The National Institute of Mental Health Highlights Ketamine for Depression

by | 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.

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!

IV Ketamine Shows Promise in Clinical Trial with Depressed Teens

by | 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.

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!

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

by | 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.

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!

Latest Pain Research News

Latest Pain Research News

by | Nov 5, 2015 | Uncategorized

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

Innate immunity of surfactant proteins A and D in urinary tract infection with uropathogenic Escherichia coli

F Hu, G Ding, Z Zhang, LA Gatto, S Hawgood… – Innate Immunity, 2015

… UTI was induced as previously described, 30 with some modifications. In brief, mice were

anesthetized by ip injection with ketamine/xylazine (90 mg/kg ketamine and 10 mg/kg xylazine),

and were gently massaged and pushed down on the bladder to expel urine. …

[PDF] Comparison of propofol and ketofol in minor gynecologic interventions

Y Işık, Z Kurdoğlu, U Göktaş, İ Katı, D Sözen – J Clin Exp Invest www. jceionline. org …, 2015

… Propofol is administered as an infusion instead of in repeated doses, which prevents

dose-dependent respiratory and cardiovascular system depression and pro- vides controlled

sedation [1]. Ketamine is preferred for premedication, anesthesia induction and main- tenance …

Anesthesia Complications of Pediatric Radiotherapy

V Verma, AB Beethe, M LeRiger, RR Kulkarni, M Zhang… – Practical Radiation …, 2015

… While agents such as ketamine (complication rates approaching 23-24%) have been used

in the past, other agents such as propofol and volatile anesthetics have lower complication

rates due to improved drug side effect profiles (0.01-3.5%). …

[HTML] Stress activates the nucleus incertus and modulates plasticity in the hippocampo-medial prefrontal cortical pathway

R Rajkumar, Y Wu, U Farooq, WH Tan, GS Dawe – Brain Research Bulletin, 2015

… Ketamine (Parnell Manufacturing Pty Ltd; Alexandria, NSW, Australia), xylazine (Ilium Xylazil,

Troy Laboratories Pty Ltd; Glendenning, NSW, Australia), enrofloxacin (Baytril 5%, Bayer Health

Care; Seoul, Korea) and carprofen (Carprieve, Norbrook Laboratories (GB), Ltd …

The role of glutamatergic, GABA-ergic, and cholinergic receptors in depression and antidepressant-like effect

K Pytka, A Dziubina, K Młyniec, A Dziedziczak… – Pharmacological Reports, 2015

Depression is one of the most common mental disorders and social issue worldwide. Although

there are many antidepressants available, the effectiveness of the th.

[HTML] Communicating with mismatch and tension: treatment provision experiences of primary care doctors treating patients with overactive bladder in Hong Kong

JY Siu – BMC Family Practice, 2015

… [P6]. During the study period, the symptoms of OAB, particularly urinary frequency and

urinary incontinence, were identified by government antisubstance abuse public service

announcements as signs and consequences of ketamine abuse. …

Hydrogen sulfide (H 2 S) attenuates uranium-induced acute nephrotoxicity through oxidative stress and inflammatory response via Nrf2-NF-κB pathways

J Zheng, T Zhao, Y Yuan, N Hu, X Tang – Chemico-Biological Interactions, 2015

… sacrificed. After urine collection, rats were anesthetized by an ip injection of

ketamine-xylazine (50 mg/kg ketamine and 5 mg/kg xylazine), and blood samples

were obtained directly from the heart ventricle in anesthetized animals. …

[PDF] General discussion and future perspectives

SA Bouwense, M de Vries, LT Schreuder, SS Olesen… – PDF hosted at the Radboud …, 2015

… even if technically successful. If central nervous system pain processing is altered,

specific treatment targeting these changes should be instituted (eg gabapentinoids,

ketamine or tricyclic antidepressants). Suitable tools are …

Propofol target-controlled infusion for sedated gastrointestinal endoscopy: A comparison of propofol alone versus propofol–fentanyl–midazolam

CD Hsu, JM Huang, YP Chuang, HY Wei, YC Su… – The Kaohsiung Journal of …, 2015

… The currently used regimens include propofol, benzodiazepines (such as midazolam and

diazepam), opioids (such as fentanyl and remifentanil), ketamine, and de-dexmedetomidine

[3], [4], [5] and [6]. Among them propofol has become popular in developed countries, because …

[PDF] A Critical Case of Closed Cervix Pyometra in a Bitch

JK Agrawal, A Saxena, P Kumar, A Patel – International Journal of Livestock Research, 2015

… General anethesia was induced and maintained by a combination of ketamine hydrochloride @

5mg/kg and Xylazine @ 0.2mg/kg body weight intravenously following premedication with atropine

sulphate @ 0.04mg/kg body weight. Laparotomy was performed …

Radiofrequency Ablation (RFA)

Treatment of Neuroendocrine Liver Metastases

HA Farley, RF Pommier – Surgical Oncology Clinics of North America, 2015

… Treatment options: radiofrequency ablation. RFA is another technique used to treat

neuroendocrine metastases of the liver, but it has limitations. One can ablate a limited number

of lesions (generally up to 5), of limited size (generally <5 cm in diameter), provided they are …

[PDF] Ablative Techniques in Advanced Pancreatic Cancer: Do They Affect The Quality of Life?–Review

D Dimitrov, H Feradova, D Gincheva, L Dall’Olio – JOP. J Pancreas (Online), 2015

… Such ablative therapies are high-intensity focused ultrasound (HIFU), radiofrequency

ablation (RFA), irreversible electroporation (IRE), iodine-125, iodine-125–cryosurgery,

photodynamic therapy (PDT) and microwave ablation [8]. …

Minimally Invasive Techniques for Resection of Pancreatic Neuroendocrine Tumors

GGF Ranvier, D Shouhed, WB Inabnet – Surgical Oncology Clinics of North America, 2015

Please note that Internet Explorer version 8.x will not be supported as of January 1,

2016. Please refer to this blog post for more information. Close. …

[HTML] Colorectal Liver Metastasis, Primary Gallbladder Carcinoma and Myelofibrosis Present Simultaneously in a Liver Resection Specimen

SA Gray, MH Raber, E Provoost, GJ Toes, JM Klaase – Case Reports in …, 2015

… An elective operation was scheduled, and the surgeon performed a wedge resection of segments

5 and 7 of the liver, and a radiofrequency ablation was used to treat a lesion in segment 3.

Although the suspicion of gallbladder carcinoma at the time of surgery was low, the …

Nontraumatic Cervical Spine for Primary Care Providers

CR Hemmer – The Journal for Nurse Practitioners, 2015

… physical therapy, a home traction unit, transcutaneous electrical nerve stimulation, epidural steroid

injections, selective nerve root blocks (transforaminal injections), botulinum toxin type A injections,

medication management, radiofrequency ablation, and surgical correction. …

Surgical Management of Adrenocortical Carcinoma: An Evidence-Based Approach

J Datta, RE Roses – Surgical Oncology Clinics of North America, 2015

Please note that Internet Explorer version 8.x will not be supported as of January 1,

2016. Please refer to this blog post for more information. Close. …

SYSTEM AND METHOD FOR RECONSTRUCTING CARDIAC SIGNALS ASSOCIATED WITH A COMPLEX RHYTHM DISORDER

S Narayan, R Sehra – US Patent 20,150,289,807, 2015

… For instance, ablation success for atrial tachycardias (a ‘simple’ disorder) may be as low as 70%. …

Thus, ablating the cause of a heart rhythm disorder can be challenging, and even experienced

practitioners may require hours to ablate certain ‘simple’ rhythm disorders …

[HTML] RADIONUCLIDE IMAGING AND THERAPY OF NEUROENDOCRINE TUMOURS

S Navalkissoor, G Gnanasegaran – Journal of Cancer & Allied Specialties, 2015

… These include surgical debulking, chemotherapy, molecular targeted therapies (eg sunitinib

and everolimus), interferon, somatostatin analogues, local therapies (eg radiofrequency ablation

or embolisation) and peptide receptor radionuclide therapy (PRRT). …

[PDF] Successful Radiofrequency Pulmonary Vein Isolation In A Patient With Pneumonectomy

F Kilicaslan, EE Gul, C Erol

… Circumferential radiofrequency ablation of ipsilateral PVs was done (30-35 W, 17

mL/min) with irrigated catheter (Sprinklr, Medtronic, Minneapolis, USA) and both,

entrance and exit blocks were achieved after the ablation. Interestingly …

[PDF] Ablation Is A Treatment Option Without Permanent Pacemaker Implantation For Bradycardia With Persistent Atrial Fibrillation

W Yamada, K Tanimoto, M Yamada, K Inagawa…

… Page 5. Rotational Atriography Of Left Atrium – A Imaging Technique Used To Support Left Atrial

Radiofrequency Ablation: A Comparison Of Anatomical Data Of Left Atrium F. Lehar, Z. Starek,

J. Jez, J. Wolf, T. Kulik, A. Zbankova, M. Novak Department of Cardiology, ICRC/St. …

Complex Regional Pain Syndrome (CRPS/RSD)

[PDF] Do insiders trade on mispricing after earnings announcements?

JP Fidrmuc, J Novák, H Contreras – 2015

Page 1. Do insiders trade on mispricing after earnings announcements? Jana P.

Fidrmuc∗ Warwick Business School Jirı Novák† Charles University Harold Contreras‡

Warwick Business School October 21, 2015 Abstract This …

[PDF] A predictive framework for evaluating models of semantic organization in free recall

NW Morton, SM Polyn – Journal of Memory and Language, 2015

Research in free recall has demonstrated that semantic associations reliably influence the

organization of search through episodic memory. However, the specific.

6-, 7-, OR 8-SUBSTITUTED QUINAZOLINONE DERIVATIVES AND COMPOSITIONS COMPRISING AND METHODS OF USING THE SAME

GW Muller, H Man – US Patent 20,150,291,555, 2015

… Examples of diseases or disorders include, but are not limited to, cancer, disorders associated

with angiogenesis, pain including, but not limited to, Complex Regional Pain Syndrome (“CRPS”),

Macular Degeneration (“MD”) and related syndromes, skin diseases, pulmonary …

[PDF] Psychological distress and stressful life events in pediatric complex regional pain syndrome

MD Hannah Brehmer, MD Boris Zernikow

… Complex regional pain syndrome (CRPS) is increasingly recog- nized as a serious pain

disorder in children and adolescents. … Specifically, it is not known which factors precipitate

CRPS and which result from the ongoing painful disease. …

[PDF] In the High Court of New Zealand Wellington Registry

L SEALES, SAOFL SEALES

… Pain News 11 (1) 2013 pages 30-33. Safarfashandi Z, Munglani R, Safarfashandi L, Sadheura

J, Jenner C “The incidence of complex regional pain syndrome (CRPS) post trauma and the

possible role of tight plaster of Paris in the aetiology of CRPS“. …

[PDF] Assessment Report

CO Onyango, Y Suwa, Y Pinto

… directory ….. 18 – Table 5: List of ASTI publications in Phase II 3 ….. 20 Table 6: Summary of

ex-post impact assessments by CGIAR Centres, CRPs and SPIA ….. 29 …

[PDF] Hereditary Immunity against Infectious Diseases

IA Shabarov, ZI Urmancheeva, SN Rumyantsev…

Page 1. 1 Innovative Immunology | www.austinpublishinggroup.com/ebooks Copyright

© Rumyantsev SN.This book chapter is open access distributed under the Creative

Commons Attribu- tion 4.0 International License, which …

Encyclopedia of Exploration Geophysics

M this Chapter

Page 1. U1-1 Abstract To produce a reliable image of the subsur- face, we must use

a depth-migration scheme that requires a detailed model of the parameter fields for

use by migration. Obtaining reliable values of all parameters …

Fibromyalgia 

[PDF] Does “Multiple Labeling” Benefit or Harm in Fibromyalgia Patients

E Trallero, C Alegre – Fibrom open, 2015

A systematic review showed that there is no evidence an accurate diagnosis of fibromyalgia 

per se could worsen prognosis in patients with this condition [1]. Indeed, it could be useful to 

reduce healthcare utilization by patients. Nevertheless, social and individual long-term …

[PDF] Comparison between Depression Levels of Women with Knee Osteoarthritis, Rheumatoid Arthritis, and Fibromyalgia Syndrome: A Controlled Study

D Karşılaştırılması, BK Çalışma – 2015

DOI: 10.5152/tftrd.2015.87894 Turk J Phys Med Rehab 2015;61:197-202 Türk Fiz Tıp Rehab 

Derg 2015;61:197-202 … Comparison between Depression Levels of Women with … Diz 

Osteoartrit, Romatoid Artrit ve Fibromiyalji Sendromlu Kadınlarda Depresyon …

NOVEL BIPHENYL DERIVATIVE OR PHARMACEUTICALLY ACCEPTABLE SALT THEREOF, AND PHARMACEUTICAL COMPOSITION FOR PREVENTING OR …

CH Lee, K Lee – US Patent 20,150,291,509, 2015

… group consisting of dermatitis, allergy, atopy, conjunctivitis, periodontitis, rhinitis, tympanitis,

pharyngolaryngitis, tonsillitis, pneumonia, gastric ulcer, gastritis, Crohn’s disease, colitis, irritable

colitis, hemorrhoids, gout, ankylosing spondylitis, lupus, fibromyalgia, psoriasis, arthritis …

[PDF] Recent advances in massage therapy–a review

SL LIU, W Qi, H Li, YF WANG, XF YANG, ZM LI, Q Lu… – Eur Rev Med Pharmacol Sci, 2015

… in animal models. In a randomized trial conducted by Ekici et al13, application of

MLD to women with fibromyalgia resulted in improvements regarding pain, health

status, and health-related quality of life. Lancaster and Crow14 …

Immediate Effect of Basic Body Awareness Therapy on Heart Rate Variability

AM Mantovani, CEPT Fregonesi, RMR Lorençoni… – … Therapies in Clinical …, 2015

To determine the immediate effect of a Basic Body Awareness Therapy (BAT) session on

measures of heart rate variability (HRV) in healthy young people.13 healthy.

[PDF] Radial shock wave therapy in the treatment of lateral epicondylitis

JD Rompe, J Decking, C Schoellner, C Theis…

… P009-e Gait analysis: An objective measurement for subgrouping fibromyalgia patients B. Auvinet

a,*, D. Chaleil b, J. Cabane c, A. Dumolard d, P. Hatron e, R. Juvin d, M. Lanteri-minet f, Y. Mainguy

g, L. Negre-pages h, F. Pillard i, D. Riviere i, Y. Maugars j a Clinique, 8, rue des …

2-OXO-2, 3-DIHYDRO-INDOLES FOR THE TREATMENT OF CNS DISORDERS

D Brunner, J Malberg, BG Shankar, S Kolczewski… – US Patent 20,150,284,386, 2015

… Fibromyalgia, which is a syndrome characterized by chronic generalized pain associated with

different somatic symptoms, such as sleep disturbances, fatigue, stiffness, balance problems,

hypersensitivity to physical and psychological environmental stimuli, depression and …

HETEROARYL COMPOUNDS AND METHODS OF USE THEREOF

JE Campbell, P Jones – US Patent 20,150,291,626, 2015

… affective disorder, seasonal affective disorder, obsessive-compulsive disorder, attention deficit

disorder, attention deficit hyperactivity disorder, vertigo, pain, neuropathic pain, sensitization

accompanying neuropathic pain, inflammatory pain, fibromyalgia, migraine, cognitive …

[PDF] How is Qigong Conducive to Women’s Health

FK Cheng – Int J Complement Alt Med, 2015

… Likewise, Tai Chi is beneficial for treating fibromyalgia, achieving better symptomatology,

aerobic capacity, dynamic balance, body strength, and walking distance [112]. Psychological

health: Studies inform the effects of Baduanjin on mental well-being. …

[HTML] Recommendations to the primary care practitioners and the patients for managing pelvic pain, especially in painful bladder syndrome for early and better prognosis

KJ Chung, ANY Han, KH Kim – Journal of Exercise Rehabilitation, 2015

… Scholar]. Nickel JC., Tripp DA., Pontari M., Moldwin R., Mayer R., Carr LK., Doggweiler R., Yang

CC., Mishra N., Nordling J. Interstitial cystitis/painful bladder syndrome and associated medical

conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic …

 

Ketamine May Reduce Chronic Pain in Adolescents

Ketamine May Reduce Chronic Pain in Adolescents

by | Nov 2, 2015 | Uncategorized

Ketamine May Reduce Chronic Pain in Adolescents

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Subanesthetic ketamine infusions are a safe and effective way to relieve chronic pain in adolescents, a new study suggests.

Ketamine, a Schedule III drug, has been used successfully to treat various chronic pain syndromes in adults, according to researchers from Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, in Washington, D.C., who conducted a longitudinal case series to determine the feasibility of ketamine injections in an outpatient setting.

“Our purpose was to look at the clinical outcomes related to our adolescents who were receiving what we considered subanesthetic dosing of ketamine,” said study author Kathy Ann Sheehy, CNS, a nurse specialist at the hospital.

The study included 63 adolescents with chronic pain conditions such as complex regional pain syndrome (CRPS), fibromyalgia and headache, and were treated in the hospital’s tertiary outpatient interdisciplinary Pain Medicine Care Complex from January 2013 to April 2014. The patients received 111 treatments (277 ketamine infusions; maximum dose of 1 mg/kg per hour) during the study period. They were divided into two groups: CRPS (n=23) and all other chronic pain syndromes (n=40). Main outcome measures were self-reported pain scores using a numeric rating scale and morphine-equivalent intake.

The researchers found that ketamine significantly decreased pain scores in 37% of the injections administered. A reduction of 20% or greater was considered significant. Patients with CRPS experienced the greatest reduction compared with the other chronic pain syndromes (P=0.029). The researchers noted that the ketamine infusions did not change the overall morphine-equivalent intake (P=0.3).

“When we looked at the difference between the types of pain syndromes, CRPS was the one that was the most statistically significant as a pain syndrome for reduction in pain scores and reduction in opioid use,” Ms. Sheehy said. “[With] the other pain scores, although overall there was a reduction, we didn’t see a reduction in headaches or other types of complex pain syndromes.”

An analysis of comorbidities showed that:

  • 23% of the patients had psychiatric/psychological disorders (e.g., anxiety, depression, bipolar disorder);
  • 10% had a history of trauma;
  • 10% had postural orthostatic tachycardia syndrome (POTS);
  • 7% had diabetes mellitus;
  • 7% had a malignancy; and
  • 5% had sickle cell disease.

The researchers found that the patients with POTS and trauma experienced the greatest pain reduction and chronic headache patients had the smallest decrease. “Our assumption for that is that both of those are autonomic sympathetic conditions, and most of our CRPS kids actually had trauma,” Ms. Sheehy said.

No adverse events were reported and the ketamine injections were well tolerated, according to the study authors. They said more research on complex pain syndromes, especially CRPS in adolescents, is needed.

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