A 41-year-old male was a victim of a severe motorcycle accident 17 years ago with right brachial plexus avulsion . He complains of severe pain in the right arm. His pain level is 10/10 on the VAS . The pain is crushing and burning. It is there all the time but fluctuates in severity. It is partially improved with morphine and pregabalin. He has had a cervical spinal cord stimulator for 5 years with limited success. Functionally, he has done very well after double gracilis free muscle flap. PMH significant for arthritis, plating for fractures of the right forearm, appendectomy, and hernia repair . FH positive for a grandmother with heart disease, prostate cancer in the father, diabetes in the mother, and a sister with lung cancer. Socially, he has smoked a pack of cigarettes a day for 30 years. On examination, he has no Horner’s syndrome, elbow flexion 4+, middle finger extension 4, and otherwise 0/5 in the remaining muscle groups of the right arm; there is no light touch sensation from C5 to T1 on the right.