Dear Ann -

I think the key point that has to be made to both the pain mgt. and psychiatric community is the finding of the Johns Hopkins study that ECT relieves chronic pain independently of depression. Wasan AD, Artin A, and Clark A. "Case-Matching Study of the Analgesic Properties of Electroconvulsive Therapy," Pain Medicine, 2004, 5:50-58.

For too long it was just assumed that depression was co-morbid with pain and if you got rid of the depression, a lot of folks pain would improve as well. The Johns Hopkins study put that to the lie.

Also, as pointed out in the article, mid-seizure ("ictal") PET scans can now show different patterns of changes in regional cerebral blood flow (rCBF) for people with depression as opposed to CRPS patients, where patients with depression tend to have too much blood flow in the cortex (which is reduced with ECT) while CRPS patients have too little blood flow in the thalamus, which is reversed with ECT. See, e.g.:

Nobler MS, Oquendo MA, Kegeles LS, et al., "Decreased Regional Brain Metabolism After ECT," Am. J. Psychiatry, 2001, 158:305-308;

Takano H, Motohashi N, Uema T, et al., "Changes in Regional Cerebral Blood Flow During Acute Electroconvulsive Therapy in Patients With Depression, British Journal of Psychiatry," 2007, 190:63-68; and

Fukui S, Shigemori S, and Nosaka S., "Changes in Regional Cerebral Blood Flow in the Thalamus After Electroconvulsive Therapy for Patients With Complex Regional Pain Syndrome Type 1 (Preliminary Case Series)," Regional Anesthesia and Pain Medicine, 2002, 27:529-532.

This is real folks. I for one am not going to stop until I can get this done. I already know of one researcher who I understand is attemping to get a double-blind study of closely matched pairs through his IRB, where one group might get 8 -10 applications of ketamine anesthesia alone, while the other group would get the ketamine in conjunction with RUL ECT. This study may be a year away from coming together, but rest assured, it will happen.

Mike

ps I stand once again willing to send pdf files of almost everything that was cited in my article to anyone who can use them: just send me a PM with your email address.

pps Forgot to include one more article of significance:

Maihöfner C, Handwerker HO, Neundörfer B, et al., "Cortical reorganization during recovery from complex regional pain Syndrome," Neurology, 2004, 63:693-701.

It's important because it demonstrates that when CRPS is relieved through other therapies, e.g. ketamine, the rCBF changes are pretty much the same as those of ECT. Cool, isn't it?

I just heard back from my pain dr. at USC to whom I had written about what was going on this morning. He's offering to try and set it up through his pyschiatry dept., which would be great if it works out and they can actually do it.

I found out yesterday in a consultation with a local ECT doctor that the ECT therapy which I have been working on for months, was not available to a variety of vague regulatory reasons except perhaps at a "tertiary medical center" and was later told that within the last few weeks, Michael Stanton Hicks, M.D. was approached by someone - who had apparently read my article - only to be told that while he could provide Prialt, the Cleveland Clinic doesn't do ECT for CRPS.

Mike

Hi Mike! Great work bro!

Sorry to hear about the set backs, but press on my friend, the squeaky wheel gets the grease as they say. At least you articles are getting notice.

I thought I was the only one that did this. It is very frustrating to say the least. At one time I could read over 1800 words per minute with over 80% comprehension. Now as I read, I read lines over and over, and cant remember what I read as I approach the end of the page. When I write it turns out just as you have said in the above quote.

I sure hope your doin well bro, and am glad to see that you have emersed yourself into some fine work.

I was offered ECT years ago for depression. That was before it was known for cronic pain.

My thought is that most everyone that has RSD deals with depression so if they could get into a therapist office and get the diagnoses of major depression then they may be able to get the ECT.

It sounds like you are on the right track Mike.

Ada

Hey Mike,
I just wanted to say congratulations on such a wonderful article! I also wanted to thank you for caring about all of us as well as yourself to do all this. I guess that it was quite a lot of work to do but in the end it paid off. Thank you so much for your efforts on everything!

Sincerely,
Tracy