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…
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I have systemic/full body CRPS. When I was diagnosed, my M.D. suggested the sub-anasthetic treatment, but I was not ready and unsure of the expense. While considering it, my pain increased to a level which was simply intolerable. I had been pursuing TMS therapy and elected to stop. The psychiatrist administering the TMS knew pain management wanted to use the Ketamine, which the psychiatrist already used subcu in patients with depression. He injected me in his office (I was given 1mg of Ativan with it) The pain disappeared. We began doing subcu (tiny amounts 20 units on a typical diabetic syringe) three times a day. For the first time in 12 years, I had no pain, could DO things and could not believe it. I used this method for 1.5 months before deciding to go ahead with the sub-anasthetic technique, believing it would furnish the same reults without having to do the shots or deal with breakthrough pain. This is not the case. If I could go back to subcu I would in a heartbeat, but the CRPS experts fear the liver toxicity issue to be an especially dangerous issue for CRPS sufferers. I’ve not heard of 10mg a month. I currently do boosters 2 days every 2 months or so (around 100 mg per day) can’t understand why this is not an issue for the liver, but there are no real studies either way and I am no M.D.