This double-blinded, randomized trial hypothesizes that 5 TMS treatments will provide a decrease in reported pain of COFP patients when compared to those who receive either an equivalent amount of sham or no stimulation while awaiting neurosurgical intervention.

51 COFP patients presenting to the Carilion Clinic for neurosurgical intervention are randomized to one of three trial arms: standard care, 5 sessions of sham TMS, or 5 sessions of therapeutic TMS. Stimulation targets the M1 hand for a train of 100 20-Hz pulses once per minute for 10 consecutive minutes. Sham stimulation requires setting the TMS coil to non-stimulatory mode while transcutaneous electrical nerve stimulation (TENS) electrodes on the scalp mimic the sensation of stimulation. Patients and administrators are blinded to the sham versus stimulation group. Participant responses to the McGill Short Form Pain Questionnaire are recorded and compared before and after stimulation and surgery, across the three groups.