Office Ketamine For Chronic Pain Poster

here is poster in pdf format:

Poster CPS 2017 ketaminefinal (2)

in word format:
Pilot Study

protocol was based on a project done in Texas:
http://painmuse.org/wp-content/uploads/anodynehealth.pdf

Side effects are occurring with especially higher doses than I used:

• cases of hypomania in bipolar subjects but generally with higher doses:
  Banwari, Girish, Prutha Desai, and Prahlad Patidar.
  Ketamine-induced affective switch in a patient with treatment-resistant depression.
  Indian journal of pharmacology 47.4 (2015): 454.
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527073/

  Rickea, Amy K., Riley J. Snookb, and Amit Ananda. “Induction of Prolonged Mania During Ketamine Therapy for Reflex Sympathetic Dystrophy.” Biol Psychiatry 70.4 (2011): e13-e14.

  https://s3.amazonaws.com/academia.edu.documents/44231916/Induction_of_prolonged_mania_during_keta20160330-12043-s3st1w.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1523400771&Signature=2mrRfXddFPazavEWgw11p773i28%3D&response-content-disposition=inline%3B%20filename%3DInduction_of_Prolonged_Mania_During_Keta.pdf

  Nichols, Stephanie D., et al.
  A case of possible iatrogenic ketamine-induced mania in a patient being treated for postoperative pain.
  Psychosomatics 57.5 (2016): 543-546.
  http://www.psychosomaticsjournal.com/article/S0033-3182(16)30058-5/abstract

  Marta, Cole J., Lynn M. Yudofsky, and Michael J. Enenbach. “Probable Ketamine-Induced Hypomanic-Like Episode in a Child With Cerebral Palsy.” The Journal of neuropsychiatry and clinical neurosciences 28.1 (2016): e6-e7.
  https://neuro.psychiatryonline.org/doi/full/10.1176/appi.neuropsych.15040091
• However, it is disputed that this happens with doses used in my poster:
  Niciu, M. J., Luckenbaugh, D. A., Ionescu, D. F., Mathews, D. C., Richards, E. M., & Zarate, C. A. (2013).
  Subanesthetic dose ketamine does not induce an affective switch in three independent samples of treatment-resistant major depression.
  Biological psychiatry, 74(10), e23-e24.
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805682/
• I had one bipolar subject get more agitated in March one year but that was around “bipolar switch” season so wasn’t sure was directed connected and patient settled by increasing her quetiapine.

Had one allergic reaction where an elderly lady had her tongue swelled and got painful though her airway was not affected and her O2 sats were good. Needed adrenaline and a visit to emergency. Confirms my practice of doing ketamine in the office and usually only after initial drowsiness improves, considered monitored use at home with a reliable partner.

addendum – I have one patient now being treated for chronic depression with intranasal ketamine: “at 126 mg once weekly (4 sprays in one nostril and 5 sprays in the other = 9 sprays).  I used 30 mg IM for a session which was about $7.00 which I absorbed into cost of visit. 126 mg would be 28 dollars/session plus cost of compounding it which would start to take it out of the price range of non-working pain victims… Until this starts to be covered by government programs, this could be a problem.