rTMS and Rehabilitation for Individuals With CRPS Type 1

Subjects with complex regional pain syndrome (CRPS) Type 1 will be randomized to receive repeated transcranial magnetic stimulation (rTMS) followed by rehabilitation or sham rTMS followed by rehabilitation. Treatment will last for 4 weeks, with the first week including 4 rTMS treatments and 2 rehabilitation treatments. Subsequent weeks will include 2 rTMS treatments followed by 2 rehabilitation treatments. Outcome measures will include pain ratings, PROMIS questionnaires, global rating of change, and grip strength or 1 repetition maximum leg press.

Inclusion Criteria:Upper or lower extremity CRPS Type 1 (also called RSD-Reflex Sympathetic Dystrophy) of at least 6 months.Pain rating on NPRS of at least 4/10No initiation of a new intervention (i.e., medication, rehab, injections) in the previous 2 months.No plan to initiate a new intervention during the study treatment timeframe (4 weeks).Exclusion Criteria:A history of seizures or epilepsyIntracranial metallic devicesPacemakerIntrathecal infusion pumpsBrain or spinal cord stimulators with epidural electrodesOther ferromagnetic metallic intracranial implantsApparent mental or psychiatric disorder that prevents adequate informed consentCurrent pregnancyNon-English speaking