Abdi et al • Electroconvulsive Therapy for Neuropathic Pain 261 Pain Physician Vol. 7, No. 2, 2004 Pain Physician. 2004;7:261-263, ISSN 1533-3159 A Case Report Electroconvulsive Therapy for Neuropathic Pain: A Case Report and Literature Review Salahadin Abdi, MD, PhD, Arita Haruo, MD, and Joshua Bloomstone, MD From Departments of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, University of Miami School of Medicine Miami, Florida and Massachusetts General Hospi- tal, Harvard Medical School, Boston, Massachu- setts. Address Correspondence: Salahadin Abdi, MD PhD, University of Miami School of Medicine, Miami, FL 33136. E-mail: sabdi@med.miami.edu Support:There was no external funding in prepara- tion of this manuscript Conflict of Interest: None Objective: To describe a case of in- tractable brachial plexopathy-induced neu- ropathic pain syndrome treated with elec- troconvulsive therapy after a failed trial of conventional drugs and interventional pain management. Case Report: A 32-year-old male had chronic intractable neuropathic pain of the right upper extremity and shoulder for about 10 years, due to brachial plexopathy. He tried multiple pain medications and underwent var- ious interventional pain procedures without signiicant pain relief. When the patient sub- sequently developed severe depression with suicidal ideation, he underwent electrocon- vulsive therapy, which signiicantly improved the depression and pain for two months. Discussion: There is a growing list of non- psychiatric conditions that may be treated with electroconvulsive therapy. Chronic intractable pain with or without depression has been on and off the list for years. Further studies may eventually demonstrate eicacy of ECT for in- tractable neuropathic pain syndromes. Keywords: Electroconvulsive thera- py, neuropathic pain, depression, intracta- ble pain Neuropathic฀ pain฀ is฀ defined฀ as฀ pain฀ that฀ results฀ from฀ damage฀ or฀ abnormal฀ function฀of฀the฀central฀or฀peripheral฀ner- vous฀system.฀฀Neuropathic฀pain฀can฀be฀dif- ficult฀to฀manage฀using฀conventional฀treat- ment฀ modalities.฀ ฀ The฀ usual฀ treatments฀ include฀ opioids,฀ anticonvulsants,฀ antide- pressants,฀ antiarrhythmics฀ and฀ interven- tional฀ procedures฀ (e.g.,฀ spinal฀ cord฀ stim- ulators,฀ nerve฀ blocks,฀ and฀ neurosurgical฀ ablation).฀ ฀ Unfortunately,฀ many฀ patients฀ fail฀ these฀ treatment฀ modalities.฀ Though฀ not฀well฀studied,฀a฀few฀case฀reports฀illus- trate฀the฀benefit฀of฀electroconvulsive฀ther- apy฀(ECT)฀in฀the฀management฀of฀chronic฀ pain฀syndromes.฀ The฀exact฀origin฀of฀ECT฀is฀unknown.฀ It฀probably฀dates฀back฀to฀the฀medical฀us- age฀of฀eels฀by฀the฀Romans฀to฀treat฀head- ache฀ and฀ later฀ the฀ experiments฀ of฀ Ital- ian฀ naturalists฀ with฀ electricity฀ (1).฀ ฀ Fur- ther,฀ the฀ physician฀ Galen฀ employed฀ elec- tricity฀in฀the฀treatment฀of฀gout฀and฀other฀ illnesses.฀฀Later,฀a฀Hungarian฀psychiatrist,฀ Laszlo฀Meduna,฀was฀credited฀with฀the฀first฀ modern฀ use฀ of฀ convulsive฀ therapy.฀ ฀ He฀ was฀intrigued฀by฀the฀studies฀of฀Nyiro฀and฀ Jablonski฀(2)฀in฀the฀1920s,฀which฀demon- strated฀ that฀ patients฀ with฀ schizophrenia฀ seemed฀ to฀ have฀ a฀ lower฀ incidence฀ of฀ ep- ilepsy฀ than฀ the฀ general฀ population.฀ They฀ postulated฀that฀dementia฀praecox฀(the฀old฀ term฀for฀schizophrenia)฀had฀a฀curative฀ef- fect฀ on฀ epilepsy,฀ and฀ Meduna฀ wondered฀ if฀ the฀ reverse฀ might฀ be฀ true.฀ ฀ He฀ found฀ that฀ convulsions฀ induced฀ with฀ intrave- nous฀Metrazol฀or฀intramuscular฀camphor฀ could฀treat฀psychosis.฀฀Though฀Meduna฀is฀ credited฀as฀the฀father฀of฀convulsive฀thera- py,฀it฀was฀not฀until฀the฀late฀1930s฀that฀Drs.฀ Bini฀ and฀ Cerletti฀ in฀ Italy฀ were฀ successful฀ in฀using฀electric฀currents฀to฀induce฀thera- peutic฀seizures฀(3). We฀ describe฀ a฀ case฀ of฀ a฀ 32-year-old฀ man฀ with฀ a฀ neuropathic฀ pain฀ syndrome฀ who฀ had฀ received฀ various฀ treatments฀ without฀satisfactory฀results.฀฀Subsequent- ly,฀ he฀ was฀ treated฀ with฀ electroconvul- sive฀ therapy฀ for฀ concomitant฀ depression,฀ which฀improved฀the฀depression฀and฀alle- viated฀the฀chronic฀pain. CASE DESCRIPTION Our฀ patient฀ was฀ a฀ 32-year฀ old฀ male฀ with฀ a฀ 10-year฀ history฀ of฀ chronic฀ right฀ arm฀and฀shoulder฀pain฀due฀to฀chronic฀id- iopathic฀brachial฀neuritis.฀฀His฀pain฀started฀ spontaneously฀as฀an฀aching,฀burning฀pain฀ in฀ the฀ right฀ shoulder,฀ which฀ then฀ spread฀ down฀the฀arm฀to฀the฀hand,฀and฀proximal- ly฀to฀the฀lateral฀portion฀of฀the฀right฀side฀of฀ the฀neck.฀฀He฀also฀complained฀of฀pain฀ra- diating฀into฀the฀scapular฀area฀and฀toward฀ the฀thoracic฀spinal฀column.฀฀He฀described฀ the฀ pain฀ as฀ burning,฀ sharp฀ and฀ crushing฀ in฀nature.฀฀There฀was฀no฀particular฀activ- ity฀ that฀ worsened฀ the฀ pain.฀ ฀ Of฀ note,฀ in฀ the฀early฀1990s฀for฀a฀year฀or฀two,฀his฀pain฀ nearly฀ resolved฀ spontaneously.฀ ฀ Follow- ing฀ a฀ bout฀ of฀ prostatitis,฀ the฀ pain฀ flared฀ up฀again.฀฀Subsequently,฀the฀pain฀became฀ progressively฀worse,฀to฀the฀level฀of฀9-10/10฀ on฀the฀visual฀analog฀scale. His฀ past฀ medical฀ history฀ included฀ hypertension,฀ seizure฀ disorder฀ and฀ de- pression.฀ ฀ He฀ was฀ treated฀ as฀ an฀ inpatient฀ and฀outpatient฀multiple฀times฀for฀depres- sion.฀฀On฀physical฀examination,฀his฀right฀ arm฀ was฀ noted฀ to฀ have฀ decreased฀ sensa- tion฀to฀light฀touch฀and฀cold฀along฀the฀pos- terior฀ aspect฀ of฀ the฀ arm.฀ ฀ There฀ was฀ hy- peresthesia฀ to฀ pinprick฀ in฀ the฀ right฀ pos- terior฀shoulder฀area,฀right฀posterior฀arm,฀ and฀the฀distal฀lateral฀wrist,฀encompassing฀ an฀ area฀ of฀ approximately฀ 5฀ cm฀ by฀ 7฀ cm.฀ There฀was฀obvious฀atrophy฀of฀the฀pectora- lis฀muscle.฀฀He฀was฀able฀to฀demonstrate฀at฀ least฀3/5-muscle฀strength฀in฀the฀shoulder.฀ MRI฀ of฀ his฀ brachial฀ plexus฀ showed฀ no฀ anatomical฀ abnormality,฀ and฀ MRI฀ of฀ the฀ cervical฀ spine฀ showed฀ no฀ cord฀ or฀ nerve฀ compression.฀ ฀ An฀ EMG฀ showed฀ chronic฀ changes฀ consistent฀ with฀ brachial฀