Chronic pain

Chronic pain is not merely a persistent pain signal from the body, but often reflects changes in the brain’s way of processing and regulating pain. When pain has persisted for months or years, the neural circuits involved in pain perception can become overactive and less flexible. As a result, the brain continues to maintain the pain even when the original tissue injury has healed or can no longer explain the intensity of the symptoms.

In chronic pain conditions, changes are often seen in the interaction between sensory, motor, and emotional brain regions. In particular, the primary motor cortex (M1) plays a central role in pain regulation through its connections to deeper structures, including the thalamus and brainstem, which are involved in pain modulation. This altered central processing contributes to persistent pain, increased pain sensitivity, and often significant functional impairment.

Chronic pain occurs in a wide range of conditions, including, among others:

  • Neuropathic pain (e.g. following nerve injury)

  • Chronic back and neck pain

  • Fibromyalgia

  • Complex regional pain syndrome (CRPS)

  • Post-stroke pain

  • Phantom limb pain after amputation

What these conditions share is that pain is, to varying degrees, rooted in central mechanisms in the brain, making them difficult to treat with medication or local interventions alone.

Treatment of chronic pain with rTMS – how it works and what to expect

In the treatment of chronic pain with rTMS, stimulation is typically directed at the primary motor cortex (M1). The aim is to influence central pain-modulating circuits and enhance the brain’s ability to dampen persistent pain signals.

Repeated stimulation of M1 can alter activity in the networks that regulate pain intensity and pain thresholds. The effect is thought to be related to neuroplasticity, whereby repeated stimulation over time contributes to more adaptive central pain regulation. The treatment does not aim to eliminate the underlying cause of the pain, but to reduce pain intensity and improve function and quality of life.

Treatment takes place at the clinic. You remain awake throughout the session and can go directly home afterwards. A session typically lasts between 20 and 40 minutes depending on the protocol, and a treatment course usually consists of multiple sessions distributed over several weeks. For chronic pain, rTMS is often used as a supplement to other treatments.

Effect and expectations

The effect of rTMS for chronic pain varies considerably between patients and pain types. Some experience a clear reduction in pain intensity, others more moderate improvements, while some experience little or no benefit. When an effect is achieved, it often develops gradually over several weeks.

For many, the benefit is not only reduced pain intensity, but also improved sleep, increased activity levels, and a better ability to participate in everyday activities. The effect is usually temporary, and maintenance treatment may be relevant in some cases.

Side effects are generally mild and transient. The most common are mild headache or discomfort during stimulation, especially at the beginning of the treatment course.

Compared with other treatment approaches for chronic pain

Chronic pain is typically treated with a combination of:

  • Pain-relieving medication (e.g. NSAIDs, opioids, or neuropathic pain agents)

  • Physiotherapy and exercise

  • Psychological treatment, including pain management

  • Multidisciplinary pain programmes

Many patients experience insufficient benefit or significant side effects with long-term medical treatment. rTMS differs in that it is a non-invasive treatment without the need for anaesthesia and with minimal side effects, which can be used as a supplement in selected patients with central pain components.