For as long as he can remember, Mitchell Florn has been an “outdoor guy.” The biopharmaceutical scientist and University of Michigan graduate reflects happily on his memories of rock climbing, mountain biking, skiing, competitive pistol-shooting and setting records in track. “I’m not a flat ground guy,” Florn says of himself. “I climb.”

This lifestyle was disrupted abruptly in 1994 when Florn suffered a debilitating injury and broke his neck, back and hip. By the early 2000s, he started noticing pain in his hand, pain that exacerbated over the next few years. Before long, Florn was in chronic pain and it had taken over his life. “I couldn’t get out of bed for 16 hours a day,” he said. “Couldn’t button my shirts, couldn’t use a toothbrush in my hand.”

Florn tried every treatment advised to him. Given his decades of experience researching infectious diseases and teaching anatomy and physiology college courses, Florn is well-versed in medicine. “There’s a list of at least 12 of the pharmaceutical immunomodulators that I had tried,” Florn recalls. He tried TNF inhibitors, hydroxychloroquine, Humira, Stelara, Etanercept and Methotrexate. By 2008, Florn was being prescribed 270 4mg pills a month of Hydromorphone, as well as 90 45mg pills a month of Oxycodone.

For the next five years, Florn was taking pills three to four times a day. Still, the medications didn’t dull his discomfort, so he began washing the pills down with alcohol. “Because the pain is so severe that you’re just like, you will do anything,” Florn said. “People do not realize, when you are in pain you will do anything to get out of pain. And I will emphasize anything.” Blinding. Stabbing. Unimaginable. These are some of the words Florn uses to describe the pain he was trying to escape. He says when you are in chronic pain, “every single motion is like shattered glass in every single one of your joints.”

The opiate analgesics helped, but they took their toll. Florn would throw up five or six times a day for months at a time. He would shake “24 hours a day.” He had lost 50 lbs., down from 180 lbs. to 130 lbs. The drugs and pain were ruining his personal life. He became irritable, hateful, cranky and miserable. “When you’re coming off of opiates, you don’t know who you are,” Florn says. One day, he was playing volleyball with his daughter when he started vomiting. In that moment, Florn realized he needed to check himself in to a rehabilitation clinic.

Florn thought he had exhausted all possible remedies when he began working with doctors in the Stanford Medicine Division of Pain Medicine throughout 2010 and 2012. In early 2018, Florn was introduced to Dr. Kristen H. Scherrer, a former postdoctoral research fellow working with Redlich Professor Sean Mackey in Stanford’s Neuroscience and Pain Laboratory (SNAPL) researching a relatively new form of pain treatment called Transcranial Magnetic Stimulation (TMS). Dr. Mackey has been working to advance TMS as a novel and safe therapy for people with chronic pain.

TMS, which has been used to treat depression for decades, is a non-invasive therapy that uses brief magnetic pulses to target regions of the brain associated with pain, according to Dr. Scherrer. Using a treatment coil that is placed over a patient’s head, TMS therapy stimulates neurons in the brain by administering magnetic pulses, inducing brief activity of nerve cells in the brain. Dr. Mackey and his group have been working to develop novel stimulation methods to make TMS more effective and provide longer pain relief. He published a paper in 2017 demonstrating how a novel TMS stimulation method provided pain relief in a group of patients with an intractable pain condition called complex regional pain syndrome (CRPS). Dr. Mackey brought TMS into the Stanford Pain Management Center with the hope of providing a novel therapy to patients and to help identify who would respond to this non-invasive therapy.

After his first round of TMS therapy, Florn had gotten movement back in his hands. Throughout other treatments, his pain scores dropped dramatically, said Dr. Scherrer. “And it’s just been a progressive improvement for him,” she added.

No longer experiencing chronic pain for the first time in years, Florn is back to hiking, climbing four to five miles a day and shooting his bow. His mood has increased, his sleep cycles have improved, and he is on no pain medications. He credits TMS therapy, along with other non-invasive treatments like acupuncture, hypnosis and massage therapy, for giving him his active lifestyle back. “It’s amazing,” Florn said of TMS. “And to me, it’s been life-changing.”

TMS therapy has been used to treat depression since the 1980s and has FDA approval to do so. Its use and effectiveness in other areas, including treatment for pain, anxiety, arthritis and cognitive issues like autism, is being researched in ongoing studies.

Dr. Scherrer says that many of her patients suffering from chronic pain have exhausted their treatment options before arriving at Stanford’s pain clinic. They have tried multiple classes of pharmacotherapies, physical therapy, chiropractic services, nerve blocks, biofeedback therapy, intravenous ketamine infusions and other treatments. After beginning TMS therapy, Dr. Scherrer says her patients notice improved physical function, overall demeanor and general happiness. They are dancing, walking and gardening, as well as spending time with their families and grandchildren. “And seeing patients progress to the point where they have has been just incredible,” Dr. Scherrer said.

Unlike opioids, which run the risk of dependence with long-term use, TMS therapy has minimal side effects. The biggest side effect is patients having a headache after TMS sessions, but “typically resolves quickly,” said Dr. Scherrer. After that, TMS therapy is virtually painless. Dr. Scherrer says she tells patients it’s “kind of like licking a 9V battery,” while Florn describes it as feeling “like a woodpecker tapping on your head.” After the first burst of pulses “it becomes very calming, very mesmerizing, and therapeutic,” Florn said. “I mean, as you’re sitting there you’re going like, ‘I can feel this working.’”

“Given the opioid crisis, we are in need of alternative therapies,” Dr. Scherrer said. “And that is why TMS represents such a promising avenue right now. Not only does it work, you don’t have the addictive potential, you don’t have the major side effects that are associated with many of these medications.”

Dr. Scherrer says that patients often come to the special care clinic with mixed emotions, including desperation, excitement and skepticism. But Florn says there is nothing to be skeptical about. “You have nothing to lose, [and] everything to gain,” Florn said.

Since TMS gave Florn his life back, he wants to “give back to society” by championing this new type of chronic pain treatment. “I’m an advocate for this therapy that is non-invasive, it’s not addictive, and it works.” Florn said. “That’s the cool part.” Dr. Mackey is thrilled that Florn has received such benefit and wants to make this technology available to others. He is currently seeking out additional philanthropic and grant support to continue these promising efforts.

The worst thing about chronic pain, Dr. Scherrer said, is that “you never know if it will ever end.” But because of TMS therapy, Florn is now able to get out of bed without feeling crushing pain. He has a better relationship with his daughter, he is back climbing in the Northern California mountains and he is able to get out of bed everyday. And, he says, “I don’t feel broken glass.”

Disclaimer: TMS for pain relief at Stanford remains an investigational treatment under a research protocol. To date, TMS has been supported by generous philanthropy from the Rainin Foundation, the Feldman Foundation, and the Redlich Pain Endowment. While we want to enroll as many people as possible, we are currently constrained by our resources. If you are interested in our TMS studies, please email Aaron Yue, MD. If you are interested in supporting our TMS research, please consider making a gift.