Electroconvulsive Therapy (ECT) Can be a Choice of Treatment for Established Postherpetic Neuralgia (PHN)

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概要

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• Postherpetic neuralgia (PHN) is recognized to be treatment-resistant and may persist for many years, causing decrease in quality of life (QOL) and depression in some patients. Electroconvulsive therapy (ECT), of which effects on depression are well established, has been reported to reduce intolerable pain associated with depression. We have already reported that ECT reduces pain and allodynia in PHN. In this study, we examined long term effects of ECT on PHN.Subjects were 7 males and 3 females with PHN. Two patients had nociceptive pain arising from bone metastasis of hepatocellular carcinoma or rheumatoid arthritis, (RA) in addition to PHN. Based on written consent from the patients and their families, a course of bilateral ECT (110V for 5sec, 6 or 12 times with interval of one to seven days) was performed. Long term effects were assessed in terms of pain score on persisitent pain, area of allodynia, frequency of intermittent pain, quality of life (QOL) and Hamilton Depression Scale (HDS) 5 to 43 months after the first course of ECT.In all patients, the first course of ECT gave relief or remarkable reducation of pain and allodynia, except for the pain due to bone metastasis or RA, and the QOL of the patients was improved. Besides improvement of pain, the depression lessened. Hypesthesia in involved dermatome remained unchanged, and nociception in the healthy skin remained inact. The pain and allodynia gradually recurred in the skin area with hypesthesia several months after the first course, while HDS remained unchanged.Another course of ECT was applied in seven patients 5 to 26 months after the first course. The second course, consisting of a smaller number of ECT trials, produced the same analgesic effects and fewer side effects of amnesia.Those results suggest that PHN patients are less tolerant to the analgesic effects of ECT than they are to morphine administration or motor cortex stimulation, hewe, ECT is a possible treatment for established PHN.

• 一般社団法人 日本ペインクリニック学会の論文

一般社団法人 日本ペインクリニック学会 | 論文

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