Use of deep repetitive transcranial magnetic (dTMS) stimulation of motor cortex and anterior cingulate cortex for complex regional pain syndrome type ii: A case report

<h2>Abstract</h2> We report the case of a 39-year-old patient diagnosed with Complex Regional Pain Syndrome (CRPS) Type II in the right upper extremity following surgery for thoracic outlet syndrome who had a rewarding outcome in response to repetitive transcranial magnetic stimulation(deep rTMS). In an inceptive attempt, two brain areas - the contralateral motor cortex and the anterior cingulate cortex - were targeted for the sensory and for the emotional aspects of pain respectively. After the intervention as per the designated protocol, the pain intensity decreased, subjectively and objectively. Her mood improved, as assessed using mood and health questionnaires. Long-term follow-up assessment (at 140 days) revealed 90% alleviation of most of her symptoms including pain. It also resulted in better quality of her life. This indicates a potential robust effect of dTMS on pain and perhaps a useful addition of a novel modality in the algorithm of this challenging pain syndrome.