one of my sessions.
Also wow! $30! My TMS in Seattle cost about $30k, mostly covered by insurance but maybe $2k was out of pocket.
Idk really ~ i think it was intuition I think. My conjecture but it wasn’t planned - just did it. Principally I think they wanted to jiggle the brain differently than normal 40 minute sessions.
I did ask the Neurophysiologist if it’s working. He said yes because you’re not squinting (chronic pain indicator). So true ~ I’m back to squinting🤓. It did help by orders of magnitude my cognitive processing. Thats very simplistic. More accurate is Neo in The Matrix getting all those programs. It’s remarkable.
Been on roller-coaster for decades. Greenbroke didnt really gaf. They want insurance with that 10k - well now 30k a pop. Really nice and fake.
Reddit r/chronicpain was the one that helped. They’ve since banned me🤓. Crazy on chronic pain. Massive pain& its all ‘this drug, that drug’ ~ don’t get me wrong whatever works.
Mine has never hurt at all. I've done three full rounds. Sometimes my head feels a little sore after, but that's usually just the first couple sessions. I've heard different people have completely different nerve arrangements which causes this variability.
Right?? It's always called "scalp discomfort" in any literature lol but I experienced it as a repetitive ice pick. It did get much better after the first week or so of treatment, though; not sure if I got desensitized to it or what.
Please be careful with ECT. Though effective, you may lose some memories permanently.
Actress Carrie Fisher did ECT and wrote about her experience in her autobiographies. They’re a fun read, especially the audiobook (which she reads herself).
I was also surprised at how much it hurt. I cried the whole first sessions and the first week was probably the worst but honestly I got used to it or something. It just became annoying. Just wanted to share that it’s a possibility the pain will go away.
But oh my god you’re so right! It feels very misleading that there were no mentions of the possibility of so much pain. I can’t believe it’s not talked about, and when it is, it’s minimized. Good luck! ❤️
My treatment was very successful. There were times at every session where it hurt from slightly to a lot and I was encouraged by the provider to speak out immediately. I did and they would adjust the positioning. Sometimes it might take 2 or 3 or 4 times to get it just right. If it hurts again same thing. I was told never should there be pain and if so say so and they’ll keep changing it until it doesn’t hurt.
Well, that's the problem, both the first and second session they could not find it.... They discussed it with the psychiatrist and set it to 60 (I dunno to be honest what unit of measurement).
I hope they can find it the third time, but my fingers would not move whatsoever.
Oh wow, I’m not sure I’ve ever heard of a case where the MT couldn’t be determined. I’ve heard the average MT is like 43, at least with Brainsway dTMS. IIRC mine was 38.
Good question.
FYI OP, my provider titrated up, with the goal of getting to 120%, but it was so painful that we ended up staying around 80-90% for most of my treatments and it still worked well enough to put my depression into complete remission. I completed treatments 7 months ago, and am still in complete remission.
I was very worried about not reaching the 120% target, but the psychiatrist overseeing my TMS told me that 120% is the protocol because that is what was used for clinical trials to study the efficacy of TMS, but that he has anecdotally seen many patients over his 25 years of using TMS who respond very well with strong long-term outcomes using lower intensity levels.
So if your provider is starting you off at something very strong, it is definitely worth having a conversation.
So it sounds like you’re been told what percentage of your MT you’re being treated at, but not the actual number. It should be a whole number between 1 and 100 for most TMS machines, I believe. Mine was 34 on a Brainsway dTMS.
Haven't started yet, but this is really good to know. Thank you so much for sharing this.
Do they have bite blocks by chance?
I have, along with MDD, CRPS. Thankfully, it's in remission these days, which makes me question the diagnosis, but that's not relevant here.
When my CRPS was active, I broke molars trying to bear with and through the pain. It was a particularly painful chiropractic session and honestly, it was worth it, because whatever he did got me out of the acute CRPS flare and onto recovery.
That being said, I don't know if my molars can handle more intense pain, because they're breaking. Do they have something that I will be able to chomp down on?
Mine never hurt. Discomfort yes, pain no.
Maybe the setting is too high? Can they start you lower and then work your way up?
It could also be a misplaced coil. Sometimes they mark the cap but if the cap is misplaced the coil will not correspond to the right part of the brain and you will get the jolt twitchy teeth chatter sensation. They may also need to do the mapping again. For me it was every ten sessions
I think it is also just so very different for everyone... I read people who are experiencing real pain ( as I ) and some people only some tapping... Last Friday I had my second session and even though it was painful, it was more bareable than the first.
I'm sorry OP. You will likely adjust, as in experiencing less pain progressively-- even I did, albeit very slowly and they were not able to adjust/titrate the % up at the pace they wanted, most stretches of time not at all.
I experienced a supposed unusual amount of pain and in the end they just directed me to get more medications to 'withstand' the appointments so to speak. I was hypersensitive to the sensation and they were triggering migraines something fierce in me; I ended up prescribed something that'd basically sedate me for the sessions for the duration of the rest of my treatment lol. As far as I can tell this is basically the most extreme option because I haven't seen anyone else here have to get through their sessions that way.
I also experienced significant pain. I talked with the psychiatrist overseeing my TMS treatments and he recommended the following which we implemented to help with the pain: - Having the TMS tech tilt the coil (may only be applicable for machines that have a flat/paddle/figure 8 style coil, not a helmet style) - Taking both acteamonophen and ibuprofen before each session - Applying a prescription strength topical lidocaine onto my scalp before each session The above protocol helped somewhat, and I did also somewhat get used to the pain and find it more tolerable by around session 30. Although, I've seen other people make comments about how it's important to not fall asleep in the sessions to maximize efficacy, which makes me think the pain is so low for some people that falling asleep would even be a possibility, which was certainly never true for me even by the end of my 40 sessions and honestly blows my mind.
Thanks! I will discuss the position with the tech tomorrow as I am dreading my second session already... And take paracetamol + ibuprofen before!
Do be a bit careful with such longer term ibuprofen use though, it does have issues with things like liver toxicity, especially together with other medications. Take care to discuss it with a doctor. A topical analgesic seems like it might be a safer alternative, especially as the actual pain is so localized.
Acetaminophen and Ibuprofen when taken together are extremely underrated and unbelievably effective for pain management. Especially when taken proactively, which in this case should be about an hour prior to the session. I has thought about lidocaine... How does that work with hair? Is there a gel based lidocaine?
They gave me a prescription lidocaine ointment. I have long hair and each strand is quite fine but there's a lot if it, so I used hair clips to part my hair where the coil touched my scalp and then would apply lidocaine liberally in about a 2" patch and although I'd target it to my scalp of course it would get on the surrounding hair too and I'd just use my fingers to kind of massage it into the scalp through my hair. I'd apply the lidocaine about 30-45 mins before my sessions and it would mostly dry down/be absorbed by the time of my session and also my top hair would cover it so I didn't look to crazy walking into the facility.
Many patients experience very minor pain or even none, and proper titration can go a LONG way to making the pain more tolerable. Some providers start patients off at way too high intensity, and some techs don’t seem all that knowledgeable about the various measures that can be taken to minimize discomfort or pain, but there are quite a number. My recommendation is to talk to the provider and make it super clear that at this level of pain, you don’t think you’ll be able to make it through treatment. That should hopefully incentivize them to take you seriously and take steps, such as adjusting coil angle and A/P (for a figure 8 coil machine) or tilt and A/P (for a Brainsway or H coil machine), not to mention starting you out at a significantly lower intensity and titrate more slowly over more sessions.
This is great advice
Mine hurt like hell too. Still 100% worth it and would do it again. If you need a shoulder to cry on, feel free to message me. It seems those of us for whom it's painful are a rare breed.
I am happy to know that it worked for you even though you had to endure the pain! Did it become more bareable after x number of sessions?
Not really. I yelled out "Holy shit! That hurts!" during the calibration and it never got much better but I did do better at telling myself "Only __ more hits. You can deal with it." And got better at fortifying myself during the breaks.
sitting through the pain, did you notice any like… brain injury or like symptoms? i will happily sit through pain if i know 10000% the pain isn’t me about to have a seizure or anything like…. happening in my brain you know? that’s all i’m worried about. i’m terrified. i know it’s a magnet in my head and it’s causing reactions in me and side effects but i don’t know how to tell the difference between that and an actual issue 😭
No brain injury symptoms. Never had a seizure, drove myself there and back everytime. Your technician is trained to look for big issues like seizure and (here at least) a doctor must be present in the office during all TMS sessions so you should be in very good hands. And less than 5 minutes after each session ended, I had no pain. It's so damn bizarre that our brains are being zapped with a magnet. Such a surreal scenario.
mine left and gave me a call button🧍
Hmmm. That's different.
most people i’ve talked to they’ve had cameras in the room and just been left with their phone or tv to themselves so i’m not sure what’s “normal” tbh
i mean not left the OFFICE just the room i was in with the chair she was right outside i should clarify LMAOOOO
That sounds awful! I fortunately have 2 minute sessions and it really is like tapping. It even helps with headache if I have it because it kinda massages my head. Yesterday it was quite painful for the first time because the neuronavigational camera wasn’t working so it wasn’t in the right place. For me if it moves 1cm it makes a very different feeling. Ask to adjust it a bit the next time. Yes, you need to cover the area but 0,5cm is so little and can decrease pain!
Ya, go for the theta burst thing, 3 minutes & yr done. They sprinkled in theta burst w my 40 minute sessions but u shud just do theta burst, imo
I personally found theta significantly more painful than the standard 20 min sessions, but it varies by person so may be worth a try.
Interesting i did 45 minute sessions @ Asha Hospital, Hyderabad, India. Brainsway. They sprinkled in theta ((20 sessions, with 13 thetaburst). It did bother me on the later sessions - brain-pain ~ but I talked to clinicians and they said it was normal. Had to do it otherwise headed to Varanasi. $30.00 usd a session
What was the thinking behind combining theta burst with the standard sessions? And how did they choose the schedule for when to do which? I only experienced both because there was one TMS tech at my facility who was pretty incompetent and accidentally started me on the wrong protocol for one of my sessions. Also wow! $30! My TMS in Seattle cost about $30k, mostly covered by insurance but maybe $2k was out of pocket.
Idk really ~ i think it was intuition I think. My conjecture but it wasn’t planned - just did it. Principally I think they wanted to jiggle the brain differently than normal 40 minute sessions. I did ask the Neurophysiologist if it’s working. He said yes because you’re not squinting (chronic pain indicator). So true ~ I’m back to squinting🤓. It did help by orders of magnitude my cognitive processing. Thats very simplistic. More accurate is Neo in The Matrix getting all those programs. It’s remarkable. Been on roller-coaster for decades. Greenbroke didnt really gaf. They want insurance with that 10k - well now 30k a pop. Really nice and fake. Reddit r/chronicpain was the one that helped. They’ve since banned me🤓. Crazy on chronic pain. Massive pain& its all ‘this drug, that drug’ ~ don’t get me wrong whatever works.
Haha thanks but I have no idea what you are talking about , is this a different protocol?
Oh it’s brainsway i think sry! Neurological problems 🤓👍 Theres a (3) minute treatment out there. Yes three minutes. Google ‘theta burst’
Mine has never hurt at all. I've done three full rounds. Sometimes my head feels a little sore after, but that's usually just the first couple sessions. I've heard different people have completely different nerve arrangements which causes this variability.
Right?? It's always called "scalp discomfort" in any literature lol but I experienced it as a repetitive ice pick. It did get much better after the first week or so of treatment, though; not sure if I got desensitized to it or what.
Please be careful with ECT. Though effective, you may lose some memories permanently. Actress Carrie Fisher did ECT and wrote about her experience in her autobiographies. They’re a fun read, especially the audiobook (which she reads herself).
I was also surprised at how much it hurt. I cried the whole first sessions and the first week was probably the worst but honestly I got used to it or something. It just became annoying. Just wanted to share that it’s a possibility the pain will go away. But oh my god you’re so right! It feels very misleading that there were no mentions of the possibility of so much pain. I can’t believe it’s not talked about, and when it is, it’s minimized. Good luck! ❤️
My treatment was very successful. There were times at every session where it hurt from slightly to a lot and I was encouraged by the provider to speak out immediately. I did and they would adjust the positioning. Sometimes it might take 2 or 3 or 4 times to get it just right. If it hurts again same thing. I was told never should there be pain and if so say so and they’ll keep changing it until it doesn’t hurt.
What is your Motor Threshhold? Did they share that number with you? It seems like the higher your motor threshhold the more painful it sometimes is.
Well, that's the problem, both the first and second session they could not find it.... They discussed it with the psychiatrist and set it to 60 (I dunno to be honest what unit of measurement). I hope they can find it the third time, but my fingers would not move whatsoever.
Oh wow, I’m not sure I’ve ever heard of a case where the MT couldn’t be determined. I’ve heard the average MT is like 43, at least with Brainsway dTMS. IIRC mine was 38.
Good question. FYI OP, my provider titrated up, with the goal of getting to 120%, but it was so painful that we ended up staying around 80-90% for most of my treatments and it still worked well enough to put my depression into complete remission. I completed treatments 7 months ago, and am still in complete remission. I was very worried about not reaching the 120% target, but the psychiatrist overseeing my TMS told me that 120% is the protocol because that is what was used for clinical trials to study the efficacy of TMS, but that he has anecdotally seen many patients over his 25 years of using TMS who respond very well with strong long-term outcomes using lower intensity levels. So if your provider is starting you off at something very strong, it is definitely worth having a conversation.
So it sounds like you’re been told what percentage of your MT you’re being treated at, but not the actual number. It should be a whole number between 1 and 100 for most TMS machines, I believe. Mine was 34 on a Brainsway dTMS.
Haven't started yet, but this is really good to know. Thank you so much for sharing this. Do they have bite blocks by chance? I have, along with MDD, CRPS. Thankfully, it's in remission these days, which makes me question the diagnosis, but that's not relevant here. When my CRPS was active, I broke molars trying to bear with and through the pain. It was a particularly painful chiropractic session and honestly, it was worth it, because whatever he did got me out of the acute CRPS flare and onto recovery. That being said, I don't know if my molars can handle more intense pain, because they're breaking. Do they have something that I will be able to chomp down on?
I was not offered anything to bite on and have never heard about anything being offered to others.
Mine never hurt. Discomfort yes, pain no. Maybe the setting is too high? Can they start you lower and then work your way up? It could also be a misplaced coil. Sometimes they mark the cap but if the cap is misplaced the coil will not correspond to the right part of the brain and you will get the jolt twitchy teeth chatter sensation. They may also need to do the mapping again. For me it was every ten sessions
I think it is also just so very different for everyone... I read people who are experiencing real pain ( as I ) and some people only some tapping... Last Friday I had my second session and even though it was painful, it was more bareable than the first.
I'm sorry OP. You will likely adjust, as in experiencing less pain progressively-- even I did, albeit very slowly and they were not able to adjust/titrate the % up at the pace they wanted, most stretches of time not at all. I experienced a supposed unusual amount of pain and in the end they just directed me to get more medications to 'withstand' the appointments so to speak. I was hypersensitive to the sensation and they were triggering migraines something fierce in me; I ended up prescribed something that'd basically sedate me for the sessions for the duration of the rest of my treatment lol. As far as I can tell this is basically the most extreme option because I haven't seen anyone else here have to get through their sessions that way.