[Sandel]

The neurocognitive effects of 5 day anesthetic ketamine for the
treatment of refractory complex regional pain syndrome

http://www.rsds.org/2/library/articl...d_Irani%20.pdf

Interesting though I believe some of their hypotheses are likely wrong.. I might even go as far as to say biased.. just my opinion.. perhaps a defensive view on my part.

What do you think?
S

[Imahotep]

There are very low correlations except for pain and this might be explained by greatly reduced activity during the trial. I (and many others) have pain primarily as a result of using the affected extremity or overdoing things.

3% of RSD patients don't experience pain. If my only problem were pain then I'd not always have much of a problem. I tend to lose consciousness when pain gets up to about level 8 so it's hard to imagine suffering such high level pain all the time. I also have a great deal of difficulty believing that RSD has a significant psychological component or real world similarities to those with conversion disorders. I was not under a great deal of stress when I contracted this and it's real enough that a heart attack has seemed preferable.

I find the whole thing a little incomprehensible and insulting. Thanks for posting it anyway, though.

[AnnBon]

Sandel,

Thanks for the 5 day ketamine study (coma) version. I read each page and it was very interesting, some points I find a little hard to believe. I work with one of the doctors listed he is very knowledgeable and extremely caring. I have done a few 5 day (awake) Ketamine procedures plus boosters. I think it works differently for all, my problem is having it stick. It is a very hard and expensive procedure for it only to stick for a few months. I have been told that new drugs are coming out 1- to help the ketamine stick and 2- new pain drugs that are not so hard on the body.

Thanks again....
Ann

[tayla4me]

Originally Posted by Imahotep

There are very low correlations except for pain and this might be explained by greatly reduced activity during the trial. I (and many others) have pain primarily as a result of using the affected extremity or overdoing things.

3% of RSD patients don't experience pain. If my only problem were pain then I'd not always have much of a problem. I tend to lose consciousness when pain gets up to about level 8 so it's hard to imagine suffering such high level pain all the time. I also have a great deal of difficulty believing that RSD has a significant psychological component or real world similarities to those with conversion disorders. I was not under a great deal of stress when I contracted this and it's real enough that a heart attack has seemed preferable.

I find the whole thing a little incomprehensible and insulting. Thanks for posting it anyway, though.

Hi there,

I am unable to get the link up yet but am working on it but I just want to comment on your take on pain levels.
Like you, and using the 0-10 pain scoring levels then I agree that 9 and above leaves no functionability. I am fainting, vomiting etc and yet constantly am surprised to read people with these pain levels who can talk, eat and use the internet.
So what does this mean? Does it mean that some people are "tougher" or some people are "weaker"? Does it simply mean that some people will say 9/10 to try and express just how miserable their pain is making them even though by interpretation of the system it is probably more likely to be a couple of numbers down the scale? Does it really mean the system is flawed and definitely not an accurate way of assessing pain even though it is accepted and used world wide on a daily basis?
Does it mean that some people do not know what each level out of 10 represents as by virtue of this interpretation then 9 or 10 out of 10 pain would certainly not see us sitting at a computer writing with such clarity?

What it does show is how individual we all are but what it also means is that somewhere along the way those who appear to be able to function at levels of pain that render most into a gibberring mess will probably be questioned as to the reality of their pain.
It isn't fair but if we are going to keep quoting a pain level out of 10 then we must truly look at what each number level means otherwise this age old system that is so needed in the Recovery and Emergency Rooms to give the most appropriate type of analgesia stands the chance of being undermined and devalued., leaving it almost impossible to use it as a means to be made as pain free as humanly possible.

So sorry for digressing here and hijacking your post but I have been pondering over this for a long long time, firstly as a nurse who became quite flippant about pain when so often I was told by a patient who was watching TV and tucking into their meal that their pain level was 9 1/2 out of 10 and now as a chronic pain patient myself who has very clear behaviour for extremely high levels of pain.
I remain confused-------anyone got some thoughts?

Happy New Year to all
Love Tayla

[Sandel]

I understand and empathise with all of your replys to this artical and in responce to Imahotep I agree, it seemed rather insulting to me as well but I thought it may bring up some good discusions as it has, I too have worse pain with activity such as bearing weight etc.. but I have ongoing pain as well. And I too was under no stress before my injury I was on top of my game and having a blast.. then boom darn car.

And Pain levels Talya.. way past due for discussion.. The pain schedule most hospitals use is 0-10, zero being no pain and 10 being the worst pain imaginable.. I once burnt my foot with alot of hot oil and that is my 10, the moment of oil contact. we have only the pain we have experienced to consider our worst pain imaginable, this system of pain intensity is very flawed as far as comparisons, some may imagine being burned alive as worst but we can only imagine that pain, we have no experience of it to be able to use effectivly as a comparison.

There is another system that quotes 1-10.. 10 being the worst pain you have ever experienced.. that is even more dificult to use as comparison in trials.. hmm this needs to be researched further.

My pain sits at about 6 most days and ocasionaly it can spike up to an 8 in which I am in a cold sweat and nausious, I also have passed out at my 9.. I like to avoid those numbers.. my chest pain brings me to 8, but it dosnt stay there. But this is only my pain scale.. it is important to realize that these are our own pain scales.. and are realy not comparable to other peoples pain levels.. in comparison.. am I making sence?
I believe this system is flawed but it is the only one useable at this point.(though they are working on ways to be able to read pain levels via instamentation a brain scan of sorts).

Ann, hi thank you so much for your reply, I think the fact that ketamine can make the RSD go into remission tends to overshadow the facts that most people only get partial results such as yourself. I would love to hear more about your experiences with that treatment at some point please.
Your 2- point, about new less invasive drugs are in my thoughts these days, my research area for now. It will be huge to all conditions that involve the inflamitory component aparently.. I can't wait I am implementing what I can now and it is helping me.. Antioxadents nuff said lol been there done that.

I look forward to more responces, and hope you all had a wonderful holiday season.

[Sandel]

Wong-Baker Faces Pain Rating Scale. The Wong-Baker scale goes from 0 to 5:

and a

[Sandel]

http://en.wikipedia.org/wiki/Pain_sc...urement_scales

[Curious]

pain levels is a great topic.

we do each have our own levels.

not to go into boring details, but my husband i and i both hurt our feet at the same time when something was dropped. bruising looked the same..yadda yadda. he went through the roof complaining of pain. said it was right up there with breaking his arm.

for me it was minor. oh it hurt, but comparing it to my emergancy c-section with ZERO anethesia...well, you catch my drift.

[Imahotep]

On my scale I start moaning at about level four. This is totally involuntary but I can supress it. They say a woman in childbirth experiences level 6 and I can't really relate to this personally but do have some sort of feel for it since I've seen it and heard descriptions. This is probably the level of some of my old injuries. I woke up from a hernia repair screaming from level five hand pain. It was horrible being caught between being awake and asleep with high level pain. It took four shots of morphine to shut me up.

The highest pain I ever felt was when I knelt down and pinched a nerve in my knee. I just call this a ten because it's the worst I've known. Everything went white and I would have lost consciousness, I'm sure, had I not been able to take the weight off of it and straighten the leg. I had level 8 pain when I slipped on ice and cracked the back of my head. I might have passed out that time but needed to get off the road to avoid being hit. I've only lost consciousness a few times and they were probably caused by the RSD. They were as pain was increasing at about level 8.

I've always been good at ignoring pain and even better at just turning it off. I guess I do a poor job of suffering it so I learned to turn it off. As a child I was doing pushups an hour after an appendectomy and taking long walks around the hospital that evening.

The RSD pain is just completely different for me. There's nothing I can do to affect it and even distracting myself from it isn't always effective. It's usuall low level and frequently goes away entirely for a few minutes or a few hours. It always seems like it's never coming back when it goes away and never leaving when it comes.

It's hard to believe that pain is the cause of the trouble with this disease since symptoms often seem to be independent of the pain. Even when they arise in unison the intensity of each seems independent of anything which can be positively identified. Sure, once in a while I'll find a trigger and have some control but it changes. Sodium Nitrite, for instance, used to cause great distress but after avoiding it for many months it no longer seems to have any causative relationship with symptoms.

Still I keep making little changes and trying to find things to help. The biggies are just to avoid stress and overdoing anything. Good sleep and good diet seem to be essential. It can be difficult sometimes to not get down and feel sorry for myself though, and this can't be good either.

[Cake]

When I was having my last ketamine infusion I had a really bad flareup- I couldn't sit still, I was crying and rocking around and breathing slowly (like through a contraction) to stop myself tensing up etc. The nurse asked me my pain level. I said it was an 8. She said "Only an 8?" I told her I've had 10's and this wasn't a ten.

Yet my SIL (for example) who is very healthy and has even climbed Mount Everest has been complaining about ankle pain from walking on concrete floors all day at work. She says she's in tears every night and having the worst pain imaginable in her ankles.

So it very hard to gauge, as I'm sure her ankle pain is the same as I get in my rsd ankle at about a 4/10- what I put up with everyday- yet to her its the end of the world!

x Kate