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Application for ESRA Abstract Prizes:Background and Aims Persistent pain after brachial plexus avulsion injury is often refractory to most treatments including analgesics, interventions and implantable devices for spinal cord and dorsal root ganglion stimulation. We report a case where we successfully treated longstanding pain following post-traumatic amputation at the upper third of the humerus, brachial plexus avulsion, phantom limb pain, post-head injury cerebral arachnoiditis, multiple rib fractures, scapular deformity and left diaphragmatic paresis following a RTA 12 years ago.Methods Patient was treated with an external neuromodulation device (Biowave corp) for 30 minutes as per protocol using two electrode pads and stimulation was well tolerated without producing any discomfort. Due to the history of brachial plexus avulsion injury, one lead was placed at T3–4 level left side of the spine and another at the inferolateral aspect of the left upper limb stump where he has maximum stump pain. Stimulation was well tolerated and could elicit it around the area of stump pain and the patient also reported that he could ‘feel the phantom limb normally’ during the stimulation.Results Prior to the procedure, the pain score was severe 8/10 on VAS and this was the average pain score he had been feeling for the past 12 years. Patient reported immediate improvement in pain during stimulation (VAS 1/10) and had sustained pain relief post-treatment (VAS 1/10) which lasted for 8 hours. Patient was offered repeat treatment on a domiciliary basis and we are monitoring the progress.Conclusions Targeted non-invasive external neuromodulation could be an effective treatment option for refractory neuropathic pain