In patient ketamine treatment
 

Hello,

I am looking for the most recent article published by Dr. Schwartzman about his in paitient ketamine treatment. I just talked to him on the phone and he wants me to come to Philly and talk with him about it. He said he just had this article published last month.

Is there anyone that read the article and knows if it is published on line anywhere?

Thanks,
Sherrie

Hi Sherrie, if you google- The Natural History of Complex Regional Pain by Dr. Schwartzman. It is his 2009 article will come up. It's good this is the paper i'm taking in for my ortho for CRPS update. Let me know what you think of the ketamine. I see Dr. S in a few months. good luck. momof4

Hello Momof4,

Thanks, for the inforation on the site. I will check it out.

Have you tried the ketamine out patient? I did that a couple years ago with Dr. S.
It was stopped after the 4th day. I need more than can be given during the out patient treatment.

I took my MP3 player to listen to while the treatment was going on. Everyone has different reactions to medications. For me the room would not stop spinning. My dreams seemed very real. When the four hour infusion was finished I was fine. I wasn't tiered and I was able to walk around and site see while in Philly. For me it didn't help my RSDS/CRPS. However, there were people there for boosters that had been pain free for months.

Let me know what your ortho says about the article. I had to have a chipped bone removed from my ankle last June. My ortho talked to Dr. S before he agreed to do the surgery. After the surgery they did a four hour ketemine infustion to keep my RSD from flaring.

Dr S's out patient ketamine didn't work for me. However, he is a great resource for information for my doctors in OH. I have even called him with questions and more times than not he personally returns the call a couple of times it has been his nurse.

I am almost certain that Sherrie may be loking for the article that FMichael posted for us a month or so ago that was in regards to Dr. S.'s double blind study on ketamine. It was published in Pain Magazine very recently. I think the paper referred to above, "The Complex History..." has been around for well more than a month.

To find FMichael's article perhaps you could do a search on his name and then review all of his postings retroactively until that one comes up.

XOXO Sandy

Hello,
I think the article he was referring to was called "Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo controlled study" and dated I believe around 8/09. I believe it was in a Pain magazine. Try www.elsevier.com/locate/pain and look under august 2009 for the article named above. Let me see if I can find it for you.
kathy d

Whoops - I see that you are right. I got the extract from Medifocus just the other day. But I do not have a username or password for the Pain magazine website or I would try to help...


Good luck, Sandy

Try this address:

http://www.rsds.org/2/library/articl...n_Pain2009.pdf

I finally found it for you. It is quite informative.
Best of luck,
kathy d

Kathy -

Unfortunately, that's an article re out-patient treatment. However, I assume it's the one he was referring to with Sherrie, where nothing else under his name, remotely relavent and published in the last few months pops up on PubMed. There is, however, the possibility that another article has yet to be indexed.

Regarding in-patient ketamine treatment, the latest article I have is Sigtermans MJ, van Hilten JJ, Bauer MC, Arbous MS, Marinus J, Sarton EY, Dahan A, Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1, Pain 2009 Oct;145(3):304-11. Epub 2009 Jul 14.

Department of Anesthesiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

Comment in: Pain 2009 Oct;145(3):271-2.

Abstract
Complex Regional Pain Syndrome Type 1 (CRPS-1) responds poorly to standard pain treatment. We evaluated if the N-methyl-D-aspartate receptor antagonist S(+)-ketamine improves pain in CRPS-1 patients. Sixty CRPS-1 patients (48 females) with severe pain participated in a double-blind randomized placebo-controlled parallel-group trial. Patients were given a 4.2-day intravenous infusion of low-dose ketamine (n=30) or placebo (n=30) using an individualized stepwise tailoring of dosage based on effect (pain relief) and side effects (nausea/vomiting/psychomimetic effects). The primary outcome of the study was the pain score (numerical rating score: 0-10) during the 12-week study period. The median (range) disease duration of the patients was 7.4 (0.1-31.9) years. At the end of infusion, the ketamine dose was 22.2+/-2.0 mg/h/70 kg. Pain scores over the 12-week study period in patients receiving ketamine were significantly lower than those in patients receiving placebo (P<0.001). The lowest pain score was at the end of week 1: ketamine 2.68+/-0.51, placebo 5.45+/-0.48. In week 12, significance in pain relief between groups was lost (P=0.07). Treatment did not cause functional improvement. Patients receiving ketamine more often experienced mild to moderate psychomimetic side effects during drug infusion (76% versus 18%, P<0.001). In conclusion, in a population of mostly chronic CRPS-1 patients with severe pain at baseline, a multiple day ketamine infusion resulted in significant pain relief without functional improvement. Treatment with ketamine was safe with psychomimetic side effects that were acceptable to most patients.

PMID: 19604642 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/sites/entrez

And while PubMed shows a comment to the article, apparently concurrent with its publication, it didn't come from Dr. Schwartzman:

Borsook D, Ketamine and chronic pain--going the distance, Pain 2009 Oct;145(3):271-2. Epub 2009 Jul 1.

P.A.I.N. Group, Massachusetts General, McLean and Children's Hospitals, Harvard Medical School, Boston, MA 02478, USA. dborsook@partners.harvard.edu

Comment on:

Pain 2009 Oct;145(3):304-11. [No abstract available.]

PMID: 19573988 [PubMed - in process]

Indeed, a PubMed search for "P.A.I.N. Group" reveals a total of 16 articles, none of which are even co-authored by Dr. Schwartzman.

That said, a friend sent me a copy of Sigtermans MJ, et al, Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1, Pain 2009 Oct. just the other day, but it's too large to post here. If anyone wants a copy, just drop me a PM with your email address and it will be on its way.

Mike

Mike - I can't figure out how to send you a message on here. Do you have to be online for me to do that? I have been trying to get a copy of that article as well.

--- That said, a friend sent me a copy of Sigtermans MJ, et al, Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1, Pain 2009 Oct. just the other day, but it's too large to post here. If anyone wants a copy, just drop me a PM with your email address and it will be on its way.

Mike[/QUOTE]

We have a new policy of not allowing PMs by new members for a short probationary time frame. This was done to block a rash of international spammers who were trying to get to our members.

After a few posts, you will have the PM function open to you.

My 15 year old daughter has CRPS and has had 4 in-patient infusions with ketamine. The difference is her doctor puts in an epidural (like women in labor get) and puts the ketamine/lidocaine combo in that way. It has no effect on the brain at all but she is numb from the waist down for the first 48 hours. Then they slowly decrease the ketamine and as long as her pain stays down it keeps decreasing. If her pain comes back they raise the levels again for a time. It takes 3-4 weeks of this to provide lasting relief but she will get a year to 18 months of pain relief from it. She recently tried out-patient IV ketamine 4 hour infusions over 4 days and it gave her great relief during and for about 6 hours after but after the final infusion her pain is back in full force. Her doc has started her on compounded oral ketamine capsules to try until we can decide whether to do the epidural again or not. We recently moved from Dallas where he doc is to Oklahoma so the distance is an issue now. We will take her down there though if that is what helps - no question!

Please share more.
 

Hi Mom with RSD Child,
I too have a daughter with RSD. I would love to know more about the doctor your daughter saw for her epidural. My 18-year-old daughter had one ketamine infusion with the experience leaving her very apprehensive about the option of trying it again. It was supposed to be a four hour out-patient procedure, but 10 hours later she still could not come out of it and had to be transferred to the main hospital. For many nights and days, she had lots of bad dreams and mental confusion. If you have a minute, would you please share the name of the doctor, etc. Thanks so much!

Her doctor is Dr. Allen Farrow-Gillespie at Children's Medical Center of Dallas. The hospital has their own pain management clinic where they do both in-patient and out-patient treatments. I forgot to mention that during the 3-4 weeks with the epidural they do about 4 hours a day of intense physical therapy in the PT department of with them in her room. Then on her "off" time she walks the halls or goes to the teen center and stuff like that. Because they are pain free they want to get out and do things even though it is tiring. It is an amazing place and I am so sad that we are no longer there locally!

Mom ... Thanks so much for sharing this information as it has the potential to help many. Is sounds like a very remarkable program. I pray that your daughter again finds relief ... this time forever.