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Reflex sympathetic dystrophy treated by electroconvulsive therapy: intractable pain, depression, and bilateral
1Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV 26506 USA.
Pain
|December 1, 1993
Summary
Electroconvulsive therapy (ECT) effectively resolved intractable reflex sympathetic dystrophy (RSD) pain and associated depression in a patient unresponsive to traditional treatments. This suggests a potential role for ECT in managing complex pain syndromes.
Area of Science:
- Neurology
- Psychiatry
- Pain Management
Background:
- Reflex sympathetic dystrophy (RSD) is a chronic pain condition often resistant to conventional therapies.
- The patient presented with intractable RSD in her left arm following injury and surgery, alongside developing depression.
Observation:
- Standard treatments including medications, nerve blocks, and behavioral therapy failed to alleviate the patient's severe pain.
- Electroconvulsive therapy (ECT) with bilateral lead placement was administered due to the patient's depression and suicide attempt.
Findings:
- The patient experienced immediate pain relief after the first ECT session, with complete resolution of RSD pain, vascular changes, and depression after a full course of ECT.
- Post-ECT psychiatric disturbances were noted, requiring long-term management.
Implications:
- This case highlights the potential efficacy of ECT in treating severe, treatment-resistant RSD and comorbid depression.
- The resolution of vascular changes suggests a possible central nervous system contribution to RSD pathophysiology, warranting further investigation into ECT's mechanisms.