Effect of drug-induced convulsive tgherapy for intractable chronic pain

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Aimms of this study: We have been being obtained good outcome of successful pain relief for the thalamic pain syndrome(TPS) and variety of intractable chronic pain(ICP) using our unique treatment method, or "modified Drug-induced Convulsive Therapy ; DICT". The mechanism of this treatment is, however, still unknown. Periodically occurring irregular waves are found in the trend electroencephalogram(EEG) in all patients treated with modified DICT. Antegrade- and/or retrograde- amnesia is also observed. It might be brought up the interesting problem concerning the pain and memory relationship.In this study, qualitative and quantitative analysis of EEG wave during the treatment were performed to clarify the pain-relief mechanism of the modified DICT.Results:(1) Animal study ; About 10-20 min after the injection, irregular wave which lasts for 1-2 min every 20-25 min were observed for 2-3 hrs. Amplitude and duration of the convulsive EEG wave were correlated with the concentration of sodium … More methylprednisolone succinate. Pain related behavior, licking and/or claudication was disappeared after the treatment.(2) Analysis of human EEG wave. ; About 10-20 min after the injection, irregular wave which is characterized typically by spike ＆ wave complex, and which lasts for 1-2 min every 20-25 min were observed for 2-3 hrs. Amplitude and duration of the convulsive EEG wave were correlated with the concentration of sodium methylprednisolone succinate. Patient was disoriented after the first convulsion, and complained no pain at all. Depression accompanied with chronic pain was disappeared in many cases. The complete disuse of pentazocine was also obtained in two cases of its addiction.Antegrade- or retrograde amnesia which recovered within 1-4 weeks was occurred in most cases and the pain-relief was superior in the patients with amnesia than without amnesia.Discussion : No pain at falling nor memory during seizure were found in poorly controlled epilepsy patient. The cerebral stimuli by MP injection seemed similar to epileptic status. It is known that repeated application of electroconvulsive therapy(ECT) for the patient with episode of depression makes effective pain relief. Multiple intermittent spike and wave complex in the EEG at one treatment so that obtained successful pain relief with single treatment. Comparative EEG irregularity and amnesia after the treatment was observed in the patient who obtained good pain relief.It is strongly suspected that transient cerebral stimuli as much as irregularity is appeared in EEG and occurred amnesia is essential for the emergence from vicious spiral of chronic pain. Less