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Electroconvulsive therapy improves severe pain associated with fibromyalgia
Chie Usui1, Nagafumi Doi, Makiko Nishioka
1Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan Department of Neuropsychiatry, Faculty of Medicine, Tokyo University, Tokyo, Japan Department of Radiology, Jikei University School of Medicine, Tokyo, Japan Department of Anesthesiology, Juntendo University School of Medicine, Tokyo, Japan Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan.
Electroconvulsive therapy (ECT) significantly reduced fibromyalgia pain and improved thalamic blood flow in patients without major depressive disorder. This study suggests ECT is a viable treatment for severe, intractable fibromyalgia pain.
Area of Science:
- Neurology
- Pain Medicine
- Psychiatry
Background:
- Fibromyalgia pathophysiology is poorly understood, with emerging theories pointing to central nervous system hyperexcitability.
- Current treatment options for fibromyalgia, especially severe and intractable cases without comorbid depression, remain limited.
Purpose of the Study:
- To investigate the efficacy of electroconvulsive therapy (ECT) as a pain remediation strategy for fibromyalgia patients without major depressive disorder.
- To assess the impact of ECT on regional cerebral blood flow (rCBF), particularly in the thalamus, and its correlation with pain reduction.
Main Methods:
- A prospective trial involving patients meeting the American College of Rheumatology criteria for fibromyalgia.
- Assessment of pain using the visual analog scale (VAS) and tender points (TPs) before and after a three-month course of ECT.
- Regional cerebral blood flow (rCBF) was measured using Technetium-99m ethyl cysteinate dimer single photon emission computed tomography.
- Beck's Depression Inventory (BDI) was used to monitor mood changes.
Main Results:
- Significant reduction in reported pain severity as measured by VAS and TPs after ECT.
- A notable improvement in thalamic blood flow was observed post-ECT.
- No significant depressive mood changes were indicated by the BDI, suggesting ECT's benefits were independent of mood improvement.
Conclusions:
- Electroconvulsive therapy (ECT) demonstrates significant efficacy in alleviating severe, intractable pain associated with fibromyalgia.
- ECT positively impacts thalamic blood flow, suggesting a potential neurobiological mechanism for pain relief in fibromyalgia.
- ECT represents a promising therapeutic option for fibromyalgia patients suffering from severe pain, even in the absence of major depressive disorder.