Multi-Day Low Dose Ketamine Infusion for the Treatment of
Complex Regional Pain Syndrome

Goldberg, Michael E.; Domsky, Richard; Scaringe, Denise; Hirsh, Robert A.; Dotson, Jessie L.; Sharaf, Imran; Torjman, Marc C.; Schwartzman, Robert J.

doi:10.36076/ppj.2005/8/175

Cited by 96 publications

(3 citation statements)

References 22 publications

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“…In his first study with lowdose ketamine for 10 days in 40 CRPS patients, he found significant reduction in pain scores, with increased ability to initiate movement and tendency to decreased autonomic regulation. A total of 36 patients had pain relief for 2 weeks, while eight Ketamine for Non-Neuropathic Pain DOI: http://dx.doi.org/10.5772/intechopen.101665 patients had pain relief for 12 weeks similar to Sigterman's study [55], but here they have used racemic ketamine [60].…”

Section: Effect Of Sub-anesthetic Infusion Of Ketaminementioning

confidence: 88%

Ketamine for Non-Neuropathic Pain

Sundaram¹,

Govindarajan²

2022

Ketamine Revisited - New Insights Into NMDA Inhibitors

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Chronic pain is one of the leading causes of years lost to disability, as most of the time it is refractory to conventional treatment. Recent advances in understanding the pain mechanisms have favored the use of ketamine as a rescue agent in refractory chronic pain conditions, as it has potential modulating effect on both sensory-discriminative and affective motivational components of pain. Preclinical studies also suggested the antinociceptive effect of sub anesthetic dose of ketamine against central and peripheral neuropathic pain conditions and non-neuropathic pain conditions such as inflammatory and nociceptive pain states. Subanesthetic infusion of ketamine along with adjuvants such as midazolam and clonidine is found to reduce the psychomimetic and cardiovascular side effects of ketamine. Even though the consensus guidelines for intravenous use of ketamine for chronic pain advocate the use of ketamine only for complex regional pain syndrome, various other clinical studies suggested its role in other refractory painful conditions. Hence the present topic focuses specifically on the effect of ketamine on non-neuropathic pain conditions such as complex regional pain syndrome, fibromyalgia, headache, ischemic limb pain, etc. Many studies had shown that ketamine not only reduces the pain scores but also the analgesic medications, which further improves the well-being and quality of life.

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Section: Effect Of Sub-anesthetic Infusion Of Ketaminementioning

confidence: 88%

Ketamine for Non-Neuropathic Pain

Sundaram¹,

Govindarajan²

2022

Ketamine Revisited - New Insights Into NMDA Inhibitors

View full text Add to dashboard Cite

show abstract

“…A randomized placebo-controlled trial revealed that IV ketamine with the rage of dose 0.35 mg/kg over 4 h for ten days found out a significant pain reduction in patients with CRPS. Additionally, a study has reported potent analgesia of transient duration while other studies revealed with more prolonged infusions for two weeks, as well as have shown analgesia extended up to 3 months [58,59].…”

Section: Ketamine Infusionmentioning

confidence: 97%

A medical mystery of complex regional pain syndrome

Eldufani

Elahmer

Blaise

2020

Heliyon

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Complex regional pain syndrome (CRPS) is a condition of neuropathic pain, which is characterized by significant autonomic and inflammatory features. CRPS occurs in patients who have limb surgery, limb fractures, or trauma. Many patients may have pain resolve within twelve months of the inciting incident; however, a small subset progresses to the chronic form. This transitional process often happens by changing from warm CRPS with dominant inflammatory phase to cold CRPS, in which autonomic characteristics or manifestations dominate. Several peripheral and central mechanisms are involved, which might vary among individuals over a period of time. Other contributors include peripheral and central sensitization, autonomic alterations, inflammatory and immune changes, neurochemical changes, and psychological and genetic factors. Although effective management of the chronic CRPS form is often challenging, there are a few high quality randomized controlled trials that support the efficacy of the most commonly used therapeutic approaches.

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“…The reported side effects include gastrointestinal disturbances, fatigue, dizziness, chest discomfort, somnolence, and nausea [ 14 ]. Ketamine has shown positive results in other pain conditions [ 16 ]. Therefore, there is interest in evaluating the novel therapeutic options for primary HA management to improve the quality of life, reduce the strain on EDs [ 7 ], and reduce lost work production [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of ketamine in the treatment of migraines and other unspecified primary headache disorders compared to placebo and other interventions: a systematic review

Chah

Jones

Milord

et al. 2021

J Dent Anesth Pain Med

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Background Migraine headaches are the second leading cause of disability worldwide and are responsible for significant morbidity, reduction in the quality of life, and loss of productivity on a global scale. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of ketamine on migraines and other primary headache disorders compared to placebo and other active interventions, such as midazolam, metoclopramide/diphenhydramine, and prochlorperazine/diphenhydramine. Methods An electronic search of databases published up to February 2021, including Medline via PubMed, EMBASE, Web of Science, and Cochrane Library, a hand search of the bibliographies of the included studies, as well as literature and systematic reviews found through the search was conducted to identify randomized controlled trials (RCTs) investigating ketamine in the treatment of migraine/headache disorders compared to the placebo. The authors assessed the risk of bias according to the Cochrane Handbook guidelines. Results The initial search strategy yielded 398 unduplicated references, which were independently assessed by three review authors. After evaluation, this number was reduced to five RCTs (two unclear risk of bias and three high risk of bias). The total number of patients in all the studies was 193. Due to the high risk of bias, small sample size, heterogeneity of the outcomes reported, and heterogeneity of the comparison groups, the quality of the evidence was very low. One RCT reported that intranasal ketamine was superior to intranasal midazolam in improving the aura attack severity, but not duration, while another reported that intranasal ketamine was not superior to metoclopramide and diphenhydramine in reducing the headache severity. In one trial, subcutaneous ketamine was superior to saline in migraine severity reduction; however, intravenous (I.V.) ketamine was inferior to I.V. prochlorperazine and diphenhydramine in another study. Conclusion Further double-blind controlled studies are needed to assess the efficacy of ketamine in treating acute and chronic refractory migraines and other primary headaches using intranasal and subcutaneous routes. These studies should include a long-term follow-up and different ketamine dosages in diagnosed patients following international standards for diagnosing headache/migraine.

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Multi-Day Low Dose Ketamine Infusion for the Treatment of Complex Regional Pain Syndrome

Cited by 96 publications

References 22 publications

Ketamine for Non-Neuropathic Pain

Ketamine for Non-Neuropathic Pain

A medical mystery of complex regional pain syndrome

Efficacy of ketamine in the treatment of migraines and other unspecified primary headache disorders compared to placebo and other interventions: a systematic review

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