Repeated electroconvulsive therapy courses improved chronic regional pain with depression caused by failed back syndrome.

BACKGROUND: Electroconvulsive therapy (ECT) is reported to be effective for intractable chronic pain with depression. However, not much has been done to clarify the ECT target in patients, whether the pain or the depression. We report a case of intractable chronic regional pain syndrome (CRPS) with secondary depression in which the depression was treated successfully with an initial acute ECT course, and the pain finally improved with two additional ECT courses.

CASE REPORTS: The patient was a 48-year-old woman with CRPS and depression caused by failed back syndrome. The CRPS with depression did not respond to standard treatments. A course of bilateral acute ECT (12 sessions) improved the depressive symptoms but not the pain. The depression relapsed 1 month after the response to ECT. A second course of acute ECT (20 sessions) followed by continuation ECT (11 sessions) improved the depression but not the pain. The depression recurred 1 year after the response to acute ECT. A third course of acute ECT (12 sessions) finally improved the pain and resolved the depression.

CONCLUSIONS: Our experience in thin case suggests that the therapeutic target in patients with chronic organic pain and secondary depression should be the pain; repeated ECT courses are likely to be effective for the pain, although the depression may resolve first.