title: Significant reduction in phantom limb pain after low-frequency repetitive transcranial magnetic stimulation to the primary sensory cortex.
abstract: OBJECTIVE
  Phantom limb pain (PLP) is believed to be linked to the reorganization of the deafferented sensory cortex. We present a case of a patient with upper extremity PLP who was successfully treated with repetitive transcranial magnetic stimulation (rTMS).
  
  
  METHODS
  We treated an active duty service member who suffered an amputation of his right upper extremity after sustaining a blast injury in Afghanistan. He had 28 sessions of alternating sequences of rTMS to the left dorsolateral prefrontal cortex and primary sensory cortex of the left cerebral hemisphere. Pain intensity was assessed with the Visual Analogue Scale.
  
  
  RESULTS
  We delivered 1 Hz stimulation to the sensory cortex corresponding to the area of amputation five times a week. After 4 sessions, the patient's pain decreased from a Visual Analogue Scale of 5 to 2. Left 10 Hz stimulation was added and after 28 sessions, the pain decreased from 2 to 1.
  
  
  CONCLUSIONS
  Our findings support that rTMS was an effective modality for this patient in treating his PLP. The significance of 10 Hz stimulation is unknown because of the lack of an effect size and is possibly associated with a floor effect.
authors.affiliation: Department of Research, National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 South Palmer Road, Bethesda, MD 20889.
authors.forename: Geoffrey G
authors.initials: GG
authors.lastname: Grammer
authors.affiliation: Department of Psychiatry, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Sonya
authors.initials: S
authors.lastname: Williams-Joseph
authors.affiliation: Department of Psychiatry, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Ashley
authors.initials: A
authors.lastname: Cesar
authors.affiliation: Department of Psychiatry, Fort Carson, 6105 Wetzel Avenue, Building 1435, Fort Carson, CO 80913.
authors.forename: David K
authors.initials: DK
authors.lastname: Adkinson
authors.affiliation: Department of Anesthesia, Georgetown University's School of Medicine, 3900 Reservoir Road, Washington, DC 20057.
authors.forename: Christopher
authors.initials: C
authors.lastname: Spevak
mesh_terms: D000671:Amputation, Surgical; D006801:Humans; D008297:Male; D010591:Phantom Limb / Q000628:therapy*; D013003:Somatosensory Cortex; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D034941:Upper Extremity / Q000293:injuries / Q000601:surgery*; D055815:Young Adult