Electroconvulsive Therapy in Complex Regional Pain Syndromes
McDaniel, William W. MD
Three cases are presented in which electroconvulsive therapy (ECT) for depression led to the relief of comorbid complex regional pain syndrome as well as depression. In one of the cases, concomitant fibromyalgia was not relieved during 2 separate series of ECT. The literature regarding the role of ECT in the management of chronic pain is reviewed and discussed in light of recent findings about ECT and changes in neurotransmission associated with seizures.
It is common knowledge that chronically painful conditions are often accompanied by clinically significant depression. 1 The relationship is manifold but includes the effect of suffering on mood, neurochemical adaptations to pain that share common pathways with depression, and social effects of chronic pain limiting the sufferer’s activities and social contacts. 1,2
Complex regional pain syndrome (CRPS) is a chronically painful condition that may arise in the site of an earlier injury or operation to a limb, resulting in changes in circulation; coldness and discoloration; and pain and stiffness progressing to joint contractures in the most severe cases. 2 Like all chronically painful conditions, it is associated with depressed mood. This diagnostic category encompasses the older categories of reflex sympathetic dystrophy and causalgia. Both diagnoses described chronic pain with neuropathically mediated circulation changes with peripheral neuropathy and similar autonomic dysfunction after injury. They are now thought to represent the same process, and both conditions are subsumed under the same diagnostic formulation, CRPS. 2
Depression responds to medications and/or psychotherapy in most cases. Electroconvulsive therapy (ECT), the oldest modern antidepressant treatment, provides relief in the great majority of the nonresponders. 3,4 ECT has been reported to relieve depression associated with regional pain syndromes and at the same time reverse the signs and symptoms of regional pain syndrome. 5-7 I report here three more cases in which ECT for depression resulted in resolution of a comorbid CRPS.
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