Electroconvulsive therapy improves severe pain associated with fibromyalgia

Abstract

The pathophysiology of fibromyalgia remains unknown. Several reports have recently suggested the novel concept that fibromyalgia is due to the central nervous system becoming hyper-responsive to a peripheral stimulus. The effect of electroconvulsive therapy (ECT) as pain remedication in cases of fibromyalgia without major depressive disorder was studied in a prospective trial lasting three months. All of the patients taking part in the study fulfilled the American College of Rheumatology diagnostic criteria for fibromyalgia. Technetium-99m ethyl cysteinate dimer single photon emission computed tomography was used to assess regional cerebral blood flow (rCBF) before and after a course of ECT. Pain assessment in the patients was undertaken by use of the visual analog scale (VAS) and by evaluation of tender points (TPs). Beck's depression inventory (BDI) was further used to assess depressive mood change in the patients. Our study clearly demonstrated that pain was significantly less severe after ECT, as indicated by the VAS scale for pain and the evaluation of TPs. A further notable observation was that thalamic blood flow was also improved. We conclude that a course of ECT produced notable improvements in both intractable severe pain associated with fibromyalgia and also in terms of thalamic blood flow.

A comparison of coping strategies in patients with fibromyalgia, chronic neuropathic pain, and pain‐free controls

“…Their hypersensitivity is, however, generalized and not confined to a specific neuroanatomically defined body part (Gormsen, Bach, Rosenberg & Jensen, ). The etiology of FM is still medically unexplained (Arnold, Lu, Crofford et al ., ; Arnold, Rosen, Pritchett ; Bennett, ; McLean & Clauw, ; Usui, Doi, Nishioka et al ., ). It is, however, hypothesized that there is a dysfunction in the descending inhibitory pathways mediated by serotonin and noradrenaline in the spinal cord and brain (Gormsen, et al ., ).…”

The impact of trait anxiety under a painful stimulus on the chaotic synchronization of respiration and pulse waves

“…In reality, trait anxiety is an individual factor that tends to lead to chronic pain in particular [5]. In patients suffering chronic pain, plastic changes with pain regulation in the central nervous system and peripheral nervous systems [6] [15][36] [42], psychological factors, and the like oftentimes retard medical treatment because they contribute to the formation of clinical conditions. However, it has been reported that the heart rate variability biofeedback method (HRV-BF method), in which fluctuations in a person's heart rate are increased by regulating respiration, lowers trait anxiety levels [32], and that it is effective against fibromyalgia syndrome, which is a model ailment when it comes to chronic pain [13].…”

Zentrale Schmerzverarbeitung bei funktionellen somatischen Syndromen

“…Dies war begleitet von einer Zunahme des rCBF (gemessen mit SPECT) im Thalamus und den Basalganglien und einer Abnahme des rCBF in einigen anderen Regionen, eine Korrelation mit klinischen Parametern fand sich nicht. Usui et al [70] untersuchten nichtdepressive Patienten mit FMS mit SPECT vor und nach einer Elektroschockbehandlung. Die Patienten gaben eine Besserung der Schmerzen an, und die Zahl der "tender points" war nach der Behandlung verringert.…”