TMS Effects on Pain and Depression in Patients with Fibromyalgia
Guest: Dr. Baron Short – Psychiatry & Behavioral Sciences, MUSC
Host: Dr. Linda Austin – College of Medicine - Dean’s Office, MUSC
Dr. Linda Austin: Dr. Baron Short, Assistant Professor of Psychiatry and Internal Medicine here at the Medical University of South Carolina, is doing some very interesting research on a common malady, but one that many people don’t understand very well, which is fibromyalgia. Dr. Short, let’s start off by talking about just what fibromyalgia is.
Dr. Baron Short: Fibromyalgia is a poorly understood disorder. It presents with an immense amount of pain in which we do not find a clear signal on an MRI or an x-ray.
Dr. Linda Austin: What kind of pain? How do patients typically describe fibromyalgia?
Dr. Baron Short: People will commonly talk about hurting all over. It can be poorly localized to any one area. Sometimes people will complain of pain in their upper back, shoulders, neck, chest, hips, and arms. I’ve heard people complain about pain all over their body.
Dr. Linda Austin: Is there a typical age of onset?
Dr. Baron Short: I’ve seen people of various ages, as early as adolescence, up to 60 years of age, and beyond. But, usually; anecdotally, I see people begin to develop this in their twenties and thirties.
Dr. Linda Austin: Are there any medications that can be used to treat fibromyalgia?
Dr. Baron Short: There are three medications that are FDA approved for the treatment of fibromyalgia. They primarily work on changing brain chemistry to help reduce how the brain is perceiving pain.
Dr. Linda Austin: What are those medications?
Dr. Baron Short: The trade names for those medications are Cymbalta, Savella and Lyrica.
Dr. Linda Austin: But, your clinical trial, that we’re going to talk about in this podcast, doesn’t use medication. What is the technology that you’re taking a look at?
Dr. Baron Short: That is correct. Some people will do quite well with medication. But, unfortunately, there are a lot of people that still suffer immensely. Those are folks that will often try to find us and look at some of the research we’re doing with brain stimulation. The technology we’re using is called transcranial magnetic stimulation (TMS). It’s basically a type of magnetic pulse that enters through the head and stimulates brain tissue. We do this to try to help modify how the brain is experiencing pain.
This has already been FDA approved for the treatment of depression. We’re studying it in a variety of pain disorders, as well as in postsurgical care. But my primary interest has been with studying it in fibromyalgia.
Dr. Linda Austin: Are there any early indications that it might actually be effective for fibromyalgia?
Dr. Baron Short: In our current treatment trial, people are receiving approximately two weeks of treatment. And just on anecdote, we’ll see people get better in a matter of days, for those that are going to respond to the treatment.
Dr. Linda Austin: Walk us through the clinical protocol. If somebody enters this so-called trial; which is really an experiment, a research study to see if somebody will respond, what would they expect?
Dr. Baron Short: First, they would come in and meet with me. We would go over what, exactly, one would be doing in the trial, or experiment. Primarily, folks will come in for two weeks to receive this treatment. Each treatment takes about 20 minutes. They will sit down, recline in a chair, and the device will be placed on the head for a 20-minute period. After that, folks usually answer a few questionnaires, and then they leave. After this two-week period, there are two follow-up visits in which folks just come in to fill out questionnaires.
Dr. Linda Austin: When you say they come in for two weeks, is that Monday through Friday, they come in for a couple of hours every day?
Dr. Baron Short: They come in Monday through Friday for approximately one hour. It’s a little longer on the first day. It probably takes us about two hours the first day. There are some other things that we do. We draw blood at the beginning and end of the study, looking for changes in inflammation. There’s some literature to support that inflammation may be involved in fibromyalgia, so we’re looking at that as well. The other days, people are usually just in and out in less than an hour.
Dr. Linda Austin: Are there any side effects to the treatment? Is it uncomfortable or scary in any way?
Dr. Baron Short: Great question. In terms of side effects, I would say, overall, there are much fewer side effects than there are with medications. The one major side effect, however extremely rare, some people have had a seizure with this type treatment. Now, that’s been about 10 treatments out of 15,000 over 15 years. We’ve never had anyone experience a seizure here at MUSC. Furthermore, we stay within safety guidelines. Most of those seizures occurred before we had clear safety guidelines. So, we feel quite confident that anyone participating in our research will do fine.
Another side effect is that some people will feel a sensation on the forehead where you receive the treatment. That’s usually the most uncomfortable the first day or two, but most people get used to it, which interesting in itself. It looks like, maybe, even an early sign of how people are perceiving pain.
Dr. Linda Austin: Is there any reason to think that the benefits of TMS; if, indeed, it does help with fibromyalgia, might be long-lasting benefits?
Dr. Baron Short: We’ve had approximately 17 people in the study so far, and I’ve had some people have a response that lasted for a couple of weeks. I’ve had other people have a response for several months. They’ve called me just to let me know that they’re still doing quite well. It’s still too early in the research to know how long this will last.
Dr. Linda Austin: But the thinking, I would imagine, if it’s like other treatments, is that maybe you would have an initial treatment, but then once every week, month, whatever, there would be a maintenance treatment in order to prolong the beneficial effect.
Dr. Baron Short: Again, we don’t know quite yet. But to draw a parallel with depression, people will get a course of TMS, and then they may return some months later, or a year later, for another course. I imagine we may run into a similar thing with fibromyalgia. Although very different disorders, they involve some similar brain pathways. Someone might come in for a course of treatment, and then if they have a flare of their fibromyalgia, they might return a month later, six months later, or a year later, depending on when that would be.
Dr. Linda Austin: Dr. Short, if somebody is interested in learning about this study or would like to participate, how can they get more information, or make a connection with you?
Dr. Baron Short: They would probably do best to call by office, at (843) 792-0199. I, or someone on the research team, would be able to contact them and try to get them some more information, to see if they’d be interested in enrolling.
Dr. Linda Austin: Well, I wish you the best of luck in this trial. It’s a fascinating area.
Dr. Baron Short: Thanks so much.
If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at: (843) 792-1414.