A clinical study conducted by researchers at the Leiden University Medical Center in The Netherlands evaluated the efficacy of a multi-day infusion regimen of intravenous ketamine for the treatment of Chronic Regional Pain Syndrome Type 1. This double blind, placebo-controlled study validated intravenous ketamine as a treatment for CRPS-1, which historically responds poorly to standard pain treatment. Sixty CRPS-1 patients were randomized into groups to undergo infusion therapy for 4.2 days with intravenous ketamine or placebo. The researchers measured pain levels in these patients using a numerical pain score assessment. They found that pain scores over the 12 week study period in patients receiving ketamine were significantly lower compared to those that received placebo (P<0.001). Importantly, after the 12th week, statistical significance between the two groups was lost, indicating that the infusion regimen that the researchers used is not a permanent fix for CRPS-1. Nonetheless, it did provide relatively long lasting relief in a patient population that is desperate for more effective therapies. Intravenous ketamine could be the answer that they’re looking for.
Future studies should focus on the optimal dose of intravenous ketamine and possible synergistic combination drugs to enhance the efficacy of this treatment option for the treatment of chronic pain conditions, like CRPS. A new combination ketamine infusion therapy is offered at the Florida Spine Institute that might just be the answer for long lasting analgesic efficacy. To find out if this procedure is right for your chronic pain, please make an appointment to see Dr. Ashraf Hanna, an expert pain management doctor with significant experience using intravenous ketamine. It is our goal at the Florida Spine Institute to conduct the cutting edge research necessary to eradicate CRPS once and for all.
Sigtermans, M.J., van Hilten, J.J., Bauer, M.C., Arbous, M.S., Marinus, J., Sarton, E.Y., Dahan, A., 2009. Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1. Pain 145, 304-311.
Intravenous Infusion Therapy
Intravenous (IV) infusion therapy is an exciting treatment option for numerous pain syndromes ranging from fibromyalgia and small fiber neuropathy to Complex Regional Pain Syndrome (CRPS) and Reflex Sympathetic Dystrophy (RSD). IV infusion therapy is very simple: an IV line is placed in the patient’s arm and the medication flows in.
There are several medications that are commonly delivered IV for pain management:
• Immunoglobulin (IG)
These medications are typically mixed with saline in an IV bag and slowly infused accordingly based on the medication and/or protocol being utilized.
Dr. Hanna will first select the appropriate medication to be used in the infusion depending on the type of pain that you are experiencing. Next, the office staff will weigh you to determine the proper amount of medication needed and mix it with saline in an IV bag. Next, Dr. Hanna will place an IV line in your arm or hand per standard IV protocols. The medication is infused through the IV over variable times depending on the medication. It’s that simple. During the infusion process, you will be placed on a monitor and your vitals will be closely observed for the duration of the infusion.
Lidocaine – Blocks sodium channels in the neuronal cell membrane that may potentially play a role in the pathogenesis and maintenance of both neuropathic and inflammatory pain
Ketamine – N-methyl-D-aspartate (NMDA) Receptor antagonist – therefore decreases sustained neuronal depolarization and excitatory transmission along afferent pain pathways in the dorsal horn of the spinal cord
Immunoglobulin (IG) – Counteracts neuroinflammation by inhibiting complement deposition, neutralizing cytokines and growth factors, speeds up clearance of potentially pain-inducing auto-antibodies, and activation of macrophages and T cells through FcγRIIb receptor
Clonidine – α2-adrenergic receptor agonist believed to reduce of norepinephrine release from the α2-adrenergic in the periphery
Dexmedetomidine – Selective α2-adrenergic agonist that may have a role in treating painful conditions that are manipulated and/or attenuated by the sympathetic nervous system
Bisphosphonates – Decreases neuropathic bone pain by suppressing bone resorption via osteoclast inhibition, shortens osteoclast life span and decreasing the acidity of the local microenvironment
Magnesium – Competitive NMDA receptor antagonist that decreases acute and chronic pain by stabilizing abnormal nerve excitation
How Many Treatments are Required?
The response to treatment varies patient by patient. Most require several treatments; the amount required depends on the medication and the protocol being used. Some people respond at first infusion, but most will not feel the full benefit until several treatments have been administered.
Is Infusion Therapy Right for me?
If you suffer from chronic pain that has not responded to medication or other traditional treatment options, then infusion therapy may be an option for you.
To make an appointment today with Dr. Hanna, call 727-797-7463.