Transcranial Magnetic Stimulation for Facial Pain

Inclusion Criteria

• Age between 18 and 110
• Diagnosis of complex oro-facial pain made by the UMPhysicians Complex Facial Pain Clinic
• Alternative treatment of proven value not available as judged by the UMPhysicians Complex Facial Pain clinic
• One of the following types of facial pain as assessed by the Burchiel Patient Pain Rating Classification Questionnaire:
• trigeminal neuralgia Type 2 (TN2)
• trigeminal neuropathic pain (TNP)
• trigeminal deafferentation pain (TDP)
• post herpetic neuralgia (PHN)
• atypical facial pain (AFP)
• nervus intermedius neuralgia (NIN)
• Willing and able to give informed consent

Exclusion Criteria

• Subject diagnosed according to the MINI as suffering from any other major Axis I disorder, such as Psychotic Disorder, Bipolar affective disorder, OCD (MDD is not contraindicated when Hamilton Depression Rating Scale -21≤26, or Beck Depression Inventory).
• Subjects with significant suicidal risk as assessed by the investigator using the Beck Suicide Ideation scale, psychiatric interview or a history of attempted suicide in the past year.
• Subject has a history of epilepsy or seizure (EXCEPT those therapeutically induced by ECT).
• Subject has a history of significant head trauma with loss of consciousness for longer than 5 minutes.
• Subject has a history of cranial surgery within 1 month of treatment.
• Subject has metallic particles in the eye or head (exclusive of mouth), implanted cardiac pacemaker or any intra-cardiac lines, implanted neurostimulators, intra-cranial implants (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or implanted medical pumps.
• Subject cannot pass the TMS Adult Safety Screen or the CMRR Safety Screen.
• Subject has severe and frequent headaches not part of their facial pain syndrome.
• Subject has a history of significant hearing loss.
• Subjects with a significant neurological disorder or insult including, but not limited to:
• Any condition likely to be associated with increased intracranial pressure
• Space occupying brain lesion
• History of cerebrovascular accident
• Transient ischemic attack within two years
• Cerebral aneurysm
• MMSE ≤ 24
• Parkinson's disease
• Huntington's chorea
• Multiple sclerosis
• Subject with a history of substance abuse including alcoholism within the past 6 months (except nicotine and caffeine).
• Inadequate communication with the patient.
• Subject is under custodial care.
• Subject is currently participating in another clinical study or enrolled in another clinical study within 30 days prior to this study.
• Subject with unstable physical disease such as unstable cardiac disease.
• Subject is currently on Benzodiazepine at a dose higher than 3 mg of Lorazepam or equivalent.
• Subject has had previous treatment with TMS.
• Women who are breast-feeding.
• Women of childbearing potential and not using a medically accepted form of contraception when sexually active.
• Inability to give informed consent