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Reflex Sympathetic Dystrophy (RSD and CRPS) Reflex Sympathetic Dystrophy (Complex Regional Pain Syndromes Type I) and Causalgia (Complex Regional Pain Syndromes Type II)(RSD and CRPS) |
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07-01-2009, 05:57 PM | #11 | |||
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Dear Ms. L -
The study to which you refer was ultimately published under the title "A Pilot Open-Label Study of the Efficacy of Subanesthetic Isomeric S(+)- Ketamine in Refractory CRPS Patients," Kiefer RT, Rohr P, Ploppa A, et al, Pain Med. 2008; 9(1): 44-54, a copy of which is attached. As set forth in the lengthy Discussion section at the end of the article, the authors struggle to explain why low dose (as opposed to the high-dose coma treatments in Germany) have no effect on patients with chronic CRPS, while at the same time there are some very good studies which strongly suggest that low dose ketamine is effective in treating acute cases of CRPS, e.g., patients who begin treatment within 3 - 6 months of the onset of symptoms. Accordingly, my read is that the stidy is by no means a rejection of the treatment for those still in the acute phase: Several trials and case studies have suggested the efficacy of ketamine in CRPS. Takahashi et al. demonstrated complete remission of CRPS after epidural ketamine administration [9]. Effective relief of severe pain and motor dysfunction has been reported for epidural ketamine in combination with morphine and bupivacaine [10]. The topical administration of ketamine ointment is effective in relieving pain and swelling in CRPS type I and CRPS type II patients [11]. Correll and colleagues reported significant pain relief in CRPS patients after prolonged infusions of subanesthetic racemic ketamine [12]. All of these reports suggest that ketamine may be more effective in earlier and more localized CRPS.As has been suggested before, the problem, at least in North America, is that too few people are (1) diagnosed with CRPS and (2) in the hands of a competant pain specialist, while their CRPS is still in the acute stage, i.e., when low dose ketamine infusions can actually be effective. For those in the chronic stage, I completely agree with you, save and except that it's been anecdotally reported here - and I've heard from others - that people who get close to anesthetic doses (500 mg. over 5 hours) may get relief lasting several weeks, but still less than has been observed in some patients with the "highest dose" ketamine coma therapy: complete remission for six months in 6 of 16 patients. Efficacy of Ketamine in Anesthetic Dosage for the Treatment of Refractory Complex Regional Pain Syndrome: An Open-Label Phase II Study, Kiefer RT, Rohr P, Ploppa A, et al, Pain Med. 2008 Feb 5. E-pub ahead of print, free full text at http://www.rsds.org/2/library/articl...a_Dietrich.pdf. (Does anyone know what the current stats are for remission in terms of years following the coma treatment?) Finally, let me turn from this aside to the subject of the thread: Where Schinkel C, Scherens A, Köller M, Roellecke G, Muhr G, and Maier C [above] found no evidence of any statistically significant elevation of Tumor-Necrosis-Factor alpha (TNF-a) in the blood serum of chronic CRPS patients, has anyone here with chronic CRPS taken Remicade (Infliximab) - potential side effects and all - and if so, what has been your experience? Mike |
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"Thanks for this!" says: | Dew58 (07-01-2009) |
07-01-2009, 06:46 PM | #12 | |||
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This is very informative;further, I am enjoying the discourse applied within this post/subject matter
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. A Positive Attitude Will Assist Me Toward An Active Life, Once Again . WC Injury 03/24/07;Two Right Knee Surgeries on 5/22/07 and 01/16/08. Surgeons and Physical Therapists ignored my concerns of burning pain, swelling, and no improvement and getting worse. Diagnosed RSD/CRPS I/Sympathetically Mediated Pain Syndrome/Chronic Pain on 06/2008 by family doc;on 08/2008 and 12/2008 diagnosis confirmed by two WC PM Doctors: Both legs;hips; hands; and spine effected by this culprit. SSDI granted 01/2009. |
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"Thanks for this!" says: | fmichael (07-01-2009) |
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