http://lib.bioinfo.pl/auth:Schwartzman,RJ

I find research can be so rewarding when you share the knowlege with all who can benifit from it.

Sandra

Sandel,
Thank you so much for sharing!!! I so appreciate the time you must spend looking for the many things you have posted to share with all of us!!

I can't stay on the computer long enough to research anymore but love to read anything and everything out there about RSD/CRPS.


BIG gentle HUGS!!!


Abbie

This one is really wild, and might beat the heck out of a long-term teatment regime involving Remicade (Infliximab) and Methotrexate, the other "cure option" I've been kicking around lately:

Pain Physician. 2007 Jul;10 (4): 573-8

Treatment of CRPS with ECT.

Marie Wojcik Wolanin, Vasko Gulevski, Robert J Schwartzman

BACKGROUND: Electroconvulsive therapy (ECT) is a well-established treatment method for medically refractory depression. ECT has also been used in the treatment of pain for over 50 years. The mechanism of action of ECT is still unknown, although several observations have been made regarding the effect of ECT on pain processes. It has been reported that several patients with medically refractory depression and Complex Regional Pain Syndrome who were treated with ECT for their depression were also cured of their CRPS symptoms.

OBJECTIVE: We report a case of CRPS in a patient who also suffered from medically refractory depression. She was treated with ECT for her depression and subsequently was relieved of all her CRPS symptoms.

CASE REPORT: A 42 year-old female patient underwent a series of 12 standard bitemporal electroconvulsive therapy treatments for medically refractory depression. Physical examination and Quantitative Sensory Testing was done before and after the patient's treatment with ECT. This standard treatment procedure for refractory depression completely resolved the patient's depressive symptoms. In addition, the patient's CRPS symptoms were also reversed. Physical examination as well as Quantitative Sensory Testing done before and after the ECT treatment correlated with her CRPS symptom improvement.

CONCLUSION: ECT was effective in the treatment of severe refractory CRPS in this patient.

I am curious to get my hands on the article and see whether or not the authors hazard a guess as to the mechanism of action. I would encourage current patients of Dr. S. to ask the man about this and report back with his comments, if they feel comfortable doing so.

Mike

Mike and Sandel,


ECT was suggested to me about 3 years ago by my PM doctor and of course my rushed and non-informed decision was a big NO!
Perhaps I should have taken the time to do some research instead of just presuming that my doc was thinking if he cured my depression then in some way it would help my CRPS!
It is silly as I have attended patients who have had very successful ECT for other reasons but I still can't get rid of that vision of Jack Nicholson and Cuckoo's nest
Cheers
Tayla

Sandel
Thanks ever so much for this interesting extract, I really enjoyed reading it and I am sure many other people will

very very interesting...

it's becoming clearer and clearer that some form of brain damage is occuring (even my consultants tell me that! they say that apparently RSD damages the brain by making the motor area of the cortex be overwritten with pain signals which means you can't move but get mega pain. Wahey!).

Thanks so so much

Love

Frogga xxxxxxxx

This is one of the most interesting articles I've ever had the opportunity to post.

By way of preview, here are the last three paragraphs:

Discussion

The mechanism of action of ECT is still unknown, although several observations have been made regarding the effect of ECT on pain processes. King and Nuss (25) and McDaniel (26) both postulated that massive quantities of neurotransmitters are released during ECT that induce changes in CNS post-synaptic receptors throughout the nervous system. The neurotransmitters affected include serotonin, dopamine, norepinephrine (27), substance P, neuropeptide Y, somatostatin, TSH, and CRH (26). Other neuromodulators, including enkephalin, immune-reactive dynorphin, and beta-endorphins, have also been implicated in the effects of ECT on pain (26,32,33). King and Nuss (25) and Abdi et al (32) have postulated that the electrical current transmission through the thalamus and hypothalamus which occurs during bilateral ECT alters pathways for pain sensation and perception. Wasan et al (27) suggested that disrupted affective processing of pain in CRPS leads to enhanced receptive fields, intensified pain perception and increased pain sensory input. ECT may interrupt this inappropriate processing of pain by disrupting the memory for pain. In addition, Wasan et al (27) have postulated that ECT may stimulate the lateral thalamic structures involved in descending pain inhibition. Fukui et al (33) have studied the effect of ECT on regional cerebral blood flow. They found that patients with chronic neuropathic pain have decreased blood flow to the thalamus. After treatment with ECT, one of their patients had increased regional cerebral blood flow to the thalamus and a dramatic reduction in pain.

Functional changes in the brains of CRPS patients have been described with functional MRI (fMRI). Maihofner et al (34) have shown that activation of the contralateral SI, bilateral SII, and insular cortex all contribute to the encoding of non-painful stimuli. Deactivation of the ipsilateral SI and the primary visual cortex was found in CRPS patients. However, CRPS patients with allodynia have widespread cerebral fMRI activation that includes the ipsilateral and contralateral SI, the primary motor cortex, the contralateral parietal association cortex, bilateral SII, insula, and frontal cortex as well as the anterior and posterior cingulate cortex. Deactivations were detected in the ipsilateral superior frontal cortices, contralateral inferior frontal cortices, visual cortices, and the contralateral temporal and posterior insular (vestibular) cortices. In addition, Maihofner et al (35) have also used magnetic source imaging to show that the brain reorganizes with pain in CRPS, particularly in the primary somatosensory cortex, and recovers from cortical reorganization when CRPS pain is reduced. Therefore, it is possible that ECT may trigger the recovery process of the brain that has been reorganized by CRPS pain to its original form. Because our patient’s symptoms did not immediately completely improve, it can be postulated that ECT may begin the process that restores the brain to its normal functional somatotopic processing capacity, but it may require a prolonged period of time to completely recover.

Conclusion

Further controlled randomized studies will be necessary to elucidate possible mechanisms involved in ECT for the benefit of severe refractory CRPS.

Attached Files

Treatment of CRPS with ECT- Wolanin Gulevski and Schwartzman - painhysicianjournal 2007.pdf (139.0 KB, 149 views)

only it's not called ECT, it's called tDCS. Just a few zaps! I believe this is what the Beth Israel clinical trial is testing: electrical stimulation of the brain and its effects on pain in people with CRPS.
(I posted the abstract of this study earlier at http://neurotalk.psychcentral.com/sh...ad.php?t=27587).

From what the doctor doing the trial told my friend S (who is participating), most of the people do get lots of relief, after 5 days of consecutive treatment. How long it will last? they don't know yet. There is a 3 month follow-up assessment, I believe, so there will be study results.

I thought the "zapping" (tDCS) was a temporary miracle for S. She has had RSD since she was 12 (21 years), beginning with a right knee injury, and spreading into both legs, left arm, trunk, neck and head. Her specific symptoms include sporadic inability to initiate movement in right leg, constant migraine, dystonia in hands, arms, face and jaw, and feet; RSD "fits"/ seizures/tremors, adrenalin storms, problems with blood pressure, body temperature, organ involvement of digestive system, heart, AND last but not least unbearable excruciating pain uncontrollable by any medication.

During the trial, she got up to 7 hours per day where her leg pain was down to about a 3 and she could walk around NYC in the afternoon! We had so much fun shopping and eating out at restaurants! She did not even need crutches. But then, after we got back from NYC, the pain relief stopped. According to the study doctor, that was a bad sign (DUH). Most of the other RSD participants had pain relief that lasted after the treatments ended. S isn't sure she'll go back for the second set of treatments... for one thing, the travel (air and hotel and food) cost $3,000! (we never did find a cheap place to stay). Second, well, you all know the second - the despair when treatment doesn't work.

Just thought you all would like to hear the story about the study - there might be a hopeful new treatment coming down the pike!!

"just a few zaps"