Ketamine use is complicated – it is a restricted drug that is abused as “special K”, it can cause dysphoria and hallucinations at higher doses; It is a general anesthetic at high dose. A pain anesthetist tells me it is just too complex to arrange IV ketamine. A usual starting dose in IV chronic pain would be 20 mg – now it looks like low dose 10 mg administered subcut can get results in CRPS.
IASP Poster Presentation Number: PH 412; Montreal 2010
KETAMINE FOR REFRACTORY CRPS: A CASE SERIES REPORT
F. B. Fukushima1, V. S. Lima1, E. I. Vidal2, M. Borges3, G. A. Barros1
- 4 cases several years refractory CRPS , moderate – severe pain (6 – 7.5/10)
- weekly ambulatory administration of 10 mg subcutaneous ketamine
- “after the first week of treatment, with VAS scores dropping from 6-7.5/10 to 2-3/10. Interestingly, significant reductions ranging from 50% to 80% in the size of the allodynic area were also exhibited by all patients”
- “improvements regarding the intensity of pain and decrease in size of the allodynic region was sustained for a period of 2 to 4 weeks after discontinuation of the treatment with subcutaneous ketamine.”
- No mention of any side effects
Comment – Sounds good but might want to have midazolam 0.5 mg for IV use in case of agitation/hallucinations. Even if results were only partial, it might be enough to convince a pain clinic to go further. Drugs like could be used as “doctor rape” agents and should not be used without a family member/female staff being present – or better yet both. The dose is so trivial major concerns are obviated.
I have had no experience with this agent and would like comments…