low dose ketamine treatment
 

Has anyone had low dose ketamine treatement? I was just reading about a Dr. Ronald Harbut at St. Josephs in Hot Springs Arkansas. It is a five day treatment. You stay in the hospital for the five days. They say 75% get relief for a long period of time. I wonder if it is dangerous. I just had a scs implant and am having some trouble with it.

Eileen

I was in Philly, ten days, of (I think, 24 hours for 10 days.)
Yea, that was it.

Had to "walk around with the thing on a wheely thing"...

Was it successful?
I'm still here.

It didn't hurt me.
I don't think it helped.
How can I know?

I got a little vacation. From my wife.

And, I'm NOT being mean. That's all I can say about it. Unless you want to "drill down", and I invite you too.....
I had a tbi, and still do, so, it just didn't seem so much a help at the time...
Got my pain down to about a 3 though!,
I'm usually around a 5 now.

So,
figure.


pete
Asb

i had i guess a not low dose, and not a coma, so medium dose? idk, but i had one in december and was in full remission for 2 months, i just had another about 6 weeks ago and again have been put back into remission. i had the infusion for 4 hours, the first time i had about 1500 mg of ketamine, and the second time i had 2000 mg of ketamine. i have a slight tolerance to it since i took it for over 2 years as my main pain med. i had it done in LA by Dr. Thomas Leverone. its outpatient so as soon as you're coherant enough you can leave. you're pretty much sleeping for 4 hours. he does it a few different ways, where you come in for the infusion for various numbers of days in a row to try to increase the amount of time ur in remission... he has had very good results with his methods and is a super nice doctor

Dear Eileen -

I too had the privilege of being wired and infused in Hahnemann Hospital in Philadelphia, back in 2004, only mine was for a preliminary 5-day infusion of lidocaine, which didn't work. I did however have the pleasure of having the catheters running out of a "central line" in the open wall of my chest, where the CRPS had so compromised my peripheral vascular functions that they couldn't get a 20 gauge needle into my arms and the hospital was perhaps months away from going to the now standard "PICC lines." I was then set for a low dose ketamine infusion when the program was temporarily put on hold, and when it was resumed, it was with a whole new set of eligibility requirements, and I was off the list for what was then an experimental trial.

Dr. Robert J. Schwartzman, who runs the program in Philadelphia through the Drexel University College of Medicine, has since suggested, in a report of a very small "pilot study," that 10 day "sub-anesthetic" ketamine infusions appear to be ineffective altogether, in "in long-standing CRPS patients who have been refractory to all standard modes of therapy." That is, 4 women received infusions for 10 days each, and none of them experience any pain relief, and "objective findings" based upon skin condition were similarly unchanged. "A Pilot Open-Label Study of the Efficacy of Subanesthetic Isomeric S(+)-Ketamine in Refractory CRPS Patients," Ralph-Thomas Kiefer, MD, Peter Rohr, MD, Annette Ploppa, MD, Boris Nohé, MD, Hans-Jürgen Dieterich, MD, John Grothusen, PhD, Karl-Heinz Altemeyer, MD, Klaus Unertl, MD, and Robert J. Schwartzman, MD, Pain Medicine, Vol. 9, No. 1, 2008, which available for free download on the RSDSA Medical Achieves webpage, below. The article further notes that the "best results of ketamine therapy to date have been demonstrated in early and well-localized CRPS."

What is really interesting about the article is how, in the "Discussion" section, the authors embrace those published reports that found ketamine to be effective in cases where patients had CRPS for 8 months or less. This included the most famous study [that of Dr. Graeme Correll and others, "Subanesthetic Ketamine Infusion Therapy: A Retrospective Analysis of a Novel Therapeutic Approach to Complex Regional Pain Syndrome," Pain Medicine, Vol., 5, No. 3, 2004, also on RSDSA webpage] that had great results using a doses substantially below that which was administered to chronic CRPS patients in the study on which the the 2008 article was based. (Perhaps not coincidently, one of the co-authors on the Correll study - Dr. Maleki - worked in Dr. Schwartzman's department at the time the 2004 article was written.) The 2008 article then goes on to briefly consider how CRPS may change when it becomes chronic:

The first hypothesis that other mechanisms than those effected through the NMDAR [N-methyl-D-aspartate receptor, a.k.a. NDMA receptor] may be important on CRPS is supported by failure of a complete translation of the animal data, which supports a crucial role of the NMDAR, in initiation of some neuropathic pain states with clinical experience. Second, the length of time a patient has suffered the disease prior to NMDAR-antagonist intervention may be important for successful NMDAR-antagonist therapy. The dosage of ketamine utilized in this study may have been insufficient to block NMDAR-mediated hyperexcitability of central pain projecting neurons. [Footnotes omitted.]

And FYI in an earlier section of the article, the "NMDAR mechanism" was defined as follows:

A great deal of progress has been achieved in understanding the neurobiology of the syndrome utilizing experimental models but there are differences in these models and the specific aspects of the illness. Recent experimental and clinical studies suggest a major role of the central nervous system in much of the symptomatology seen in CRPS patients. Peripheral and central sensitization of nociceptive [the process of pain transmission, usually relating to a receptive neurone for painful sensations] pathways appears to be a major mechanism. There is solid evidence that the N-methyl-D-aspartate receptor (NMDAR) is involved in central sensitization. [Footnotes omitted.]

But a discussion into what happens as the body shifts to chronic CRPS is way beyond the scope of your question. (To say nothing of my lack of a scientific and/or medical education, as well as that small matter of being far, far removed from an IQ north of 160, where to my knowledge, no one other than Anne Louise Oaklander, MD of Harvard - see below and http://www.neurologynow.com/pt/re/ne...d=1&nav=search - claims to have solved all elements of the CRPS riddle.) However, as to the issue of effective dosing, virtually the same group of authors have been running the "ketamine coma" program for a number of years in Germany, and report, in another article on the RSDSA website, that a study of 20 patients with chronic CRPS that had failed every other treatment showed significantly better results, coupled with (potentially) far greater side-effects. "Efficacy of Ketamine in Anesthetic Dosage for the Treatment of Refractory Complex Regional Pain Syndrome: An Open-Label Phase II Study," Ralph-Thomas Kiefer, MD et al, Pain Medicine, 2008 Nov; 9(8): 1173-201, Epub 2008 Feb 5, also available on the RSDSA webpage.

To find the articles mentioned, just go to the RSDSA Medical Achieves webpage at http://www.rsds.org/2/library/articl...ive/index.html and scroll down to the heading labeled "Ketamine Treatment," where you can open pdf files of a total of 15 articles, which can be freely downloaded.

All that said, I have a good friend with chronic CRPS who gets good, temporary and very expensive relief from four hour ketamine infusions delivered at a decidely "anesthetic" doses, something perhaps along the lines of what Andrea was describing in her post. So to each their own.

Good luck!

Mike

ps For an editorial by a leading researcher questioning whether the central nervous system plays any role in CRPS, see, "RSD/CRPS: the end of the beginning," Oaklander AL, Pain, 2008 Oct 15;139(2):239-40, Epub 2008 Sep 13, also available on the RSDSA webpage under the heading "CRPS Overview." I can also site anyone who's interested to a couple of recent articles that offer fairly convincing evidence that a significant part of chronic CRPS is maintained by the brain itself!

My wife had the low dose infusion and weekly shots but it didn't work. The reason it didn't may have been because she had untreated RSD for years and moved to level 3 before the infusions.

I have been having ketamine infusions for now 8 months and really is helping a great deal. I started with the 10 out-patient and then went to 2x a week for 4 weeks then every day a week since. My doctor doesnt just end the infusions after the 10 days many of the patients like me come back for booster infusions most are once a month but due to my RSD being more severe my body cant handle going longer than a week at the moment. I have probably met 100 others at my doctors office and all cant imagine their lives without the infusions and I cant either. My RSD is full body and internal and before the infusions I was in the ER's up to 3 times a week due to flares as without controlling the flare my bladder would shut down and my blood pressure would get dangerously high but ever since the ketamine I end up in the ER maybe once a month which is really good for me.

Niki

I did the 10 day out patient in Philly with Dr. S. I had a reaction on the 3rd day and at the end of the 4th day the treatments where discontinued. It wasn't helping my pain and my heart rate and blood pressure where too high. I had to have cardio clearance before the treatment began and everything was fine. I have full body RSD and Dr. S said we would have had a better chance if my conditon wasn't full body.
What didn't work for me has worked for others. There were people there getting booster treatments.
Take care,
Sherrie

I'd like to know what it is about this disease that some methods work for some and don't on others. There's something big missing in the treatment of RSD, a big component, the larger picture that is common to all who suffer from it. Maybe the medical community can't see the forest through the trees and the answer is in front of our noses. I pray for the day someone somewhere will find that missing link because that may be where the cure lies.

I'm coming at this discussion cold so if the question doesn't make any sense let me know and I'll try again.

NIH is conducting a study (not sure what tense that should be) for ketamine as it relates to treatment resistant depression ("TRD"). Given everyone's experience here can you make a connection as it might relate to a depression protocol? Any thoughts?

And no, I'm not sure what I'm asking so feel free to help me with the question.

Many thanks.

Well it sounds like NIH is conducting research using ketamine as a antidepressant. My understand of ketamine use in those who have RSD is to calm or put to sleep and or reboot the human nervous system. I'm sure the doses in these 2 uses of ketamine are extremely different.

I had looked into this in Tampa with Dr Kirkpatrick. I was also suggested it by a pain doc too but in combo with other treatments like scs and methadone. I know my current doc siad it is just key to be in a reputable place cause many major hospitals do not do this so if it is a small outpatient clinic so that you are really monitored for hallucinations so on. On the depression stand point I too would say about the changing of the brain chemistry. Like when people go on meds for bipolar.

Hi eileen15565 and welcome,
I have not had the ketamine treatment. But I do know that several years ago, Dr. Harbut was with Dr. Schwartzman and others Drs. in a study about ketamine done at the Mayo Clinic here in Scottsdale. One of my friends, worked with them during the study. One of the Drs. was from Germany and went back afterward. Hope that whatever you try works well with pain relief. Take care, loretta