Dear Linda -

The USC Pain Center is currently trying to set up a 10-day outpatient infusion program, where each infusion would last 4 hours and entail up to 200 mg. of ketamine over that time period. However, as of a couple of weeks ago, I understood some of the details had yet to be finalized. That said, hands down, my vote for the best CRPS specialist in So Cal is my treating physician, Steven H. Richeimer, MD, Chief of Pain Medicine at USC, Director of the USC Pain Clinic and Associate Prof. of Anesthesiology and Psychiatry. He combines sheer competence with utter humility and deep compassion, something you don't see every day. I understand that it currently takes about six weeks to get a new patient appointment with him, no referral required: 323-442-6202.

Two other names you might want to check out are Sheldon Jordan, MD and Joshua Prager, MD, both of whom I understand have done work with ketamine, and in contrast to Dr. Leverone, are specialists in pain management, whereas the last time I was able to find a resume on his website, Dr. Leverone, an anesthesiologist by training, claimed subspecialty specialization only in addiction medicine.

That said, while a number of people, including myself, have found that while Dr. Prager knows his stuff, he can be difficult to work with. By example in 2002, 14 months into this, when (in his words) "my block" failed to provided any relief, he simply declared that I didn't have RSD, even though I had responded to a few block at Cedars 8 months earlier. As I understand it, the first article(s) showing that responses to blocks were time sensitive came out a year or two later, although the folks at Cedars were well aware of the profile through their own experience by the time I left in the Spring of 2002. (Word is that Dr. Prager can also be expensive.) Here's a link to his practice group, which at the present time contains no explicit reference to ketamine, which is not to say that it is unavailable as such. http://www.californiapainmedicinecenter.com/profile

And as far as Dr. Jordan is concerned, at one time he was known for the frequency with which he administered blocks. More recently, his interested have included highly focused rTMS (repetitive Transcranial Magnetic Stimulation) where the target areas are first precisely mapped in the course of an fMRI. http://www.smartbrainandhealth.com/default.asp

Drs. Prager and Jordan are in Westwood and Santa Monica, respectively.

Since you are still at the earliest stage of the disease, I would push for an in-patient infusion or a carefully considered series of daily out-patient infusions by someone credentialed in pain management. And thus far, at least looking at the articles on the RSDSA website, the 10-day outpatient protocol may have the best track record. http://www.rsds.org/2/library/articl....html#Ketamine

Mike