Hello, and greetings!

By way of a direct answer to your question, after spending several hours conducting online searches, I don't know of any VA facilities currently administering ketamine as part of their pain treatment programs. That said, I may have come up with some useful information. To begin with, after reading your post, I started cruising through the webpage of the VA's Palo Alto facility, which is affiliated with Stanford and produces a large amount of very sophisticated research on pain topics. http://www.palo-alto.med.va.gov/researchpa.asp Unfortunately, that facility doesn't appear to even have so much as a pain clinic. I then went national, with somewhat better results. Here is the homepage for VHA Pain Management: http://www1.va.gov/Pain_Management/ As you can see, right at the top it links to a page on "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach" which is never encouraging when you are looking for medical interventions.

Perhaps the most interesting page is under the heading of Administrative Resources at http://www1.va.gov/Pain_Management/page.cfm?pg=42 If you open the page and look the articles entitled "James A. Haley (Tampa) VA Chronic Pain Rehabilitation Program Policy" and "VHA Pain Management Strategy Overview," you'll see that pain management at the VA appears to be very much of a work in progress, which is really sad, especially compared to the leadership Walter Reed has taken under the direction of Col. (Dr.) Chester C. Buckenmaier III, Chief of Army Regional Anesthesia and Acute Pain Management Initiative. By way of example:

A unique presentation of complex regional pain syndrome type I treated with a continuous sciatic peripheral nerve block and parenteral ketamine infusion: a case report, Everett A, Mclean B, Plunkett A, Buckenmaier C, Pain Med. 2009 Sep;10(6):1136-9. Epub 2009 Sep 9. Free full text at http://www.rsds.org/2/library/articl...n_Plunkett.pdf

Walter Reed Army Medical Center-Army Regional Anesthesia & Pain Medicine, Washington, DC 20307, USA.

OBJECTIVE: To successfully treat a patient with complex regional pain syndrome, refractory to standard therapy, to enable a rapid and full return to professional duties. SETTING: This case report describes the rapid resolution of an unusual presentation of complex regional pain syndrome type I after four days of treatment with a continuous sciatic peripheral nerve block and a concomitant parenteral ketamine infusion. The patient [a first year West Point Cadet] was initially diagnosed with complex regional pain syndrome (CRPS) I of the right lower extremity following an ankle inversion injury. Oral medication with naproxen and gabapentin, as well as desensitization therapy, failed to provide any relief of her symptoms. She was referred to the interventional pain management clinic. A lumbar sympathetic block failed to provide any relief. The patient was diagnosed with CRPS I and was admitted for treatment with a continuous peripheral nerve block and parenteral ketamine. CONCLUSION: This case suggests therapeutic benefit from aggressive treatment of both the peripheral and central components of CRPS.

PMID: 19744217 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

But as to the VA, right now, your best chance may be in taking advantage of the list provided under the heading "VISN Pain Management Point of Contact Information" towards the end of the Administrative Resources page and just start calling some of the people listed. The one that sticks out, just because he appears to have all the right credentials, is:

Amr Zidan, MD
Anesthesiology and Pain Management
Chief, Pain Management
4500 S. Lancaster Rd
Dallas, TX 75216

214-857-0384
Pager: 214-759-2023
Amr.Zidan@va.gov

Alternatively, if you would be more comfortable calling anyone else on the list to begin with, then by all means do so.

I would call, begin by saying that you got his or her name off of the list of contact persons on the VHA Pain Management website, and explain that you are a vet with confirmed diagnoses of TOS, RSD, CPS, DDD etc. Then, briefly describe the failure of your treatments to date, and explain that you understand Col. Buckenmaier at Walter Reed has recently published work on the use of ketamine in the treatment of CRPS (aka RSD) and you would very much like to know where (or when) in his understanding the VA will offer ketamine therapies as well.

For that matter, you may wish to inquire as to what facilities have any expertise in dealing with RSD & TOS, where, just based upon the headings under "Clinical Practice Guidelines" also on the Administrative Resources page, pain management treatments at VA facilities appear to be focussed pretty much on cancer, low back pain and the like. (Please note that although the titles remain, the articles under the sub-heading "VA OPQ Clinical Practice Guidelines pain services" are no longer available.) To put it generously, references to RSD/CRPS are few and far between. However, I have to confess that the VA's latest word on the treatment of chronic pain isn't particularly encouraging. From the VA's National Center for PTSD, check out a document I accessed directly through the VA's search engine (on a search for "reflex sympathetic"), "The Experience of Chronic Pain and PTSD: A Guide for Health Care Providers," Lorie T. DeCarvalho, Ph.D, August 20, 2009, which reads in part as follows:

What is the experience of chronic pain like physically?

There are many forms of chronic pain, including: pain felt in the low back (most pervasive or common), the cervical area, the mouth and face, the temporomandibular joint (TMJ), the pelvis, or the head (e.g., tension and migraine headaches); complex regional pain syndrome (formally reflex sympathetic nerve dystrophy (RSD)); fibromyalgia; and cancer-related pain. Of course, each type of condition results in different experiences of pain. But, as an example, chronic low back pain (CLBP) is known to result in severe disability and limitation of movement. In its most severe forms, CLBP may cause paralysis and numbness, loss of gross motor control, loss of bowel and bladder control, loss of reflexes in lower limbs, spasticity, and nerve degeneration.

Patients with chronic pain tend to experience ongoing pain and sometimes experience disability secondary to their condition. Most resort to invasive assessment or treatment procedures, including surgery, to help ameliorate the pain. Individuals with chronic pain are less able to function in daily life than those who do not suffer from chronic pain. Patients with severe chronic pain and limited mobility oftentimes are unable to perform activities of daily living, such as walking, standing, sitting, lifting light objects, doing paperwork, standing in line at a grocery store, going shopping, or working. Many patients with chronic pain cannot work because of their pain or physical limitations.

* * *

Treating individuals who have chronic pain and PTSD

Cognitive-behavioral therapy (CBT) is a psychotherapeutic intervention that helps patients manage chronic pain (Turk, Meichenbaum, & Genest, 1983). Other types of treatment that help patients with chronic pain include: stress inoculation training, behavior modification/operant conditioning, self-directed treatments, and adjunctive treatments such as biofeedback and relaxation training (Brown & DeCarvalho, 2004). There are also manualized treatments that specifically address avoidance behaviors and hypervigilance, because these behaviors tend to reinforce fear reactions (e.g., Meichenbaum, 1986). Beyond this, Shipherd, Beck, Hamblen, Lackner, and Freeman (2003) piloted a more specific protocol for providing CBT treatments to address PTSD symptoms in patients with chronic pain. Results from this small study suggested that along with positive improvements in patients' psychiatric diagnoses following application of this treatment, there were also improvements in pain-related functioning. This was true even though the pain was specifically not addressed in the intervention, which suggests that the beneficial effects of PTSD treatment may generalize to other problems without the need for direct intervention. Further research is still needed in this area, but this study indicates that when treating patients with chronic pain, it is vital that health care providers address patients' symptoms of PTSD and depression. In so doing, patients are more likely to have improvements in their levels of pain as well as in their physical and emotional functioning.

http://www.ptsd.va.gov/professional/...-providers.asp

Good luck and good hunting!

Mike

I forgot I also did a booster at St. Lukes under a Dr. Ronald Hertz he was very nice but I don't think I would do a 5 day inpatient. Just my opinion. Dr. Hertz was very nice but I just felt they were not equip, but I have heard it has changed. You have to check this facilitie out.

I did only go back to work Part Time and at a much less position then I had before, but at least I went back part time.

As far as metabolism it has slowed down tremendously and I have gained a lot of weighted. The metabolism theory is only my opinion and I am hypo-thyroid but I have been hypo-thyroid all my life and been on synthroid since I was 7 and I am 40 now.

I hope I answered all of you questions....

Gabbycakes

Hello,

I did the 10 day out patients treatment with Dr. S in Philly about a year ago. After the
4th day the treatments were stopped they were not helping. As far as hollucinations I didn't have any problems. They give versade with the ketamine to help with the hollucinations. I need a stronger dose than they can give with the infusions and he wants me to go to Germany for the coma.

Best of luck in were every you decide.
Take care,
Sherrie

Hi Brittany and Welcome to Neurotalk,
I'm so sorry you and your fiance have the swine flue. I'm getting tested tomorrow-had chest infection for long long time. But I know a poor immune system goes with RSD.
Sorry I don't know about ketamine, only that the trial study was done here at the Mayo in Scottsdale. A friend of mine was their assistant. I always wondered since they did the trial, why didn't they proceed in offering the treatment to patients? We live just a couple miles from it, maybe I'll check that out.
My Dr. just built and opened two clinics here in AZ. He has a HBOT in each of the clinics and having success in the HBOT treatment. I've saving to undergo the treatment. My Dr. is a neurologist, psychiatrist and pharmacologist. I've been seeing him for 5 years. As soon as I can affort it, I'm going for the HBOT.
Wish you well in getting treatment. I was 31 when my only daughter was born. From my heart, I hope you can have your baby. Others on here, have said their rsd went away when they were pregnant, then came back.
Take care, loretta soft hugs

my first infusion lasted 6 weeks. my second one lasted 5 months. i'm getting ready to schedule a 3rd.

i went in for 4 hours, and was knocked out the whole time. no breathing tube needed tho. i was out of it for the rest of the day/night. with my first infusion once i was coherant i had no side affects. i was given ketamine pills to take twice a day along with ativan to take at night to prevent hallucinations. because i was already taking ketamine for over 2 years i had a tolerance built up and during the infusion was still semi awake and able to hold a conversation. which had never happened with any of my doc's patients before. so for the second infusion he doubled the dose. at first i was not given the ativan because i didn't have any hallucinations with the first one. but my first night after the infusion i had constant music playing in my head- thought there was a radio on somewhere.... and there were hellicopters going all night and i thought i was like in war zone or something cause of it. so the next day i had my doc call in ativan to pick up when i got home from la (6 hour drive). once i got those i had no more side affects. both times my pain completely went away, along with all other symptoms. once in a while my hand would shake some but definately not as bad as it had been. i was also able to completely get off all my meds. right away.

i would definately recommend it! i gained back so much of my freedom and independence because of it. not to mention a normal life again. there is not guarentee tho that everyone will go into remission. but he has a very high success rate, and even if a full remission isn't gained there seems to always be a decrease in pain levels.

he does not take insurance for the infusion. and depending on what ur able to afford he has various treatment options- a single 4 hour infusion, or coming in for 3 of them- with a day in between each one, or coming in for like 7 or 10 of them- again with a day in between each. each infusion he charges $2k. and you can always try to submit it to your insurance afterwards and see if they'll reimburse you.

Sorry to hear that you have had the Swine Flu, Britanny - I hope you are feeling better now!

I don't have any experience with the Ketamine infusions as they don't do them in under 16s over here in the UK but my Doctor put me on oral Ketamine about a year ago and it helps me a little. I am only to take it when I am in a really bad flare due to my age etc but it helps lower my pain a little. It doesn't help as much as it used to unfortunatley though.

I have a few online RSD friends on another forum and they have had Ketamine infusions and they have worked well for some and not well for others ... I guess it's one of those things with RSD where what works for one person, wont work for another unfortunatley.

I wish you the best of luck should you wish to try them and hope you get the pain relief and remission you so desperately need and deserve!

Keep us updated,
Alison

Would anyone who has done the ketamine infusion please contact me at *edit*

Much appreciated.

Many thanks.



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