Repetitive Transcranial Magnetic Stimulation for Refractory, Widespread Complex Regional Pain Syndrome Type II: A Case Report.

Complex regional pain syndrome (CRPS) is a poorly understood pain disorder often resistant to conventional therapies. Although typically localized, CRPS can spread to other regions. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment showing promise for neuropathic pain associated with CRPS. A 33-year-old active-duty service member developed widespread, refractory CRPS following a severe ankle sprain, with persistent pain and functional limitations despite medications, ketamine infusions, and sympathetic nerve blocks. The patient received 21 rTMS sessions over four weeks, targeting the left primary motor cortex. Pain scores decreased from 5.9 to 3.8 (legs) and 5.3 to 3.3 (hands) following treatment sessions. A 10% pain reduction was sustained at one-month post-treatment. No significant adverse effects were observed. rTMS was safe, well-tolerated, and associated with clinically meaningful pain reduction in this case of refractory, widespread CRPS, supporting further investigation of rTMS for severe CRPS.