Prolonged ketamine infusion as a therapy for complex regional pain syndrome: synergism with antagonism?

Pickering, Anthony E.; McCabe, Candy

doi:10.1111/bcp.12157

Cited by 17 publications

(16 citation statements)

References 48 publications

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“…Although the literature has demonstrated some efficacy for oral and intranasal applications in the treatment of NP, therapeutic use is highly limited by difficulties in controlling and monitoring its administration and possible adverse effects. It is our opinion that the potential risks of diversion, abuse as a recreational drug [89] as well as its reported potential to facilitate date-rape [96,97], unfortunately far outweigh oral ketamine's potential therapeutic benefit in clinical practice.…”

Section: Route Of Administrationmentioning

confidence: 98%

“…One of the hallmarks of CRPS is that of central sensitization caused by a reduction in the firing threshold of Ad and C fibers leading to the ongoing release of neurotransmitters and peptide neuromodulators from peripheral afferent terminals [89]. As the most potent clinically available NMDA receptor antagonist, ketamine is an ideal candidate in the treatment of CRPS because of its potential to reverse central sensitization, alter neural plasticity and reduce neuroinflammation [90].…”

Section: Literature On Ketamine Use In Complex Regional Pain Syndromementioning

confidence: 99%

“…Similar to PCP, ketamine has also been a drug of abuse, taken recreationally for its hallucinogenic and euphoric action [89]. Although ketamine has been safely used for over 35 years in clinical anesthesia, concerns have been raised regarding NMDA antagonist-induced neurotoxicity [100].…”

Section: Adverse Effects and Complications Of Therapymentioning

confidence: 99%

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The Use of Ketamine in Neuropathic Pain

O’Brien

Pangarkar

Prager

2014

Curr Phys Med Rehabil Rep

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Hyperactivity of N-methyl-D-aspartate (NMDA) receptors may be one of the factors in the genesis of neuropathic pain (NP). Ketamine is a dissociative anesthetic and analgesic that is the most potent NMDA receptor antagonist currently available for human use. There is a growing body of literature for three decades suggesting efficacy of subanaesthetic doses of ketamine in the treatment of NP, particularly the pain in complex regional pain syndromes. The primary limitations of ketamine use are secondary to psychotomimetic and, to a lesser extent, sympathetic activation. The purpose of this article is to review the history, pharmacology, pharmacodynamics, clinical benefits, and limitations of ketamine for treatment of NP. Methods of administration and management of adverse effects are highlighted based on the clinical experience of the authors.

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Section: Route Of Administrationmentioning

confidence: 98%

Section: Literature On Ketamine Use In Complex Regional Pain Syndromementioning

confidence: 99%

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The Use of Ketamine in Neuropathic Pain

O’Brien

Pangarkar

Prager

2014

Curr Phys Med Rehabil Rep

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“…13 • Opioids. [18][19][20] • IV magnesium. Opioids can be used for neuropathic pain, with methadone having advantages because of N-methyl-D-aspartate (NMDA) antagonism.…”

Section: Topics In Pain Management February 2015mentioning

confidence: 99%

Topics in Pain Management CME Quiz

2015

Topics in Pain Management

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“…Multizentrische RCTs zum Vergleich der aktuell bestmöglichen Therapie mit und ohne zusätzliche Ketamininfusionen, sowie Langzeitbeobachtungen mit besonderer Berück-sichtigung der Risiken sind notwendig, bevor diese Therapie empfohlen werden kann [ 58 ] . In einer Fallserie von 2 Patienten mit CRPS (einer davon mit fi xierter Fehlstellung), welche mit niedrig dosiertem Naltrexon behandelt wurden, wird über einen positiven Verlauf nach 2 Monaten berichtet.…”

Section: Andereunclassified

Neues aus der Forschung zum Komplexen Regionalen Schmerzsyndrom (CRPS)

2013

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▼ Complex regional pain syndrome (CRPS) typically develops following extremity injuries and is characterised by distally generalised sensory, motor, trophic, vaso-and sudomotor dysfunctions, as well as joint affl iction. CRPS cases without nerve lesions are defi ned as type I -those involving nerve damage as type II. The diagnosis is primarily based on the clinical presentation using the so called 'Budapest criteria'. Important for the diagnosis is the exclusion of other potential conditions which could account for the patient-reported symptoms and demonstrable clinical signs. Triple-phase bone scans are helpful for the early and diff erential diagnosis due to their high specifi city (98 %), although their sensitivity decreases as the disease progresses. In the acute stage of the disease, pro-infl ammatory factors seem to play an important role, allowing for a potential therapeutic approach. As the disease progresses, however, they are unrelated to the clinical severity. Chronic stages are primarily determined by central nervous system changes including a reduced cortical representation of the aff ected limb, changes in body scheme, neglectlike symptoms, as well as dystonic deformities. The most common sensory abnormality is pressure hyperalgesia over muscles, most likely a result of peripheral sensitisation. In addition to the clinically detectable focal autonomic disorders, more generalised autonomic dysfunction is also found. The pathogenesis of dystonic symptoms, however, remains poorly understood, making therapeutic treatment more diffi cult. Treatment of CRPS should be multimodal and take place in a multi-disciplinary setting, adapted to the level of pain. Invasive interventions should be limited to strict indications and specialised centres.

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Prolonged ketamine infusion as a therapy for complex regional pain syndrome: synergism with antagonism?

Cited by 17 publications

References 48 publications

The Use of Ketamine in Neuropathic Pain

The Use of Ketamine in Neuropathic Pain

Topics in Pain Management CME Quiz

Neues aus der Forschung zum Komplexen Regionalen Schmerzsyndrom (CRPS)

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