How having electric currents fired into my brain cured my chronic pain
“I was told that my pain would last for the rest of my life,” Berenice Holt, 44, says. “That there were only ways to manage it, like seeing a therapist, trying acupuncture or seeing a chiropractor, and staying active when I could. There were medications, too, pregabalin, diazepam, strong painkillers and antidepressants. I tried them all and nothing worked.”
Holt had a happy, normal childhood in rural France. “I was a very active child, doing six hours of sport a week – gymnastics, swimming, dancing, cycling around the countryside where I lived with my parents,” she recalls. Then, at age 12, she witnessed a violent attack at a supermarket in her quiet home town of Bray-sur-Seine.
“Someone had been seriously injured in the head. Other people were running for their lives but I froze and started to hyperventilate. My whole body was stuck stiff for an hour and a half while I waited for an ambulance to come and get me. My arms and legs were in an incredible amount of pain.”
What came after that was a life defined by chronic pain. “At 14 or 15, I started to have pain in my back,” Holt recalls. “I’d try to stand and seize up. By my 20s, I had the physical abilities of an 80-year-old woman.” Then there were stranger symptoms still, flaring up and then disappearing over weeks or days: intense pains that presented at random in different parts of her body, along with constant exhaustion and brain fog. At the same time, she struggled to get to sleep.
Into her 30s, Holt’s pain became disabling. At times she was in such severe pain that she was unable to leave her bed, forcing her to give up work. British doctors eventually delivered her diagnosis, at the age of 31: she had fibromyalgia, a long-term condition that affects some 2.5 million people in Britain.
What causes chronic pain?
“Chronic pain is pain that has outlasted its usefulness,” says Prof Annette Dolphin, a world-leading researcher who has spent years investigating the mechanisms behind pain in the body.
“Acute pain is essential because it’s this response that makes you withdraw your limbs from something that puts them in danger. Chronic pain meanwhile is where the nervous system continues to produce the same response after that danger or injury has passed.”
Blair Smith, a professor of population health science at the University of Dundee, has spent the bulk of his career investigating chronic pain and its causes.
When it comes to what turns a normal pain or injury into long-lasting chronic pain, “that’s extremely complicated,” Prof Smith says. “Usually there’s some trigger, like an illness or an injury, after which the body keeps playing out the pain it felt then. Stress throughout your lifetime, and childhood trauma especially, can have a huge impact on whether that happens.”
Holt’s doctors never suggested to her that the incident she witnessed as a 12-year-old could have caused her to develop fibromyalgia. “In rural France 30 years ago, no one knew anything about PTSD and how it can impact your body as well as your mind,” she says. “My parents were told after I left the hospital that I might be more nervous, but it wasn’t something that was discussed.”
In recent years, however, explanations for why some are struck down by chronic pain focused on the role of childhood trauma, which almost one in nine people with fibromyalgia have experienced. Even migraines and lower back pain become much more likely in those with traumatic childhoods: people who experience adverse childhood experiences are up to twice as likely to develop these conditions than people without them.
Other research shows that the chance of developing lower back pain throughout a lifetime could be as much as 70 per cent down to your genes. “There is a genetic underlying, and whether that’s expressed depends on what your experience of life is, from how your pain was dealt with when you were a child to how stressful your life is as an adult,” Prof Smith says.
Why chronic pain is so hard to treat
This complex interplay makes chronic pain difficult to treat with medication. “There are drugs like gabapentin that work by binding to a particular protein in your body and blocking the movement of some of the channels that carry pain signals to your brain, but these only seem to be somewhat effective, and only in some people,” says Dr Antonis Pantazis, a scientist researching electrical signals in our bodies in the hope of discovering how to dampen chronic pain.
“Opioid drugs meanwhile are extremely effective at blocking those channels, but they’re also extremely addictive,” Dr Pantazis says. “My team and I work to find ways to block those channels effectively without resorting to those drugs. We try to target the specific channels in the body that seem responsible for chronic pain. We’ve recently had breakthroughs here that could lead to new drugs one day, but it’s a mammoth task.”
The psychological roots of chronic pain mean that talking therapies such as cognitive behavioural therapy (CBT) as well as mindfulness techniques like meditation have been prescribed to treat the problem. Some forms of talking therapy are effective in around two-thirds of people with chronic pain. Holt experienced some relief from eye movement desensitisation and reprocessing (EMDR), a kind of trauma therapy, which she says “really helped with the trauma” but didn’t alleviate her pain.
Holt was also prescribed antidepressants in a small dose, a practice that has become increasingly commonplace in Britain. Around 10 million people are prescribed the drugs “off-label” for this reason each year. Rather than targeting low mood, which many sufferers of chronic pain also experience, the drugs are given instead as a form of painkiller. They work well for up to half of patients, but for Holt, they did “very little to ease my pain”.
The ‘life changing’ treatment that cured Holt’s chronic pain
Holt now lives in Clapham with her husband and son, and has a career as a personal assistant. Her life today is largely pain-free. She found relief where none of her doctors had expected: from repetitive transcranial magnetic stimulation (rTMS), where magnetic pulses are delivered to the brain from a metal coil, using an electric current. Licensed in the UK to treat depression since 2015, rTMS works for both depression and chronic pain by activating the parts of the brain that become less active because of long-term mental illness, increasing brain cell activity.
Holt’s chiropractor of over a decade told her about patients she knew were having the treatment. “It was expensive [between £3,000 and £8,000] but there weren’t any serious side effects,” Holt recalls. She then visited Dr Stephanie Barrett, the founder of The BrainWave Clinic on Harley Street, a specialist rTMS clinic set up to treat chronic pain. “Even my first visit, before my first rTMS session, was life-changing,” says Holt. “It was the first time that a doctor told me that they had something that could take away some of my pain, instead of just managing it.”
Dr Barrett has been working for the last six years to develop a special form of rTMS for people with fibromyalgia. While patients can access similar treatments at some hospitals or in private clinics, Dr Barrett’s background as a consultant rheumatologist makes her practice unique. “In our field, we deal with the whole person, rather than just looking at a series of separate diagnostic labels,” she explains. “We approach chronic pain from the physical perspective but we liaise with many other specialities, to uncover as much as we can and to make fascinating links, like a jigsaw puzzle.”
“I started looking into chronic pain when I was collaborating with a psychiatrist who was already using rTMS to treat depression. We found that by using a slightly different protocol, we could also give patients a really significant level of relief from chronic pain. We then bought an rTMS machine for my own rheumatology practice. To my knowledge, we’re the first in the UK to use this technique to treat fibromyalgia in this way systematically.”
How rTMS works to relieve chronic pain
“Chronic pain and fibromyalgia especially have always been an area of poor clinical understanding and ineffective treatments,” Dr Barrett adds. “Most of my patients and colleagues have despaired at the lack of solutions over decades. My colleagues and I at the London Rheumatology Centre developed a specific protocol so that patients could at last get some relief, without drugs or invasive treatments.”
Dr Barrett initially recruited 50 case-study patients with chronic pain to trial the treatment, with each participant undergoing 20 rTMS sessions. “We found that 93 per cent of patients responded to treatment, which is a huge number,” Dr Barrett says. “Many went into complete remission and have stayed that way for two years. Some have come back for top-ups, but most haven’t needed to. With pain reduction, we also saw massive improvements with fatigue and brain fog.”
Holt is one of 70 patients that Dr Barrett has now treated for fibromyalgia. “The vast majority have seen huge improvements, not only in pain but in their mood and anxiety levels, and their disability scores,” she says. “We’re seeing people brought back to the place they were in before their illness.”
This was what Holt experienced after her 20 sessions of rTMS. “When I used to have flare-ups, I’d be bed bound for two weeks at a time,” she says. “I haven’t had any flare ups since my rTMS with Dr Barrett. Straight after my sessions, I visited my husband’s family in Vancouver, for the first time in my life. I could get up at 7am, run around after my son and have breakfast with my family. It would take me hours to get out of bed beforehand.”
Holt’s case was “amazing, and beautiful to behold,” Dr Barrett recalls. “She was a woman in her prime but was completely knocked out by her illness. Seeing her come back into the world has been incredibly rewarding, and a life changer for her and her family.”
What happens in an rTMS session
When a patient undergoes an rTMS session, “a small but powerful electric current is transmitted from the magnetic coil to the brain areas most involved in pain processing,” Dr Barrett says. “From the front of the brain, the current travels through the brain’s complex network of pain centres and resets the brain in a healthy way.”
Dr Barrett explains that the rTMS procedure is effective because it works by “desensitising the parts of the brain which have become overactive, restoring normal levels of activity and promoting new neural pathways,” she explains.
“With chronic pain, it’s as though the brain’s thermostat for pain regulation has become stuck and won’t calm down, so it’s firing signals to the body telling it that something is seriously wrong when there isn’t.” This is where rTMS has the potential to be transformative. “Up until now, nobody’s been able to reverse that problem and bring the soaring pain levels back down. After rTMS, patients still feel pain when they’re injured, but that pain isn’t amplified.”
The procedure is non-invasive and painless. “I could feel my muscles twitching, and a weird sound near my face, like two marbles clicking together, but I didn’t feel any pain,” Holt says. The repetitive nature of rTMS means that some patients have up to three sessions in a single day, to speed their recovery. “I had my 20 sessions over a month, which was quite intense,” Holt adds.
“Doctors have been safely using rTMS for depression for the last 10 to 15 years,” Dr Barrett says, with the treatment approved for use on the NHS 10 years ago. “We are the first rheumatology centre in the UK to use this technique of neuromodulation for fibromyalgia and chronic pain. rTMS makes a big difference for people’s pain and fatigue, but then we have to rebuild their health, with gentle physiotherapy, supplements and any other medical support that they need.”
Is brain stimulation the solution for chronic pain?
Dr Barrett understands the vast range of factors that can make someone develop chronic pain. Could magnetic brain stimulation really become a one-stop treatment for people suffering with everything from fibromyalgia to back pain and arthritis, with a wide variety of causes of their pain – from genes and injuries to childhood trauma?
“The emphasis recently has been that depression or anxiety are what trigger chronic pain, where people have a genetic disposition to it,” Dr Barrett says. “My thinking is that this is the wrong way to look at the problem. Chronic pain, including conditions like fibromyalgia, are physical conditions, therefore we can get in and reverse the problem in a physical way. In that sense, the work we’re doing on rTMS turns the conventional view of treating chronic pain on its head.”
Her work suggests too that there may be even more underlying chronic pain than genes and trauma. “Of the patients we’ve treated for fibromyalgia, 100 per cent had underlying hypermobility, where their joints are more flexible than normal,” says Dr Barrett. “My thinking is that when those people keep dislocating their joints and injuring themselves all the time, right from being a tiny child up into adulthood, that overstimulates the brain, making that thermometer get stuck.”
The idea of having electric currents fired at your brain is enough to make many nervous, and some anecdotal reports from patients who have undergone rTMS for depression suggest that it can worsen symptoms of low mood and even cause seizures or insomnia. Serious side effects are believed to be rare, however.
To date, there have been no large-scale studies investigating whether rTMS can be called a “cure” for chronic pain. This could soon change: Dr Barrett is beginning research into her rTMS protocol that will use functional MRI scans to “show what lights up in the brain of someone with chronic pain before they’re treated, and what that looks like after seven days”.
She expects the results of this study to be released towards the end of 2025. “At that point, we might have enough figures and evidence to put in front of NICE, which approves treatments to be made available on the NHS,” Dr Barrett says. At the moment, some NHS trusts offer similar treatments for chronic pain using an rTMS machine, but only for a very limited number of patients. “We think that full approval will be a question of when, not if. This is a bona fide treatment and for chronic pain, it’s really the best we’ve got.”
For Holt, in the meantime, life is exciting again. “My pain is virtually gone,” she says. “I’ve been given back the life I’ve always wanted.”
