Clinical Research Directory

Inclusion Criteria: * Age ≥ 21 years old of any sex and race * Ischemic or hemorrhagic stroke affecting the thalamus ≥6 months from symptom onset * Development of refractory neuropathic pain (biologically plausible pain with confirmed stroke lesion, ≥6 months symptom duration, visual analogue scale \[VAS\] ≥5, failed 2 medication trials of at least 3 months each * The ability to provide consent * Presence of CPSP as defined by pain distribution in a neuroanatomically plausible distribution, a history suggestive of stroke, an MRI confirming the stroke lesion, as well as negative or positive sensory signs. PAIN-DETECT score must be ≥13. Exclusion Criteria: * Diagnosis of a co-morbid pain syndrome * Documented seizure disorder before or after stroke * Scalp wound or bone defect (i.e., craniotomy) * Contraindications to MRI or rTMS (i.e., implanted metallic devices in the head, neck or chest) * No changes in pain medications during the prior 4 weeks, and no intention to change pain medications during the study * Significant change (1.2) in VAS between the two baseline visits to suggest instability of the CPSP * Pregnancy