Suzuki Kazumasa, Ebina Yukio, Shindo Tsuyoshi, Takano Takehisa, Awata Shuichi, Matsuoka Hiroo
Department of Psychiatry, Tohoku University Hospital, Aoba-ku, Sendai, Japan.
Med Sci Monit. 2009 Apr;15(4):CS77-9.
Electroconvulsive therapy (ECT) is reported to be effective for intractable chronic pain with depression. However, not much has been done to clarify the ECT target in patients, whether the pain or the depression. We report a case of intractable chronic regional pain syndrome (CRPS) with secondary depression in which the depression was treated successfully with an initial acute ECT course, and the pain finally improved with two additional ECT courses.
The patient was a 48-year-old woman with CRPS and depression caused by failed back syndrome. The CRPS with depression did not respond to standard treatments. A course of bilateral acute ECT (12 sessions) improved the depressive symptoms but not the pain. The depression relapsed 1 month after the response to ECT. A second course of acute ECT (20 sessions) followed by continuation ECT (11 sessions) improved the depression but not the pain. The depression recurred 1 year after the response to acute ECT. A third course of acute ECT (12 sessions) finally improved the pain and resolved the depression.
Our experience in thin case suggests that the therapeutic target in patients with chronic organic pain and secondary depression should be the pain; repeated ECT courses are likely to be effective for the pain, although the depression may resolve first.
据报道，电休克治疗（ECT）对伴有抑郁症的顽固性慢性疼痛有效。然而，在明确ECT治疗此类患者的靶点是疼痛还是抑郁方面，所做的工作不多。我们报告一例伴有继发性抑郁症的顽固性慢性区域疼痛综合征（CRPS）病例，该患者最初接受一个疗程的急性ECT治疗后，抑郁症得到成功治疗，最终又接受两个疗程的ECT治疗后疼痛有所改善。
患者为一名48岁女性，患有因腰椎手术失败综合征导致的CRPS和抑郁症。伴有抑郁症的CRPS对标准治疗无反应。一个疗程的双侧急性ECT（12次）改善了抑郁症状，但未缓解疼痛。ECT治疗有效后1个月，抑郁症复发。第二个疗程的急性ECT（20次），随后进行维持性ECT（11次），改善了抑郁症状，但疼痛仍未缓解。急性ECT治疗有效后1年，抑郁症再次复发。第三个疗程的急性ECT（12次）最终缓解了疼痛并治愈了抑郁症。
我们在此病例中的经验表明，患有慢性器质性疼痛和继发性抑郁症患者的治疗靶点应为疼痛；尽管抑郁症可能首先得到缓解，但重复进行ECT疗程可能对疼痛有效。
