OBJECTIVE: Recently, somatosensory cortex stimulation has been proposed as a possible treatment for neuropathic deafferentation pain, based on a simple 4-step concept: (1) pain is associated with increased activity in the somatosensory cortex, (2) allodynia evoked BOLD fMRI activation depicts the area involved in the pain, (3) if fMRI guided neuronavigation based TMS can transiently suppress the pain, (4) an extradural electrode can be implanted targeting the same area. CASE DESCRIPTION: A patient who was successfully treated for over 6 years for trigeminal anesthesia dolorosa associated with a subjectively malpositioned eye after multiple recurrent facial skin tumor removals with this approach develops new pain after more extensive surgery. Reprogramming the implanted electrode is unsuccessful. The presence of the electrode yields too many artifacts on a renewed fMRI and therefore a PET scan is performed under evoked allodynia. Fusing the previous fMRI with the new PET images depicts 2 novel targets for stimulation, 1 anterior and 1 posterior of the previous target and beyond the spatial configuration of the implant. After the addition of 2 new electrodes the pain can again be controlled in a placebo controlled way, but only when the 2 electrodes are activated. CONCLUSION: Combining fMRI and PET scanning can potentially demonstrate continuing map plasticity under progressive somatosensory deafferentation. The functional imaging data can be used as target for pathophysiology based somatosensory cortex stimulation.