Hi All,

I just had a conversation with my PM doctor in regards to RUL ECT. I have tried almost everything possible ketamine more than once, epidurals, trigger point injections, some meds but we keep it low because one day I will be over this nightmare and will have to get off the meds I am on, so I chose to keep it light.

Anyway the protocol is suppose to be in orderr to do RUL ECT "It must be combined with very, very bad depression" , he or any one else he knows who works with RSD Patients just would not do it for that reason only,just RSD.
I think the reason we are hearing a lot about it is because most RSD patients are depressed some more than others. I was also very excited when I first read about it but I don't think it will become a common theraphy for RSD.

Keep us posted.

Ann

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.