florida spine institute Archives - Dr. Hanna CRPS Pain Doctor Tampa Clearwater

Double-Blind Clinical Trial Shows that Dose Matters with Ketamine in Depressed Patients

by admin | Nov 14, 2018 | Uncategorized

The results of a new clinical trial with ketamine were published in Nature’s Molecular Psychiatry journal. Researchers conducted a double-blind, placebo-controlled, dose-ranging trial of intravenous ketamine as adjunctive therapy in treatment-resistant depression (TRD). 99 subjects, 18-70 years old with TRD (defined as having less than 50% improvement in depression symptoms with conventional therapies) were randomized into one of five arms: a single intravenous dose of ketamine 0.1 mg/kg (n = 18), a single dose of ketamine 0.2 mg/kg (n = 20), a single dose of ketamine 0.5 mg/kg (n = 22), a single dose of ketamine 1.0 mg/kg (n = 20), and a single dose of midazolam 0.045 mg/kg (active placebo) (n = 19).

The authors found that the 0.5 and 1.0 mg/kg doses of ketamine were superior to the active placebo comparator, supporting its use as a novel antidepressant therapy. Interestingly, the lower doses that were tested did not separate from the placebo comparator. This is study is incredibly important because previously no dose range finding studies have been conducted with ketamine in patients with TRD. Their data suggests that clinicians who use lower doses of ketamine may not see any significant clinical response. This is typical of most drugs and is an important step toward developing the ideal dosing regimen that balances clinical benefit and risk.

If you or someone you know is depressed, please make an appointment to see if you are a good candidate for ketamine. Dr. Ashraf Hanna is located in Clearwater, FL and is one of the leading experts in IV ketamine therapy. Dr. Hanna is a licensed anesthesiologist and Director of Pain Management at the Florida Spine Institute. He has performed thousands of infusions and patients travel from all over the world to benefit from his expertise. If you want to learn more, visit his website and listen to his patient testimonies. You won’t be disappointed! What are you waiting for? Make an appointment today!

The National Institute of Mental Health Highlights Ketamine for Depression

by admin | Aug 25, 2018 | Uncategorized

The National Institute of Mental Health (NIMH) issued a highlight on ketamine for treating depression.

The most commonly used antidepressants are largely variations on a theme; they increase the supply within synapses of a class of neurotransmitters believed to play a role in depression. While these drugs relieve depression for some, there is a weeks-long delay before they take effect, and some people with “treatment-resistant” depression do not respond at all.

The delay in effectiveness has suggested to scientists that the medication-induced changes in neurotransmitters are several steps away from processes more central to the root cause of depression. One possibility for a more proximal mechanism is glutamate, the primary excitatory, or activating, neurotransmitter in the brain. Preliminary studies suggested that inhibitors of glutamate could have antidepressant-like effects, and in a seminal clinical trial, the drug ketamine—which dampens glutamate signaling—lifted depression in as little as 2 hours in people with treatment-resistant depression.³⁴

The discovery of rapidly acting antidepressants has transformed our expectations—we now look for treatments that will work in 6 hours rather than 6 weeks. But ketamine has some disadvantages; it has to be administered intravenously, the effects are transient, and it has side effects that require careful monitoring. However, results from clinical studies have confirmed the potential of the glutamate pathway as a target for the development of new antidepressants. Continuing research with ketamine has provided information on biomarkers that could be used to predict who will respond to treatment.³⁵ Clinical studies are also testing analogs of ketamine in an effort to develop glutamate inhibitors without ketamine’s side effects that can then be used in the clinic.³⁶ Ketamine may also have potential for treating other mental illnesses; for example, a preliminary clinical trial reported that ketamine reduced the severity of symptoms in patients with PTSD. ³⁷ Investigation of the role of glutamate signaling in other illnesses may provide the impetus to develop novel therapies based on this pathway.

Left: Change in the 21-item Hamilton Depression Rating Scale (HDRS) following ketamine or placebo treatment.
Right: Proportion of responders showing a 50 percent improvement on the HDRS following ketamine or placebo treatment.³⁴

Source: Carlos Zarate, M.D., Experimental Therapeutics and Pathophysiology Branch, NIMH

One of the imperatives of clinical research going forward will be to demonstrate whether the ability of a compound to interact with a specific brain target is related to some measurable change in brain or behavioral activity that, in turn, can be associated with relief of symptoms. In a study of ketamine’s effects in patients in the depressive phase of bipolar disorder, ketamine restored pleasure-seeking behavior independent from and ahead of its other antidepressant effects. Within 40 minutes after a single infusion of ketamine, treatment-resistant depressed bipolar disorder patients experienced a reversal of a key symptom—loss of interest in pleasurable activities—which lasted up to 14 days.³⁸ Brain scans traced the agent’s action to boosted activity in areas at the front and deep in the right hemisphere of the brain. This approach is consistent with the NIMH’s RDoC project, which calls for the study of functions—such as the ability to seek out and experience rewards—and their related brain systems that may identify subgroups of patients with common underlying dysfunctions that cut across traditional diagnostic categories.

The ketamine story shows that in some instances, a strong and repeatable clinical outcome stemming from a hypothesis about a specific molecular target (e.g., a glutamate receptor) can open up new arenas for basic research to explain the mechanisms of treatment response; basic studies can, in turn, provide data leading to improved treatments directed at that mechanism. A continuing focus on specific mechanisms will not only provide information on the potential of test compounds as depression medications, but will also help us understand which targets in the brain are worth aiming at in the quest for new therapies.

IV Ketamine Shows Promise in Clinical Trial with Depressed Teens

by admin | Aug 14, 2018 | Uncategorized

Researchers from the University of Minnesota and The Mayo Clinic found that ketamine caused an average decrease of 42% on the Children’s Depression Rating Scale(CDRS)—the most widely used rating scale in research trials for assessing the severity of depression and change in depressive symptoms among adolescents. The study recruited adolescents, 12-18 years of age, with treatment-resistant depression (TRD; failure to respond to two previous antidepressant trials). The teens were administered intravenous ketamine (0.5 mg/kg) by infusion six times over two weeks.

The study reported that the average decrease in CDRS-R was 42.5% (p = 0.0004). Five (38%) adolescents met criteria for clinical response (defined as >50% reduction in CDRS-R). Three responders showed sustained remission at 6-week follow-up; relapse occurred within 2 weeks for the other two responders. The ketamine infusions were generally well tolerated; dissociative symptoms and hemodynamic symptoms were transient. Interestingly, higher dose was a significant predictor of treatment response.

“Adolescence is a key time period for emergence of depression and represents an opportune and critical developmental window for intervention to prevent negative outcomes,” the authors wrote in the study.

“Unfortunately, about 40% of adolescents do not respond to their first intervention and only half of non-responders respond to the second treatment,” they said. “Because standard interventions require prolonged periods (e.g., weeks to months) to assess efficacy, serial treatment failures allow illness progression, which in turn worsens the outcome. Hence, novel treatment strategies to address treatment-resistant depression in adolescents are urgently needed.”

The authors concluded that their results demonstrate the potential role for ketamine in treating adolescents with TRD. Additionally, evidence suggested a dose–response relationship; future studies are needed to optimize dose.

Yale study found no safety issues with long-term ketamine treatment

by admin | Aug 8, 2018 | Uncategorized

Researchers at Yale published a new study titled “Acute and Longer-Term Outcomes Using Ketamine as a Clinical Treatment at the Yale Psychiatric Hospital” in Clinical Psychiatry. In late 2014, Yale began providing ketamine as an off-label therapy on a case-by-case basis for patients who could not participate in research protocols. The authors observed 54 patients that received IV ketamine infusion for the treatment of severe and treatment-resistant mood disorders such as depression.

“Ketamine is being used as an off-label treatment for depression by an increasing number of providers, yet there is very little long-term data on patients who have received ketamine for more than just a few weeks,” Samuel T. Wilkinson, MD,from the department of psychiatry, Yale School of Medicine and Yale Psychiatric Hospital, told Healio Psychiatry.

The Yale researchers studied the acute and longer-term outcomes in this patient population. Importantly, a subset of patients (n=14) received ketamine on a long-term basis, ranging from 12 to 45 total treatments, over a course of 14 to 126 weeks. The researchers found no evidence of cognitive decline, increased proclivity to delusions, or emergence of symptoms consistent with cystitis in this subset of long-term ketamine patients. They also reported that the infusions were generally well-tolerated.

Although this study population was relatively small, limiting the conclusions that can be drawn, this is still an important first step in establishing the long-term safety of ketamine for the treatment of a myriad of diseases that it’s being used to treat.

Weekly Breaking Pain Research Updates

by admin | Oct 1, 2015 | Uncategorized

Weekly Breaking Research Updates

Scientific breakthroughs happen every day! In an effort to help our patients stay up to speed on the most cutting edge treatment options available for them, our scientists monitor current research and publish weekly research updates. The title of each article below is a link to the full study report. If you’d like to make an appointment with Dr. Hanna to discuss your treatment options, please contact us.

Ketamine

Ketamine Derivatives

JW Sleigh, WA Denny, J Jose, SA Gamage, MG Harvey… – US Patent 20,150,259,277, 2015

Abstract: The present invention relates to ketamine derivatives of the formula (I),

pharmaceutical compositions comprising them, and methods for treating pain comprising

administering them, and their use in the manufacture of medicaments for treating pain. …

Comparing the hemodynamic parameters and seizure duration between ketamine and thiopental during Electroconvulsive therapy in patients with Major depressive …

M Mohseni, A Ghanbari, MA Motazedi Ghajar… – Anesthesiology and Pain, 2015

Aim and Background: Today the effect of Electroconvulsive therapy (ECT) in cure of Major

depressive disease (MDD), and psychiatric patients is well accepted and usage of this

method is developed every day. In this regard, selecting the most effective hypnotic drugs …

The antinociceptive efficacy of morphine-ketamine-magnesium combination is influenced by the order of medication administration.

SM Vučkovič, VKR Savič, DP Srebro, BM Medič… – European review for …, 2015

OBJECTIVE: Ketamine and magnesium, both N-methyl-D-aspartate (NMDA) receptor

antagonists, enhance the antinociceptive effects of opioid analgesics in different animal

models of pain, as well as in humans. This study aimed at evaluating whether magnesium …

[HTML] Hemodynamic Effects of the Non-Peptidic Angiotensin-(1-7) Agonist AVE0991 in Liver Cirrhosis

S Klein, CB Herath, R Schierwagen, J Grace… – PLOS ONE, 2015

… Cholestatic model. BDL was performed in 40 rats (180g) after anesthesia with ketamine/xylazine

(78mg/kg and 10mg/kg body weight) as previously described [12]. … Briefly rats were anesthetized

with ketamine/xylazine (78mg/kg and 10mg/kg body weight), respectively. …

[HTML] Systemic and Cardiac Depletion of M2 Macrophage through CSF-1R Signaling Inhibition Alters Cardiac Function Post Myocardial Infarction

AL Leblond, K Klinkert, K Martin, EC Turner, AH Kumar… – PLOS ONE, 2015

… Procedures were performed under anesthesia induced by ketamine (90mg/kg), xylazine

(10mg/kg) and urethane (1.25mg/kg) and analgesia by ip delivery of carprofen (5 mg/Kg). … Mice

were anesthetized with ketamine (90mg/kg), xylazine (10mg/kg) and urethane (1.25mg/kg). …

Morphological Pulmonary Diffusion Capacity for Oxygen of Burmese Pythons (Python molurus): a Comparison of Animals in Healthy Condition and with Different …

JM Starck, I Weimer, H Aupperle, K Müller… – Journal of Comparative …, 2015

… Snakes were anaesthetized (1 mg/kg diazepam intramuscularly [i/m]; Faustan; Temmler Pharma,

Marburg, Germany, followed by 40 mg/kg ketamine hydrochloride i/m; Ketavet; Pfizer Pharma,

Berlin, Germany) and placed in the CT scanner (Brilliance CT 6; Philips, Hamburg …

[PDF] Articles in PresS. Am J Physiol Lung Cell Mol Physiol (March 27, 2015). doi: 10.1152/ajplung. 00291.2014

BA MacKenzie, I Henneke, S Hezel, D Al Alam… – 2015

… Mice were genotyped as described previously (3, 12, 34). 148 149 Bleomycin administration

150 10–14 week-old female mice were anaesthetized with a mixture of 0.6 µl/g Ketamine 10%

151 (100 mg/ml) and 0.3 µl/g Dormitor 10% (0.5 mg/ml) dissolved in 0.7% saline. …

Anesthesia for Endoscopy

M Asakawa – Veterinary Clinics of North America: Small Animal …, 2015

… 26 Another study found that a combination of acepromazine and butorphanol followed by induction

with propofol had minimal effect on splenic volume, whereas medetomidine and butorphanol

as premedicants followed by ketamine and diazepam for induction were associated …

[HTML] Generation and Characterization of Live Attenuated Influenza A (H7N9) Candidate Vaccine Virus Based on Russian Donor of Attenuation

S Shcherbik, N Pearce, A Balish, J Jones, S Thor… – PLOS ONE, 2015

… replication in multiple organs. Anesthesia occurred through an intramuscular injection

of a ketamine-xylazine-atropine cocktail (25 mg/kg ketamine, 2 mg/kg xylazine,

and 0.05 mg/kg of atropine). For euthanasia, ferrets were …

[HTML] Standardized surgical approaches to ear surgery in rats

P Li, D Ding, K Gao, R Salvi – Journal of Otology, 2015

… studies using rats. 2. Anesthesia and pre-operative preparation. Health SD rats

weighing about 250 g were selected and anesthetized with intraperitoneal ketamine

(100 mg/kg) and chlorpromazine (5 mg/kg). The skin around …

Radiofrequency Ablation (RFA)

Is radiofrequency ablation of lung metastases the most radical treatment?

M Zielinski, R Zaimi, P Sabatier, P Bagan – European Journal of Surgical Oncology, 2015

We read with interest the article on long term results of radiofrequency ablation (RFA) to lung

metastases from colorectal cancer 1. This article is an interesting retrospective analysis on

long term survival in patients with lung metastases from colorectal cancer treated with this …

Uninterrupted new oral anticoagulants compared to uninterrupted Vitamin K antagonists in ablation of atrial fibrillation. A Meta-analysis

R Nairooz, K Ayoub, P Sardar, J Payne, A Almomani… – Canadian Journal of …, 2015

… NOAC= new oral anticoagulant, VKA=vitamin K antagonist, N/A=not available, TEE=

trans-esophageal echocardiogram, ICE= intra-cardiac echocardiogram, UFH=

unfractionated heparin, s= seconds, RFA= radiofrequency ablation. …

Magnetic resonance imaging of atrial fibrosis: redefining atrial fibrillation to a syndrome

P Gal, NF Marrouche – European Heart Journal, 2015

… Post-ablation DE-MRI allows for assessment of the total scar burden, complete encirclement

of pulmonary veins, and the assessment of residual fibrosis, which were all reported to

be strong predictors of arrhythmia recurrences post-ablation. …

Imaging Hepatocellular Carcinoma with Dynamic CT Before and After Transarterial Chemoembolization: Optimal Scan Timing of Arterial Phase

M Saake, MM Lell, A Eller, W Wuest, M Heinz, M Uder… – Academic Radiology, 2015

… In eight patients previous TACE and in five patients previous radiofrequency ablation had been

performed and follow-up imaging had demonstrated HCC recurrence. … First, in a part of our cohort

the HCCs had been treated previously by TACE or radiofrequency ablation. …

Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) trial

K Kaitani, K Inoue, A Kobori, Y Nakazawa, T Ozawa… – European Heart Journal, 2015

… fasttrack ★ Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation

for Atrial Fibrillation (EAST-AF) trial. Kazuaki Kaitani, Koichi Inoue, Atsushi Kobori,

Yuko Nakazawa, Tomoya Ozawa, Toshiya Kurotobi, Itsuro …

PAEDIATRIC CT EXPOSURE PRACTICE IN THE COUNTY OF RIO DE JANEIRO: THE NEED TO ESTABLISH DIAGNOSTIC REFERENCE LEVELS

FM de Jesus, LAG Magalhães, S Kodlulovich – Radiation Protection Dosimetry, 2015

… are essential for the diagnosis and monitoring of patients with complex cardiovascular disease

(2–4) , for the diagnosis of pulmonary embolism (5) and for guiding interventional procedures,

such as radiofrequency ablation, biopsy, abscess drainage and nephrostomy (6) . In …

Substrate Mapping for Unstable Ventricular Tachycardia

P Santangeli, FE Marchlinski – Heart Rhythm, 2015

… Scar dechanneling, linear ablation through sites matching VT with pacing and the core isolation

approach focus on more discrete … and/or inducible arrhythmias by means of physiological

maneuvers, although this does not necessarily translate in less radiofrequency lesions to …

[HTML] Evaluation and management of chronic coccygodynia: Fluoroscopic guided injection, local injection, conservative therapy and surgery in non-oncological pain

A Galhom, M al-Shatouri, SA El-Fadl – The Egyptian Journal of Radiology and …, 2015

… 23). The beneficial effect was retained with repeated injections (21). Radiofrequency

ablation using two needles achieved a pain reduction of >50% for an average duration

of 2.2 months, in a series of 13 patients (24). Another …

[HTML] Assessment of prognosis of patients with stage II colon cancer

S Martins, P Martins – Journal of Coloproctology, 2015

… Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined

resection/ablation for colorectal liver metastases. Ann. Surg., 239 (2004), pp. 818–825 discussion

825–27. 9; K. Lang, JR Korn, DW Lee, LM Lines, CC Earle, J. Menzin; …

Energy delivery systems and uses thereof

DW van der Weide, PF Laeseke, FT Lee, CL Brace – US Patent 9,119,649, 2015

… tissue for a wide variety of applications, including medical procedures (eg, tissue ablation,

resection, cautery … the device is configured to deliver a sufficient amount of energy to ablate the

tissue … In some embodiments, the energy is microwave energy and/or radiofrequency energy …

Chronic Regional Pain Syndrome (CRPS/RSD)

Side-Channel Assisted Modeling Attacks on Feed-Forward Arbiter PUFs Using Silicon Data

R Kumar, W Burleson – … : 11th International Workshop, RFIDsec 2015, New …, 2015

… However, the performance of modeling attacks is impacted by the presence of

error-prone CRPs in the training set. To that extent … error-prone CRPs. The terms

“error-prone” and “error- inflicted” refer to the same set of CRPs. …

Making Invisible Intersectionality Visible Through Theater of the Oppressed in Teacher Education

B Powers, PB Duffy – Journal of Teacher Education, 2015

… Thank you! We ended there on the first day. Day 2. After initial warm-ups, the students broke up

into four groups. Each group, of about five to six students, was asked to create two to three

tableaux that explored their positions within schools as it relates to the course of CRPs. …

Energy geographies: thinking critically about energy issues in the classroom

E Delgado – Journal of Geography in Higher Education, 2015

Analysis of suicide attempts and completions at the South Texas Veterans Health Care System: a retrospective review

R Oliveira, TA Moore, CA Gutierrez – Mental Health Clinician, 2015

… Additional information collected included psychiatric medications used during the review period,

including psychiatric MPRs for 6 months before the suicide attempt. The MPRs were calculated

manually using the prescription refill history available in CRPS. …

[PDF] Cadmium toxicity in diazotrophic Anabaena spp. adjudged by hasty up-accumulation of transporter and signaling and severe down-accumulation of nitrogen …

S Rai, S Singh, LC Rai – 2015

… Percentage of total protein variability explained in PC1 and PC2 is given in parenthesis.

Protein spots in red color represent variables whereas text in blue color indicates time points.

Fig. 5. Cluster analysis of Cd responsive (CRPs) in Anabaena spp. …

[PDF] The migraine brain in transition: girls vs boys

V Fariaa, N Erpeldinga, A Lebela, A Johnsona… – 2015

Page 1. NUMBER 1 OF 1 AUTHOR QUERIES DATE 7/25/2015 JOB NAME PAIN ARTICLE

PAIN-D-14-13318 QUERIES FOR AUTHORS V. Faria et al. THIS QUERY FORM MUST

BE RETURNED WITH ALL PROOFS FOR CORRECTIONS …

Structure-function relationships in mammalian Histidine-Proline-Rich Glycoprotein

F Ronca, A Raggi – Biochimie, 2015

Histidine-proline-rich glycoprotein (HPRG), or histidine-rich glycoprotein (HRG), is a serum

protein that is synthesized in the liver and is actively internalis.

Fibromyalgia

[PDF] Adult attention-deficit and hyperactivity disorder and fibromyalgia: a case-control study

A Golimstok, MC Fernandez, MM Garcia Basalo – Neuro Open J, 2015

ABSTRACT Introduction: Fibromyalgia syndrome (FMS) is a disorder characterized by

widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.

An association between attention deficit and fibromyalgia was reported. However, to our …

Fasting and rheumatic diseases (ahead of publication)

MH Jokar – Journal of Fasting and Health, 2015

… Predicting chronic symptoms after an acute “stressor”—lessons learned from 3 medical conditions.

Med Hypotheses 2004;63:653-8. 17-Chervin RD, Teodorescu M, Kushwaha R, et al. Objective

measures of disordered sleep in fibromyalgia. J Rheumatol 2009;36:2009-16. …

… —With treatment approaches for fibromyalgia evolving over the course of modern medicine, many clinicians are reviewing the Diagnosing and Treating Fibromyalgia: …

C Palsy, CPCLE Row

The pathophysiology of fibromyalgia includes central sensitization (amplification of pain in

the spinal cord via spontaneous nerve activity, expanded receptive fields, and augmented

stimulus responses), abnormalities of descending inhibitory pain pathways (dysfunction in …

[HTML] Select a Site

V Promise, VO Heritage, B Areas, L Diabetes…

Neuroscience covers both mental disorder and pain manifestations. Mental disorder covers Bipolar

Disorder, Schizophrenia,Depression and General Anxiety Disorder while pain includes Diabetic

neuropathy, Fibromyalgia and chronic pain. … 54th ed. Lange; 2015. Fibromyalgia. …

The measurement of bridging social capital in population health research

E Villalonga-Olives, I Kawachi – Health & Place, 2015

… capital (a combination of social resources that can be beneficial to a person’s physical health

and well-being), personal coping strategies, and additional personal and disease-related factors,

contribute to the functioning and quality of life (QoL) of fibromyalgia (FM) patients. …

Therapeutic Effects of the Mineral Waters from Copahue Spa

AM Monasterio, F Armijo, F Maraver – Copahue Volcano, 2015

… and chondrolysis, Fioravanti et al. (2011) reported: • A reduction in the levels of

circulating pros- taglandins E2 (PGE-2) and leukotriene B4 (LT-B4) in patients with

osteoarthritis or fibromyalgia. • Reductions in tumour necrosis …

Seven Steps to Choosing Joy!: Discover the Power of Your Inner Wisdom

L Ackles – 2015

DRUG DELIVERY CONJUGATES CONTAINING UNNATURAL AMINO ACIDS AND METHODS FOR USING

IR Vlahov, CP Leamon – US Patent 20,150,258,203, 2015

… any one of the preceding embodiments wherein the disease is selected from the group consisting

of arthritis, including rheumatoid arthritis and osteoarthritis, glomerulonephritis, proliferative

retinopathy, restenosis, ulcerative colitis, Crohn’s disease, fibromyalgia, psoriasis and ..

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