by admin | Apr 13, 2015 | Uncategorized
Ketamine has long been used as an anesthetic in both adults and children for more than 50 years. Although it is still used for anesthesia and also off-label for the treatment of many pain and psychiatric disorders, concerns of possibly deleterious neurocognitive effects have lingered. This is due to sparse reports of children that have experienced neurocognitive delays following multiple surgeries using a ketamine and other anesthetics. Since these occurrences were not associated with any primary endpoints in a clinical study setting, the cognitive delays could not be attributed to ketamine but it did raise the question.
A recent clinical study was conducted by researchers at the University of Rochester (Rochester, New York) and published in the Journal of Palliative Care & Medicine. These investigators designed a clinical trial to monitor neurocognitive function and pain levels in pediatric patients with chronic pain. Patients enrolled in the trial completed 2 weeks of daily oral ketamine exposure. Neurocognitive assessments were conducted at baseline and at weeks 2 and 14. Further, pain levels were assessed using the Numerical Rating Scale.
The researchers found no deleterious effects on neurocognitive function in the children at any time point during the study or for 3 months following completion of the study. In fact, they found that executive function scores improved in children following oral administration of ketamine. These findings support the safe use of ketamine in pediatric patients with chronic pain that is refractory to more conventional medications, such as opioid medicines.
Dr. Hanna’s clinical team at the Florida Spine Institute has used intravenous ketamine therapy to treat pediatric cases of chronic regional pain syndrome with great success. To learn more about intravenous ketamine infusions, click here. To find out if ketamine therapy is right for you, please make an appointment by contacting Dr. Hanna.
For full article, visit the Journal of Palliative Care & Medicine.
Citation: Bredlau AL, Harel BT, McDermott MP, Dworkin RH, Korones DN, et al. (2015) Neurocognitive Changes after Sustained Ketamine Administration in Children with Chronic Pain. J Palliat Care Med 5: 215. doi:10.4172/2165-7386.1000215
by admin | Jan 8, 2015 | Uncategorized
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:
• Lidocaine
• Ketamine
• Immunoglobulin (IG)
• Clonidine
• Dexmedetomidine
• Bisphosphonates
• Magnesium
These medications are typically mixed with saline in an IV bag and slowly infused accordingly based on the medication and/or protocol being utilized.
Procedure Overview
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.
Medication Overview
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.
by admin | Dec 12, 2014 | Uncategorized
Migraine Headaches
Do you need to see a Florida Headache Treatment Specialist?
A wide range of factors can cause headaches and the pain felt with one type of headache can be unique from the pain felt with another type of headache. Some headaches are caused by tension, such as after a long day at the office. Other headaches may be caused by pressure on the spine or other factors caused by an accident or injury. Still other headaches may be associated with recurring migraines that you experience. Dr. Hanna is a headache treatment specialist at the Florida Spine Institute and may provide you with a source of relief from the headache pain that you are feeling today.
We know headaches and how to treat them
When you meet with Dr. Hanna, you will be able to learn more about the many treatment options that have been used with great results to minimize pain or to provide complete relief for the pain that you are feeling. Some headaches can be so intense that they can cause other severe symptoms, such as nausea and vomiting. Others may prevent you from being able to get out of bed and function normally until the pain subsides. Through effective treatment for the pain, you may be able to alleviate your pain now with great results. In some cases, certain headache treatment options can be used to treat an underlying condition that is causing the pain, and this can remove the pain entirely.
Contact the Florida Spine Institute today
If you have been dealing with recurring or regular headaches and your headaches are causing interruption in your life, now is the ideal time to contact Dr. Hanna at the Florida Spine Institute. Our goal is to help each of our valued patients explore their options for pain intervention through injections in greater detail during an initial consultation. An effective treatment plan will be designed and implemented patient-by-patient by our team of specialists. Living with regular or recurring pain can be debilitating, but we strive to provide you with the best results possible. Contact our office now to learn more about the steps that we can take to alleviate the pain that you are feeling.
