疼痛を伴う処置後に変換症/転換性障害を疑う意識消失を生じた1症例

<p>  Conversion disorder consists of changes in motor or sensory function that cannot be explained by other diseases, and its symptoms cannot be explained physiologically or anatomically. We herein report a case of disturbed consciousness that was suspected of having been caused by conversion disorder arising after various painful treatments.</p><p>  A 33-year-old woman had received stellate ganglion blocks for the relief of her right myofascial pain and neuropathic pain in the right lower molar region. After completing the stellate ganglion block and intravenous injection, we performed professional mechanical tooth cleaning (PMTC) as requested by the patient. Five minutes after the end of the PMTC, however, the patient suddenly lost consciousness. Her electrocardiogram (ECG) was normal, her heart rate was 60 beats per minute, her blood pressure was 85/46 mmHg, and her pulse oximetry was 99%. Approximately 10 minutes later, she recovered briefly. However, approximately 20 minutes thereafter, she once lost consciousness once again. Her heart rate was 75 beats per minute, her blood pressure was 127/83 mmHg, and her pulse oximetry was 100%. Her symptoms persisted for 90 min, at which time she was rushed to an emergency hospital. A head CT and blood tests performed at the emergency hospital showed no abnormalities. Approximately 180 minutes later, her condition resolved and she was discharged home.</p><p>  The clinical findings in this case allowed commonly occurring complications to be ruled out. The patient’s loss of consciousness was diagnosed as conversion disorder by a psychiatrist. Severe pain and emotional distress occurring during the PMTC procedure were thought to have been the cause. The present case suggests that patients with chronic pain should be treated with greater caution when performing procedures that may cause pain.</p>