by admin | Jun 24, 2015 | Uncategorized
What’s Causing Your Headache?
When your head is pounding, you just want to make it stop. But knowing what kind of headache you have is the first step to feeling better fast. Here’s how to find relief…
The kids need to be picked up from soccer practice, dinner has to be made and laundry is piling up. But when you’re hit with a headache, getting through routine tasks is a challenge. Headache specialists and neurologists generally categorize headaches into 5 types: tension headaches, migraines, cluster headaches, chronic daily headaches and hormonal headaches. Some people get only one kind; others are prone to different types at various times (but not at the same time). While each has its own triggers and symptoms, they’re often mistaken for one another. And that might prolong your pain. For intense and chronic headaches, see your doctor. Besides making a diagnosis and prescribing treatment, your doctor can make sure your symptoms aren’t caused by a more serious disorder, such as a brain tumor, aneurysm or meningitis. Determining the kind of headache you have is critical to proper treatment, says Susan Hutchinson, M.D., director of the Orange County Migraine & Headache Center in Irvine, Calif., and author of The Woman’s Guide to Managing Migraine (Oxford University Press).
Headache Types
1. Tension headache
This is the most common type of headache – the kind you notice on a Monday morning or during a traffic jam when you’re running late.
Some describe it as a tight band around the head. It usually targets the area a baseball cap would cover, like the forehead, temples, top of the head and, sometimes, the eyes.
While frustrating, “a tension-type headache typically doesn’t interfere your ability to carry out activities,” says Sheena Aurora, M.D., clinical associate professor of Neurology and Neurological Sciences at Stanford University School of Medicine, where she is part of the Headache Clinic.
Common causes: Environmental triggers, such as eyestrain from poor lighting and bad posture. Certain emotions – particularly grief, stress, depression and anxiety – can also bring on or worsen them.
Best treatments: This type of headache responds well to over-the-counter treatments such as ibuprofen (Advil), naproxen (Aleve), acetaminophen (Tylenol) and Excedrin, a caffeine-acetaminophen-aspirin combo.
2. Migraine
Migraines are commonly misdiagnosed as tension headaches, Dr. Hutchinson says. (Here are 10 other migraine myths debunked.)
Actually, a migraine is a vascular headache, meaning pain is caused by inflamed and swollen blood vessels in the brain.
Migraine pain throbs or pulsates and is often felt more strongly on one side of the head. Plus, it can cause vomiting, nausea, and sensitivity to light, noise and smells.
Nearly 36 million Americans – 12% of the population – suffer from migraines, according to the American Migraine Federation (AMF). And three times as many women have them as men.
Because migraines are debilitating, they cost the U.S. $20 billion each year in medical expenses and lost productivity, the AMF estimates.
Some sufferers (about 10%-15%) have pre-migraine symptoms, called an aura, says Dr. Hutchinson. This can make you see flashing lights or zigzag lines, or cause a loss of vision. It may make one side of your body tingle or slur your speech.
The aura generally lasts less than an hour, Dr. Hutchinson says. And then the headache hits.
Common causes: Notable triggers include certain foods (including chocolate and aged cheeses), changes in weather and barometric pressure, skipped meals, too much or too little caffeine, alcohol, lack of sleep, stress and hormonal changes.
Family history also increases your likelihood of migraines.
Best treatments: Because of their severe symptoms, migraines respond better to prescription medications than over-the-counter pills.
Botox Injections have been shown to treat migraine headaches very effectively.
A class of drugs called triptans (Imitrex, Zomig and Treximet) is most effective because they’re vasoconstrictors, meaning they help inflamed blood vessels shrink to their normal size.
Lifestyle modifications, such as regular exercise and avoiding trigger foods, can also reduce frequency and duration.
Could these surprising triggers be causing your headache?
If you get auras before your migraines, you may be able to head off the pain before it strikes. Dr. Hutchinson suggests either a triptan or non-steroidal anti-inflammatory drug (NSAID) as preventative measures.
3. Cluster headaches
Considered the most painful of all headaches, cluster headaches are also referred to as “suicide headaches” because the intense pain can drive sufferers to consider killing themselves.
Attacks occur suddenly and repeatedly over one or several days, usually at night, according to the Mayo Clinic. They typically last about 30-45 minutes.
When a cluster headache strikes, people often bang their head against a wall for relief, pace and complain of a piercing pain behind one eye. That eye may also produce tears, and the eyelid on the affected side might droop.
As the name implies, this kind of headache tends to “cluster” together for weeks or months, says Dr. Hutchinson.
Fortunately, it can also go away for months or years.
Other good news: It’s also relatively rare.
Less than 1% of the population is afflicted, and twice as many men than women, according to the American Headache Society.
Common causes: The cause for cluster headaches is unknown, according to the Mayo Clinic, but abnormalities of the hypothalamus may be involved.
Common triggers include alcohol, cigarette smoking, high altitudes, bright light, heat, and certain medications such as nitroglycerin, according to the National Institutes of Health.
Best treatments: Pure oxygen delivered through an oxygen mask is one of the most effective, quickest remedies, says the Mayo Clinic.
Traditional migraine drugs, such as Imitrex, also help. So might these alternative migraine treatments.
But because of intense pain, doctors often recommend injections – the fastest way to administer the medication – rather than pills.
4. Chronic daily headaches
This headache category can include the other kinds (migraine, tension or cluster), says headache specialist Frederick G. Freitag, D.O., associate professor at the Medical College of Wisconsin.
The difference is in its frequency. Chronic headaches strike 15 or more days a month for at least three months, according to the Mayo Clinic.
That means you have a headache more days than you are pain-free.
About 5% of the population get chronic headaches, also known as chronic daily migraine, rebound headaches and transformed migraines.
The syndrome typically starts with sporadic headaches over a long period of time. These are manageable and respond to over-the-counter medications. Then they become more frequent, causing sufferers to pop pain relievers more often than the drug’s packaging recommends.
These painkillers, however, actually make the pain more severe and frequent. That’s why they’re also known as medication-overuse headaches.
What’s too much? If you take pills for a headache more than twice a week, you’re overusing the medication, according to the National Headache Foundation.
Common causes: Most don’t have an identifiable cause, according to the Mayo Clinic.
Best treatments: Since over-the-counter treatments can make the problem worse, you’ll need to see a doctor for prescription medicine relief.
Preventive medications include beta blockers – originally used to treat heart conditions – such as propranalol (Inderal); anti-seizure medications, such as topiramate (Topamax) and valproic acid (Depakote); and tricyclic antidepressants, including nortriptyline (Pamelor) and Amitriptyline (Elavil), says the Mayo Clinic.
Botulinum toxin (Botox) injections may also provide relief.
But lifestyle changes, such as exercise, relaxation, meditation, stress-management, and getting 6-8 hours of uninterrupted sleep a night, can also help, according to the National Institutes of Health.
More tricks to keep pain away: Try changing your pillow or sleeping position, and practice good posture.
5. Hormonal Headaches
Estrogen fluctuations – up or down – are at the root of these headaches, also known as menstrual migraines or period headaches (because the levels of this hormone fluctuate and dip during those days in your cycle).
Not surprisingly, women usually start getting them during puberty, when a woman’s estrogen production goes up.
The good news: Another major hormonal shift – like pregnancy, perimenopause or menopause – can make you less susceptible.
Pregnancy, for example, makes estrogen levels rise, get very high and then stay fairly constant, says Dr. Hutchinson.
“For many women, migraines go away or get much better during pregnancy.”
Common treatments: Birth control pills can even out estrogen fluctuations throughout your cycle.
“For example, if birth control pills are given continuously and the woman only [stops taking them] every three months, her menstrual migraines may improve,” Dr. Hutchinson says.
This treatment is tricky, however, since estrogen can sometimes makes headaches worse.
Magnesium may also bring relief. According to Dr. Hutchinson, the ideal oral dose appears to be 400 mg daily, often taken as 200 mg twice a day.
By Mary Gustafson
by admin | Jun 22, 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 and Phencyclidine: the good, the bad and the unexpected
D Lodge, MS Mercier – British Journal of Pharmacology, 2015
ABSTRACT: The history of ketamine and phencyclidine from their development as potential
clinical anaesthetics, through drugs of abuse and animal models of schizophrenia to
potential rapidly acting antidepressants is reviewed. The discovery in 1983 of the NMDA …
Intra‐and postoperative low‐dose ketamine for adolescent idiopathic scoliosis surgery: a randomized controlled trial
R Minoshima, S Kosugi, D Nishimura, N Ihara, H Seki… – Acta Anaesthesiologica …, 2015
Background In this randomized controlled trial, we examined whether intra-and
postoperative infusion of low-dose ketamine decreased postoperative morphine
requirement and morphine-related adverse effects as nausea and vomiting after scoliosis …
Period Prevalence of Ketamine-Propofol Admixture “Ketofol” in the Operating Room among Anesthesia Providers at an Academic Medical Center
AN Olson, WR Rao, ME Marienau, NJ Smischney – Medical Science Monitor, 2015
BACKGROUND: The primary aim of this study was to determine the period prevalence of the
single-syringe ketamine-propofol admixture used for sedation and induction among
anesthesia providers during a 5-year period before and after educational sessions …
Electrochemiluminescence immunosensor for ketamine detection based on polyamidoamine-coated carbon dot film
Q Li, W Tang, Y Wang, J Di, J Yang, Y Wu – Journal of Solid State Electrochemistry, 2015
Abstract In this work, we reported the synthesis of water-soluble carbon dots (CDs) by a one-
step hydrothermal synthetic route using polyamidoamine (PAMAM) as platform and
passivant, where the formation of CDs capped with PAMAM and the surface passivation …
Letter to the editor: When what you see might not be what you get: prudent considerations of anesthetics for murine echocardiography
J Wu, J You, S Wang, Y Ye, X Wang, J Jia, Y Zou – American Journal of Physiology- …, 2015
… In their well- designed experiments, the authors compared four popular an- esthetic regimens
(ketamine-xylazine, ketamine alone, avertin, and isoflurane) used in mice during
echocardiographic mea- surement, with conscious state as a reference. …
Ketamine promotes inflammation through increasing TLR4 expression in RAW264. 7 cells
C Meng, Z Liu, G Liu, L Fu, M Zhang, Z Zhang, H Xia… – Journal of Huazhong …, 2015
Summery Ketamine (KTM), a N-methyl-D-aspartate (NMDA) receptor antagonist, was found
to has an anti-inflammatory effect, but some patients suffered from exacerbated pro-
inflammatory reactions after anesthesia with KTM. The present study was aimed to …
The effect of NMDA receptor antagonists and antidepressants on resting state in major depressive disorder
A Dutta – 2015
fMRI ; major depressive disorder ; resting state ; antidepressant ; lanicemine ; ketamine ; citalopram
; anterior cingulate cortex ; NMDA ; glutamate. … Ketamine and other NMDA antagonists have
improved MDD symptoms within 24 hours though the effects are short lasting. …
Assessing Measures of Suicidal Ideation in Clinical Trials with a Rapid-Acting Antidepressant
ED Ballard, DA Luckenbaugh, EM Richards, TL Walls… – Journal of Psychiatric …, 2015
… Received 22 April 2015, Revised 21 May 2015, Accepted 5 June 2015, Available online 16 June
2015. Highlights. • Clinical trials of ketamine and suicide will require appropriate measurement. •
We compared several suicide assessment measures in ketamine clinical trials. • …
d-Cycloserine
AR Durrant, U Heresco-Levy – Encyclopedia of Psychopharmacology, 2015
… of this concept became evident during the last decade when robust antidepressant effects
emerging within 2–4 h and lasting up to more than 2 weeks were obtained and replicated fol-
lowing intravenous administration of single sub-anesthetic doses of ketamine (Krystal et al. …
Depression: Response and Remission
SD Østergaard, GI Papakostas, M Fava – Encyclopedia of Psychopharmacology, 2015
… of this concept became evident during the last decade when robust antidepressant effects
emerging within 2–4 h and lasting up to more than 2 weeks were obtained and replicated fol-
lowing intravenous administration of single sub-anesthetic doses of ketamine (Krystal et al. …
Is pre-emptive administration of ketamine a significant adjunction to intravenous morphine analgesia for controlling postoperative pain? A randomized, double-blind, …
A Fiorelli, A Mazzella, B Passavanti, P Sansone… – … and Thoracic Surgery, 2015
OBJECTIVES To evaluate if the pre-emptive administration of ketamine would potentiate the
effect of intravenous morphine analgesia in the management of post-thoracotomy pain.
METHODS This was a unicentre, double-blind, placebo-controlled, parallel-group, …
Kappa-Opioid Agonists
E Opioid – 2015
… It is considered a precancerous condition. Ketamine … Synonyms Ketalar; Ketaset Definition
Ketamine is an FDA-approved medication for induction and maintenance of anesthesia
in adults. It is a phencyclidine derivative first synthetized in 1962. …
Investigation of the effects of stress on some liver enzymes (AST, ALT, ALP) in rats.
YG Gencer, A Çınar, B Comba – Atatürk Üniversitesi Veteriner Bilimleri Dergisi, 2015
… was applied intraperitoneally (ip) to the experimental group. After 3 h, blood samples
were collected from both groups under ketamine anaesthesia, using appropriate
techniques. The control group serum AST, ALT, ALP values …
Back to the Future: Are Tumor-Targeting Bacteria the Next-Generation Cancer Therapy?
RM Hoffman – Gene Therapy of Solid Cancers, 2015
… 7. Anesthetic reagents (ketamine, xylazine, acepromazine maleate). 8. Kanamycin. 9. Nair. 10. …
1. Four-week-old female mice were anesthetized by a ketamine mixture (10 μl ketamine HCL,
7.6 μl xylazine, 2.4 μl acepromazine maleate, and 10 μl H 2 O) via sc injection. …
[PDF] The Protective Effect of Melatonin vs. Vitamin E in the Ischemic/Reperfused Skeletal Muscle in the Adult Male Rat Model
EA Mohamed – J Cytol Histol S, 2015
… All surgical procedures were performed under anesthesia with IP injection of
Ketamine hydrochloride (Ketame, Egyptian Int. Co. … After 2 hours of reperfusion, the
rats were sacrificed by Ketamine hydrochloride (100 mg/kg) [10]. …
[PDF] CORM2 protects from myocardial ischemia reperfusion injury via modulation of the inflammatory response and apoptosis
NR Hadi, FG Al-Amran, KA Muhsin, A Taher – Journal of Advanced Pharmacy …, 2015
… 2% vials (RompunTM, Bayer AG, Leverkusen, Germany), ketamine (Hikma, Jordan), ethanol
(Fluka, Switzerland) and normal saline (KSA). Rat (IL-1β), (IL- … Surgical LAD ligation The rats were
anesthetized by intraperitoneal injection with a mixture of ketamine and xylazine in a …
[HTML] Long-term correlation of the electrocorticogram as a bioindicator of brain exposure to ionizing radiation
LAA Aguiar, IMS Silva, TS Fernandes, RA Nogueira – Brazilian Journal of Medical and …, 2015
… The irradiation was carried out with the animals anesthetized with 10 mg/kg xylazine and 75
mg/kg ketamine administered intraperitoneally. … To record the ECoG, animals were anesthetized
with 10 mg/kg xylazine and 75 mg/kg ketamine administered intraperitoneally. …
[HTML] The Anti-Tumor Effects of Adipose Tissue Mesenchymal Stem Cell Transduced with HSV-Tk Gene on U-87-Driven Brain Tumor
SM de Melo, S Bittencourt, EG Ferrazoli, CS da Silva… – PLOS ONE, 2015
… The animals were anesthetized via the ip injection of a ketamine (100 mg/kg) and xylazine
(10 mg/kg) solution (Syntec, 1356009 and 1720407) and fastened to a stereotaxic
instrument (David Kopf) equipped with a mouse adapter (Enlaup). …
[HTML] Intrarectal Lidocaine-Diltiazem-Meperidine Gel for Transrectal Ultrasound Guided Prostate Biopsy
F Imani, Y Moghaddam, RS Moharari, F Etezadi… – Anesthesiology and Pain …, 2015
… 4, 6) or bupivacaine as a single agent (7). These latter studies have suggested that rectal
administration of lidocaine gel is a safe, simple modality, without any discomfort for patients (8).
Not only local anesthetic agents but also intravenous anesthetic drugs (ketamine) (9) or …
[PDF] Alcohol Withdrawal Syndrome: Improving Outcomes Through Early Identification And Aggressive Treatment Strategies
AF Pizon – 2015
Page 1. June 2015 Volume 17, Number 6 Authors Joseph H. Yanta, MD Medical
Toxicology Fellow, Division of Medical Toxicology, Dept. of Emer- gency Medicine,
University of Pittsburgh Medical Center, Pittsburgh, PA Greg …
Radiofrequency Ablation (RFA)
Use of Contact Force Sensing Technology During Radiofrequency Ablation Reduces Recurrence of Atrial Fibrillation: A Systematic Review and Meta-Analysis
MR Afzal, J Chatta, A Samanta, S Waheed… – Heart Rhythm, 2015
ScienceDirect is phasing out support for older versions of Internet Explorer on Jan 12, 2016.
For the best product experience, we recommend you upgrade to a newer version of IE or
use a different browser: Firefox or Chrome. For additional information please see the …
Comparison of Surgical Resection and Radiofrequency Ablation for Hepatocellular Carcinoma: Take Care Not to Neglect Radiofrequency Technic and Device.
A Hocquelet, M Montaudon, P Balageas, N Frulio… – Annals of Surgery, 2015
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining
your privacy and will not share your personal information without your express consent. For more
information, please refer to our Privacy Policy. … Skip Navigation Links Home > …
Effect of different ablation settings on acute complications using the novel irrigated multipolar radiofrequency ablation catheter (nMARQ)
T Deneke, P Müller, P Halbfaß, A Szöllösi, M Roos… – Journal of Cardiovascular …, 2015
Background: Single-shot ablation devices for pulmonary vein isolation (PVI) in patients with
symptomatic atrial fibrillation (AF) have been increasingly used in clinical practice. Objective:
A novel mapping-system integrated irrigated multipolar circular ablation catheter (nMARQ) …
Long-Term Effects of Ganglionated Plexi Ablation on Electrophysiological Characteristics and Neuron Remodeling in Target Atrial Tissues in a Canine Model
X Wang, M Zhang, Y Zhang, X Xie, W Wang, Z Li… – Circulation: Arrhythmia and …, 2015
… Long-Term Effects of Ganglionated Plexi Ablation on Electrophysiological Characteristics and
Neuron Remodeling in Target Atrial Tissues in a Canine Model. … Atrial electrophysiological
characteristics were examined before ablation, immediately and continuously after ablation. …
… to Letter From Bisbal et al Regarding,“Repeat Left Atrial Catheter Ablation: Cardiac Magnetic Resonance Prediction of Endocardial Voltage and Gaps in Ablation …
JL Harrison, C Sohns, NW Linton, R Karim, SE Williams… – Circulation: Arrhythmia and …, 2015
… Tolosana JM,; Arbelo E,; de Caralt TM,; Perea RJ,; Brugada J,; Mont L. CMR-guided
approach to localize and ablate gaps in repeat AF ablation procedure. JACC Cardiovasc
Imaging . 2014;7:653–663. doi: 10.1016/j.jcmg.2014.01.014. …
Pulmonary vein stenosis after pulmonary vein isolation using duty-cycled unipolar/bipolar radiofrequency ablation guided by intracardiac echocardiography
S Asbach, F Schluermann, L Trolese, M Langer… – Journal of Interventional …, 2015
Purpose Concerning rates of pulmonary vein (PV) stenosis were reported following PV
isolation (PVI) with a circular pulmonary vein ablation catheter (PVAC). As this may depend
on intraprocedural imaging, we evaluated the incidence of PV stenosis in patients …
Atrioventricular Block During Slow Pathway Ablation Entirely Preventable?
H Chen, M Shehata, W Ma, J Xu, J Cao, E Cingolani… – Circulation: Arrhythmia and …, 2015
… In a small percentage of cases of AVNRT, it may be necessary to ablate within the CS
with larger atrial potentials, however, ablation at the roof of the proximal CS carries
a high risk of AV nodal block during radiofrequency application. …
Is There Still a Role for CFAE Ablation in Addition to Pulmonary Vein Isolation in Patients with Paroxysmal and Persistent Atrial Fibrillation? A Meta-Analysis of 1,415 …
R Providência, PD Lambiase, N Srinivasan, GG Babu… – Circulation: Arrhythmia and …, 2015
… Is There Still a Role for CFAE Ablation in Addition to Pulmonary Vein Isolation in Patients with
Paroxysmal and Persistent Atrial Fibrillation? … We aimed to assess the impact of CFAE ablation
in addition to pulmonary vein isolation (PVI) in patients undergoing ablation for AF. …
Real-Time Contact Force Measurement A Key Parameter for Controlling Lesion Creation With Radiofrequency Energy
DC Shah, M Namdar – Circulation: Arrhythmia and Electrophysiology, 2015
… Low CF values are also advisable in the vicinity of already ablated sites, where the … for the
acquisition of reliable mapping information and achievement of stable ablation lesions … 183 gs)
as area under curve (red hatched zone) during short duration of radiofrequency (RF) energy …
Atrioventricular Nodal Block With Atrioventricular Nodal Reentrant Tachycardia Ablation
SJ Asirvatham, WG Stevenson – Circulation: Arrhythmia and Electrophysiology, 2015
… a relatively slow stable, junctional rhythm with consistent stable retrograde atrial conduction during
radiofrequency application. … of energy delivery, junctional rhythm may not be seen despite adequate
slow pathway ablation, and the operator may be inclined to ablate at more …
[HTML] Near-infrared spectroscopy integrated catheter for characterization of myocardial tissues: preliminary demonstrations to radiofrequency ablation therapy for atrial …
RP Singh-Moon, CC Marboe, CP Hendon – Biomedical Optics Express, 2015
Abstract Effects of radiofrequency ablation (RFA) treatment of atrial fibrillation can be limited
by the ability to characterize the tissue in contact. Parameters obtained by conventional
catheters, such as impedance and temperature can be insufficient in providing …
A Phase 2, Open-Label, Randomized Study of Pexa-Vec (JX-594) Administered by Intratumoral Injection in Patients with Unresectable Primary Hepatocellular …
CJ Breitbach, A Moon, J Burke, TH Hwang, DH Kirn – Gene Therapy of Solid Cancers, 2015
… Download Protocol (725 KB). Abstract. Primary liver cancer (hepatocellular carcinoma; HCC)
in patients not eligible for surgery or transplant is currently treated by locoregional therapeutic
approaches, including trans-arterial chemoembolization and radiofrequency ablation. …
[PDF] Feasibility and efficacy of helical tomotherapy in cirrhotic patients with unresectable hepatocellular carcinoma
CM Huang, MY Huang, JY Tang, SC Chen, LY Wang… – World Journal of Surgical …, 2015
… Several other treatment modalities for patients with unresectable HCC, including percutaneous
ethanol injection (PEI), radiofrequency ablation (RFA), and transcatheter arterial
chemoembolization (TACE), seem to be more effective in smaller tumors and are contraindicated …
The Wolf-Parkinson-White ECG Pattern-Assessing the Mortality Risk
E Posan – Journal of Insurance Medicine, 2015
… 32. MANAGEMENT. Radiofrequency Ablation Therapy … With pacing maneuvers, the accessory
pathway properties are defined, potential tachycardias are induced, accurate mapping (localization)
of the accessory pathway is achieved and radiofrequency ablation is employed. …
[HTML] Congenital (in growing) osteoma skull in 20-day-old neonate
PG Devi, TS Venkatachalam, YV Sharma, MP Kumar – CHRISMED Journal of …, 2015
… 6. 7. Virayavanich W, Singh R, O’Donnell RJ, Horvai AE, Goldsby RE, Link TM. Osteoid osteoma
of the femur in a 7-month-old infant treated with radiofrequency ablation. Skeletal Radiol
2010;39:1145-9. Back to cited text no. 7. 8. McHugh JB, Mukherji SK, Lucas DR. …
[PDF] Simulating and Optimizing the Response of a Sine Wave Finite state Machine with Timestamp Simulation Using Simulink
M Kalpna, MA Varma – International Journal of Research, 2015
… [5.] Dagmara M. Dołęga, Jerzy Barglik, (2012) “Computer modeling and simulation of
radiofrequency thermal ablation“, COMPEL – The international journal for computation and
mathematics in electrical and electronic engineering, Vol. 31 Iss: 4, pp.1087 – 1095 …
[PDF] Coexistence of permanent junctional reciprocating tachycardia with rheumatic valvular disease; a case sucessfully treated with radiofrequency ablation
M Aydın, A Yıldız, M Yüksel, Y İslamoğlu
Abstract A seventeen years old female had presented with palpitation. On the
electrocardiography (ECG), long RP, narrow QRS tachycardia, inverted P waves in leads
D2, D3 and aVF were noticed. On transthoracic echocardiography, rheumatic mitral …
[PDF] Macrophage Inflammatory Protein Derivative ECI301
T Radiotherapy
… inhibition by ECI301 was not attributable to radiation alone but also shown to other factors such
as the heat generated from high-frequency alter- nating current, namely radiofrequency ablation
(RFA; ref. … 5B), significant differences were ablated by the anti- HMGB1 antibody. …
[PDF] Regenerative Injection Treatment in the Spine: Review and Case Series with Platelet Rich Plasma. J Stem Cells Res
D Aufiero, H Vincent, S Sampson, M Bodor – Rev & Rep, 2015
… back or neck pain refractory to physical therapy, trigger point injections, medial branch blocks,
or radio- frequency ablation. … There is scarce evidence supporting less commonly performed
non-surgical treatments for lumbar radiculopathy including pulsed radiofrequency to the …
[HTML] Modern medicine-morcellation
SC Olmstead
… abandoned as a surgical procedure? What about noninvasive treatment options that
leave the presumed fibroid inside the body, such as uterine artery embolization,
MRI-guided focused ultrasound, and radiofrequency ablation? …
Chronic Regional Pain Syndrome (CRPS/RSD)
What outcome measures are commonly used for Complex Regional Pain Syndrome clinical trials? A systematic review of the literature
S Grieve, L Jones, N Walsh, C McCabe – European Journal of Pain, 2015
… Background and objective. Complex Regional Pain Syndrome (CRPS) is a chronic pain condition,
often triggered by trauma to a limb and characterized by sensory, motor, autonomic and trophic
changes within the affected limb. … 2.4 Classification of CRPS clinical trials. …
[PDF] MIRROR THERAPY: A REVIEW OF EVIDENCES
A Najiha, J Alagesan, VJ Rathod, P Paranthaman – Int J Physiother Res, 2015
… Three particular conditions that have been studied the most are stroke, CRPS and phantom
limb pain. … MT was used in conditions like stroke, cerebral palsy (CP), complex regional pain
syndrome (CRPS), phantom limb pain (PL) and fracture rehabilitation. …
Physical Therapy Treatment for Patients Diagnosed with Complex Regional Pain Syndrome
J Connole – 2015
… Abstract. This case study and evidence-based research analyzes the effects of physical
therapy interventions on a patient diagnosed with type 1 complex regional pain
syndrome (CRPS) to determine the most beneficial treatments. …
Hybrid short-term freeway speed prediction methods based on periodic analysis
Y Zou, X Hua, Y Zhang, Y Wang – Canadian Journal of Civil Engineering, 2015
Page 1. Hybrid short-term freeway speed prediction methods based on periodic
analysis By Yajie Zou, Ph.D. Research associate 133B More Hall, Box 352700
Department of Civil and Environmental Engineering University of …
[HTML] Japanese MD Develops Nutritional Protocols for Gardasil/Cervarix HPV Vaccine Injury
LC Botha – 2015
… subacute sclerosing panencephalitis; CRPS: Complex regional pain syndrome; POTS:
Postural orthostatic tachycardia syndrome; Anti-phospholipid antibody syndrome;
SLE: systemic lupus erythematosus; Rheumatoid arthritis; …
The social behavior of children adopted from Russian Federation: a controlled study
C Caprin, L Ballarin, L Benedan, A Castelli – Psicologia clinica dello sviluppo, 2015
… Nonostante nella ricerca si sia utilizzata la forma estesa per genitori dello strumento
(CRPS-R:L; Conners, validazione Italiana a cura di Nobile, Alberti e Zuddas, 2007), composta
da 80 item (valori di a com- presi fra 0.57 e 0.91 per i maschi e 0.58 e 0.89 per le femmine), in …
A Review of the Use of Stellate Ganglion Block in the Treatment of PTSD
E Lipov, EC Ritchie – Current Psychiatry Reports, 2015
… 14. Lipov EG, Joshi JR, et al. A unifying theory linking the prolonged efficacy of the stellate
ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes,
and posttraumatic stress disorder (PTSD). Med Hypotheses. …
Addiction Recovery in Services and Policy: An International Overview
A Laudet, D Best – Textbook of Addiction Treatment: International …, 2015
… model is growing in popularity nationwide: in the past decade, growing concerns about substance
use on campus and federal agencies’ focus on building a community-based continuum of care
system for youths have fueled a fivefold increase in the number of CRPs, from four …
[HTML] Related Products
R Frank
… 43. Canalith Repositioning Procedures. The recommended treatment for BPPV is a canalith
repositioning procedure (CRP). There are several CRPs described in the literature; the most
studied and used in the United States was first described by Epley in 1992. …
Central habituation and distraction alter C‐fibre‐mediated laser‐evoked potential amplitudes
P Hüllemann, YQ Shao, G Manthey, A Binder, R Baron – European Journal of Pain, 2015
Skip to Main Content. Wiley Online Library. Log in / Register. Log In E-Mail
Address Password Forgotten Password? Remember Me. …
Nuclear Medicine Imaging of Sport Injuries of the Wrist, Hand and Fingers
M Sathekge, FE Suleman, MD Velleman, R Clauss – Nuclear Medicine and …, 2015
… Abductor pollicis longus. CRPS: Chronic regional pain syndrome. … 1997 ). 24.7 Complex Regional
Pain Syndrome (Reflex Sympathetic Dystrophy, Sudeck’s Dystrophy). Complex regional pain
syndrome (CRPS) is one of the most challenging chronic pain conditions of the limbs. …
The Child with a Painful Limp
J Robb – Paediatric Orthopaedic Diagnosis, 2015
… There may be symptoms of psychological distress and further specialist evaluation may
reveal an underlying cause. Complex Regional Pain Syndrome (CRPS). Children with
CRPS type 1 affecting the lower limb often limp (Wilder et al. 1992 ). …
Complex regional pain syndrome type I. An analysis of 7 cases in children
VP Stalla, CM Olaso, VK Almada, GG Rabelino – Neurología (English Edition), 2015
Complex regional pain syndrome (CRPS) is characterised by the presence of pain accompanied
by sensory, autonomic and motor symptoms, usually preceded by a lesio. …
Vitamin C, Extremity Trauma and Surgery
N Shibuya, MR Agarwal, DC Jupiter – 2015
… 987 Abstract Complex regional pain syndrome (CRPS) is a devastating condition often seen
after extrem- ity injury and surgery. … Efficacy and safety of vitamin C used to prevent CRPS are
discussed. List of Abbreviations CRPS Complex regional pain syndrome Introduction …
Psychological Factors as Outcome Predictors for Spinal Cord Stimulation
T Bendinger, N Plunkett, D Poole, D Turnbull – Neuromodulation: Technology at the …, 2015
… SCS trials were offered for the following indications: failed back surgery syndrome (FBSS),
refractory radiculopathy or peripheral neuropathy, complex regional pain syndrome (CRPS),
and refractory angina (at the beginning of observed period—since 2008, this indication is not …
[PDF] The Role of Transitional Justice and Access to Justice in Conflict Resolution and Democratic Advancement
MF Moscati – 2015
… year mandate. The Community Reconciliation Processes (CRPs) of Timor-Leste were created
with the specific aim of dealing with disputes between … perpetrators into their communities. The
possibility of recourse to CRPs was established by the United Nations Transitional …
Complex Regional Pain Syndrome in Children: a Multidisciplinary Approach and Invasive Techniques for the Management of Nonresponders
MJ Rodriguez‐Lopez, M Fernandez‐Baena, A Barroso… – Pain Practice, 2015
… Complex regional pain syndrome (CRPS) is multifactorial condition with complex
pathogenesis characterized by spontaneous or stimulus-induced pain that is
disproportionate to the inciting event. It is also commonly accompanied …
Analgesic response to intravenous ketamine is linked to a circulating microRNA signature in female complex regional pain syndrome patients
SR Douglas, BB Shenoda, RA Qureshi, A Sacan… – The Journal of Pain, 2015
Although ketamine is beneficial in treating complex regional pain syndrome (CRPS), a subset
of patients respond poorly to therapy. We investigated treatment-ind. … Highlights. • We studied
ketamine treatment induced miRNA alterations in blood from CRPS patients. • …
Peptide signalling during the pollen tube journey and double fertilization
LJ Qu, L Li, Z Lan, T Dresselhaus – Journal of Experimental Botany, 2015
… In general, plant peptides can be categorized into two classes: secreted peptides and
non-secreted peptides. Secreted peptides can be further divided into two major classes:
cysteine-rich peptides (CRPs) and non-CRPs (NCRPs). … CRPs are significantly larger peptides. …
[HTML] Overexpression of the Arabidopsis thaliana signalling peptide TAXIMIN1 affects lateral organ development
J Colling, T Tohge, R De Clercq, G Brunoud, T Vernoux… – Journal of Experimental …, 2015
… Two distinct classes of secreted peptides can be distinguished in plants: small post-translationally
modified peptides such as the CLAVATA3/ENDOSPERM SURROUNDING REGION (CLE) family,
and cysteine-rich peptides (CRPs), exemplified by the EPIDERMAL …
METHODS OF MODULATING DRUG PLASMA LEVELS USING ERYTHROHYDROXYBUPROPION
H Tabuteau – US Patent 20,150,157,582, 2015
… In some embodiments, a combination of dextromethorphan and an antidepressant, such as
bupropion, may be administered to relieve complex regional pain syndrome, such as complex
regional pain syndrome type I (CRPS-I), complex regional pain syndrome type 11 (CRPS-II …
METHODS FOR THE SAFE ADMINISTRATION OF IMIDAZOLE OR IMIDAZOLIUM COMPOUNDS
H Tabuteau – US Patent 20,150,157,564, 2015
… embodiments, an osteoclast inhibitor, such as a nitrogen-containing bisphosphonate, eg
zoledronic acid, ibandronic acid or minodronic acid, may be administered to relieve complex
regional pain syndrome, such as complex regional pain syndrome type I (CRPS-I), complex …
Fibromyalgia
The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity
F Wolfe, BT Walitt, JJ Rasker, RS Katz, W Häuser – The Journal of Rheumatology, 2015
Objective The polysymptomatic distress (PSD) scale is derived from variables used in the
2010 American College of Rheumatology (ACR) fibromyalgia (FM) criteria modified for
survey and clinical research. The scale is useful in measuring the effect of PSD over the …
Association of different levels of depressive symptoms with symptomatology, overall disease severity, and quality of life in women with fibromyalgia
A Soriano-Maldonado, K Amris, FB Ortega… – Quality of Life Research, 2015
Purpose This study examined the associations of different levels of depression with pain,
sleep quality, fatigue, functional exercise capacity, overall fibromyalgia (FM) severity, and
health-related quality of life (HRQoL) in women with FM. Methods A total of 451 women …
Fibromyalgia: Clinical Guidelines and Treatments
E Lawson, M Wallace – 2015
Major Classes of Medication for Treatment of Fibromyalgia
AM Kelly, K Mauer – Fibromyalgia: Clinical Guidelines and Treatments, 2015
Implications of proposed fibromyalgia criteria across other functional pain syndromes
N Egloff, R von Känel, V Müller, UT Egle… – Scandinavian Journal of …, 2015
Objectives: In 2010, the American College of Rheumatology (ACR) proposed new criteria for
the diagnosis of fibromyalgia (FM) in the context of objections to components of the criteria of
1990. The new criteria consider the Widespread Pain Index (WPI) and the Symptom …
Omar I. Halawa and David A. Edwards
DA Edwards – Fibromyalgia: Clinical Guidelines and Treatments, 2015
Psychophysiological Methods
RH McAllister-Williams – Encyclopedia of Psychopharmacology, 2015
… potential. Tramadol reduces pain substantially in osteoarthritis and fibromyalgia
(Bennett et al. 2003). Methadone … below). There is evidence of a mild degree of benefit
in low back pain, fibromyalgia, and headaches. Anticonvulsant …
PTSD and Fibromyalgia Syndrome: Focus on Prevalence, Mechanisms, and Impact
W Häusera, J Ablinb, B Walittc – 2015
Abstract The association between fibromyalgia syndrome (FMS) and posttraumatic stress
disorder (PTSD) is of growing interest in psychosocial research. The mechanisms by which
both disorders are interconnected are not well understood. The article presents an …
Conditioned Pain Modulation: Neurophysiological, Cognitive, And Pharmacological Aspects
RR Nir, D Yarnitsky – Topics in Pain Management, 2015
… The relevance of modulatory pain mechanisms in the clinical arena is represented through
cumulative research reporting impaired pain inhibition associated with pain disorders, particularly
fibromyalgia, irritable bowel syndrome, migraine, tension-type headache …
Ryan D. McConn and Magdalena Anitescu
RD McConn – Fibromyalgia: Clinical Guidelines and Treatments, 2015
[HTML] Another dimension of pain
TH Khan – Anaesth Pain & Intensive Care, 2015
… Pain Manag Nurs. 2013 Dec;14(4):368-78. [PubMed] doi: 10.1016/j.pmn.2011.08.001. Menzies
V, Taylor AG, Bourguignon C. Effects of guided imagery on outcomes of pain, functional status,
and self-efficacy in persons diagnosed with fibromyalgia. J Altern Complement Med. …
[HTML] Pattern of irritable bowel syndrome and its impact on quality of life: A tertiary hospital based study from Kolkata on newly diagnosed patients of irritable bowel …
U Sinharoy, K Sinharoy, P Mukhopadhyay… – CHRISMED Journal of …, 2015
… [6],[7],[8],[9] IBS can coexist with other functional disorders, most notably fibromyalgia, chronic
fatigue syndrome … 10. 11. Aaron LA, Burke MM, Buchwald D. Overlapping conditions among
patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. …
[PDF] Disability Status, Disability Type, and Training as Predictors of Job Placement
J Stahl – 2015
… Deafness Hearing, Communicating Deafness Neurological Memory, Speaking TBI, Multiple
Sclerosis, Fibromyalgia Developmental Reading, Writing, Speaking Autism, Williams Syndrome …
Mental Neurological Memory, Speaking TBI, Multiple Sclerosis, Fibromyalgia …
[HTML] Pilates for Fibromyalgia
DPT Tom Lavosky, C MDT
By Gabrielle Shirer As originally seen in the Fall 2006 edition of the Pilates Coreterly
According to the National Fibromyalgia Association, Fibromyalgia Syndrome (FMS) is an
increasingly recognized chronic pain illness characterized by widespread …
New study by guidelines author dismisses risk of chronic Lyme disease
D Cameron
… In addition, these patients were not more prone to developing fibromyalgia and/or chronic fatigue,
according to two additional papers by Dr. Wormser. … [1]. And previous studies report there’s a
high risk of developing fibromyalgia after having Lyme disease. …
[HTML] Evolution of Skin Temperature after the Application of Compressive Forces on Tendon, Muscle and Myofascial Trigger Point
MF Magalhães, AV Dibai-Filho, EC de Oliveira Guirro… – PLOS ONE, 2015
… of musculoskeletal, tendon or nervous injuries in the upper limb, history of fracture in the upper
limb, use of painkillers, anti-inflammatory drugs or muscle relaxants during the previous week,
presence of systemic or neuromuscular diseases, and medical diagnosis of fibromyalgia …
[HTML] Rejuvenate With Stem Cells
R Schilling – 2015
… literature. This combination (laser activated, intravenous mesenchymal injection) has
the potential for being useful for a multitude of chronic illnesses like fibromyalgia,
MS, generalized arthritis, just to mention a few. Mesenchymal …
[PDF] Regenerative Injection Treatment in the Spine: Review and Case Series with Platelet Rich Plasma. J Stem Cells Res
D Aufiero, H Vincent, S Sampson, M Bodor – Rev & Rep, 2015
… Positive results for Prolotherapy have been published for a variety of conditions including lateral
epicondylosis [21], osteoarthritis [22], sacroiliac joint pain [23], chondromalacia patellae [24],
fibromyalgia [25], chronic groin pain [26] and Osgood-Schlatter disease [27]. …
[PDF] APPROVAL SHEET
M Holman – 2015
… Page 14. Effect of US and Graston on Muscle Contraction 11 plantar fasciitis,
patellofemoral disorders, fibromyalgia, scar tissue, and trigger finger. 13 The Graston
Technique allows for controlled application of friction massage to the …
[HTML] Blueg rass Doctors of Physical Therapy, PLLC Physical Therapy Care Provider in the Louisville, Kentucky We provide EXPERT CARE for YOUR Health!
N Patient, C Forms
… There are many symptoms that can lead the person with fibromyalgia syndrome (FMS)
and/or chronic myofascial pain (CMP) to your office. … Research indicates that fibromyalgia
may increase the risk of cardiovascular disease (Curtis, O’Keefe Jr 2002). …
by admin | Jun 9, 2015 | Uncategorized
Ketamine: Reinventing Chronic Pain Management
Author: Jeannette Y. Wick, RPh, MBA, FASCP
For patients who respond poorly or incompletely to opioids, ketamine may be the answer. In the middle of the past century, phencyclidine hydrochloride—called PCP or angel dust on the street—was developed to be a safe, effective anesthetic that did not cause cardiovascular and respiratory depression. However, its propensity to cause convulsions at high doses and long-lasting psychoactive side effects during emergence from anesthesia destroyed its potential.
Ketamine—a PCP derivative—was synthesized in 1963 and was tested on 20 prison volunteers in 1965. One-tenth as potent as PCP, ketamine was intended to induce anesthesia like PCP, but with greater specificity and fewer side effects.
.1 The FDA approved it in 1970, and its widespread use in the Vietnam conflict theater catapulted its popularity
.2 Today, ketamine is used less and less in the operating suite
.3 Although ketamine’s psychomimetic side effects are milder than those of PCP, they can be problematic (Table 12-10).
Recreational abuse has dogged ketamine since its approval. Abusers have injected, inhaled, and smoked ketamine, revealing characteristics of the drug that would otherwise remain unknown. Researchers hypothesize that abusers may develop tolerance because ketamine induces liver enzymes.11 Abusers rarely experience withdrawal, instead reporting a sensation called the K-hole—a constellation of visual hallucinations, dissociation, and out-of-body, and sometimes, near-death experiences. Heavy, prolonged ketamine use can cause cognitive and psychological impairment.4,12-15
Up to one-third of chronic ketamine abusers develop dose-dependent urinary tract symptoms within weeks to years: lower urinary tract irritation (vesicopathy), hydroureter, and hemorrhagic or ulcerative cystitis.13,16,17
The symptom etiology remains unclear, but may be direct toxic damage, immune system activation, or the effect of unknown bacteria.16,18
Long-term complications include hepatotoxicity (jaundice, itching, or elevated liver enzyme levels, especially in alcoholic patients) and/or cholangiopathy.19,20
Some long-term abusers develop corneal edema.21
These complications reverse after cessation of ketamine use.17,20,21
Clinically, the most common side effects of ketamine are inebriation, mental alteration, headache, hypertension, and altered liver enzymes.22
Newer, cleaner drugs or biologics are replacing ketamine in the operative suite. Yet ketamine is finding a new place in clinical therapy. Ketamine, an N-methyl-D-aspartate (NMDA)–receptor antagonist, is becoming an option for perioperative pain management among patients with opioid tolerance, acute hyperalgesia, and chronic neuropathic pain.1
NMDA Receptors
NMDA receptors are 1 of 3 glutamategated ion receptors. Gated by a magnesium ion, they normally open only briefly to allow calcium ions and other cations to enter the cell. Calcium activates second- messenger systems, causing neuronal hyperactivity.1,22-24 NMDA receptors may be involved in neuronal survival and maturation, synaptic plasticity, and memory. Abnormal NMDA function may cause neurologic disorders including Alzheimer’s disease, amyotrophic lateral sclerosis, depression, epilepsy, multiple sclerosis, Parkinson’s disease, and schizophrenia.25 Unrelenting NMDA receptor excitation allows continuous calcium influx into the cell and creates hyperexcitability. This presents clinically as opioid tolerance, hyperalgesia, and allodynia.22,26,27
Ketamine is the most potent clinically available, uncompetitive, open-channel NMDA-receptor blocker (it only works if the receptor is activated and the channel is open). Ketamine depresses the thalamus and limbic systems, preventing central nervous system centers from receiving or processing sensory input. This creates anesthesia, analgesia, and amnesia, and sometimes unpleasant psychomimetic effects or emergence phenomena.23,28,29
Sympathetic cardiovascular stimulation caused by ketamine is unique among intravenous anesthetics: it inhibits neuronal catecholamine reuptake, thereby increasing heart rate, cardiac output, and systemic and pulmonary blood pressure.30,31 Theoretically, ketamine use should be avoided in patients with prolonged QT syndrome.32 Ketamine inhibits neuronal serotonin reuptake, causing an emesis that is reversed by 5-HT–receptor blockers.33,34
What Route?
To minimize adverse events associated with ketamine use, researchers are examining the use of administration routes other than intravenous. Oral ketamine, as an injectable liquid or a compounded product, is subject to hepatic first-pass metabolism and is less effective than parenteral doses. It also lacks a clear dose-response relationship.22,35 Some study results suggest that the oral route leads to few side effects.36 Topical formulations of ketamine or ketamine with other potential analgesics has been used for managing several painful conditions (eg, pelvic pain, pruritus) with mixed results.22,37-39
Managing Pain
Ketamine use in pain management evolved from its perioperative use. Perioperative pain is expected, but may have physical or psychological consequences that delay rehabilitation and prolong hospitalization.1 Most surgeons use opioids to treat postoperative pain and supplement with regional anesthesia, other analgesics, and adjuvant agents as needed.1,23,40 Some patients respond poorly or incompletely to opioids; ketamine may help these patients.26,27,41
In low doses, NMDA-receptor antagonists can provide analgesia and circumvent opioid-related tolerance, hyperalgesia, and allodynia.10,23,40 Randomized, placebo-controlled, double-blind clinical trials (RCTs) have found that perioperative subanesthetic doses of ketamine added to opioid analgesia improved pain scores and reduced opioid consumption by approximately 30% to 50%. Ketamine was given as an intermittent low-dose intravenous bolus or a continuous infusion. It reduced opioid-related nausea and vomiting and added no additional significant adverse effects.42,43
Ketamine can also be given with morphine patient-controlled analgesia, contributing a morphine-sparing effect. Patients with chronic neuropathic pain, opioid dependence or tolerance, and acute hyperalgesia seem to benefit more.42,43 Low-dose ketamine administered before the surgical incision can lead to better analgesia for 24 hours after surgery.1 Most studies report no significant increase in psychomimetic adverse effects when ketamine is added to morphine.42,43
Sickle Cell Crisis and Chronic Noncancer Pain
Acute sickle cell disease creates severe pain with a neuropathic element. Several published guidelines recommend using opioids as first-line treatment, but some patients are unresponsive to even high opioid doses. Rapidly escalating opioid doses may induce acute tolerance and opioid-induced hyperalgesia.29,44 Case studies (but no RCTs) indicate that adding a low-dose ketamine infusion to opioids can improve pain in sickle cell disease.44 Usually, NMDA receptors activate continually only after a severe, sustained painful stimulus allows sufficient glutamate release. This is why ketamine may be useful as an adjuvant in several types of chronic central and peripheral neuropathic pain (Table 223,45,46).
Several of ketamine’s properties may prevent chronic pain from developing:
Dampening of nociception
Prevention or attenuation of hyperalgesia, allodynia, and tolerance
Attenuating central sensitization and windup phenomenon from repeated noxious stimuli when previously nonpainful stimuli become exaggerated and painful23,40
Clinicians have used short-term subanesthetic doses of ketamine to treat neuropathic pain.45 Scheduled infusions over several days can improve pain scores in patients with chronic pain; a few studies report pain relief persisting for weeks following treatment, indicating that ketamine may be disease modifying.46
Cancer Pain
Limited but increasing data support ketamine use in refractory cancer pain. Adding a small dose of ketamine to opioid therapy in a patient with opioid tolerance, called burst therapy, can improve pain management.12,47 Patients on highdose opioids whose cancer pain has a neuropathic component may respond to oral ketamine.48 Adding a small dose of ketamine to patient-controlled morphine seems to improve pain management, and some researchers are testing a ketamine mouthwash for mucositis.49,50
Endnote
Large, well-designed RCTs are needed to confirm the analgesic role of ketamine. Most studies suggest, and experts believe, that ketamine use should be reserved for patients in whom opioids, anticonvulsants, or antidepressants have failed.3,36 Because pain management is an off-label use for ketamine, clinicians should consult with field experts for dosing recommendations.
Ms. Wick is a visiting professor at the University of Connecticut.
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