Effect of drug-induced convulsive tgherapy for intractable chronic pain

本研究的目的：我们使用我们独特的治疗方法，或“改良药物性惊厥疗法”，成功地缓解了丘脑痛综合征（TPS）和各种顽固性慢性疼痛（ICP）的疼痛，取得了良好的结果；DICT”。然而，这种治疗的机制尚不清楚。所有经改良的DICT治疗的患者的趋势脑电图（EEG）均出现周期性的不规则波。顺行性和/或逆行性健忘症也被观察到。这可能会引出一个有趣的问题关于疼痛和记忆的关系。本研究对治疗过程中的脑电图进行定性和定量分析，以阐明改良的DICT的镇痛机制。结果：(1)动物实验；注射后约10-20分钟，每20-25分钟出现1-2分钟的不规则波，持续2-3小时。惊厥脑电图的振幅和持续时间与琥珀酸甲泼尼龙钠的浓度相关。治疗后疼痛相关行为、舔和/或跛行消失。(2)人体脑电波分析。;注射后约10-20 min，观察到以峰波复合为特征的不规则波，每20-25 min持续1-2 min，持续2-3 h。惊厥脑电图波幅和持续时间与琥珀酸甲基强的松龙钠浓度相关。病人在第一次抽搐后失去方向感，并无痛感。抑郁伴慢性疼痛在许多病例中消失。在两例戊唑嗪成瘾病例中，戊唑嗪也被完全停用。多数病例出现1 ~ 4周内恢复的顺行性或逆行性遗忘，遗忘组疼痛缓解效果优于非遗忘组。讨论：控制不良的癫痫患者在癫痫发作时无跌倒疼痛和记忆。MP注射对大脑的刺激与癫痫状态相似。众所周知，反复应用电痉挛疗法（ECT）对抑郁症发作的患者可以有效缓解疼痛。在一次治疗中，脑电图出现多个间歇性尖峰和波复合体，因此单次治疗即可成功缓解疼痛。在疼痛得到较好缓解的患者中观察到治疗后脑电图异常和失忆的比较。我们强烈怀疑脑电图中出现的短暂性脑刺激和不规则性以及发生的健忘症是慢性疼痛恶性循环出现的必要条件。少

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