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Ketamine for reflex sympathetic dystrophy

Yuan-Yuan Lu, Chieh-Hsin Lin, Hsien-Yuan Lane
Ketamine, a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, has multiple clinical uses. On the other hand, ketamine abuse or recreational use has been gaining increasing attention. Induction of mania and psychotic symptoms has been reported in a patient receiving IV ketamine therapy for reflex sympathetic dystrophy. We here report a 26 year-old man who abused ketamine by inhalation for 12 months and developed manic-like symptoms after ketamine use. This case suggests a possible relationship between manic symptoms and ketamine abuse...
2016: Neuropsychiatric Disease and Treatment
Anne Louise Oaklander, Steven H Horowitz
Complex regional pain syndrome (CRPS) is the current consensus-derived name for a syndrome usually triggered by limb trauma. Required elements include prolonged, disproportionate distal-limb pain and microvascular dysregulation (e.g., edema or color changes) or altered sweating. CRPS-II (formerly "causalgia") describes patients with identified nerve injuries. CRPS-I (formerly "reflex sympathetic dystrophy") describes most patients who lack evidence of specific nerve injuries. Diagnosis is clinical and the pathophysiology involves combinations of small-fiber axonopathy, microvasculopathy, inflammation, and brain plasticity/sensitization...
2015: Handbook of Clinical Neurology
Maria M Wertli, Alphons G H Kessels, Roberto S G M Perez, Lucas M Bachmann, Florian Brunner
OBJECTIVE: Guidelines for complex regional pain syndrome (CRPS) 1 advocate several substance classes to reduce pain and support physical rehabilitation, but guidance about which agent should be prioritized when designing a therapeutic regimen is not provided. Using a network meta-analytic approach, we examined the efficacy of all agent classes investigated in randomized clinical trials of CRPS 1 and provide a rank order of various substances stratified by length of illness duration. DESIGN: In this study a network meta-analysis was conducted...
September 2014: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Porin Perić
In 1994, a consensus group of experts gathered by the International Association for the Study of Pain (IASP) agreed on new diagnostic criteria for the reflex sympathetic dystrophy (RSD) and causalgia, and renamed them complex regional pain syndrome (CRPS) types I and II, respectively. CRPS is a complex pathophysiological entity characterised by pain, trophic and vasomotoric changes, limited function of affected body part and relatively fast development of osteoporosis of affected region. We described possible pathophysiological mechanisms which caused the pain, clinical presentation of the disease and treatment which includes all available pharmacological modalities as well as interventional procedures...
2013: Reumatizam
Andrzej Żyluk, Joanna Pastuszka
Abstract Chronic algodystrophy is difficult to treat, because the disease in this stage is usually resistant to many therapies. It particularly concerns conditions with predominant severe, intractable pain and disability of the involved extremity. In these, the severest cases, searching for effective pain control therapy is extremely important. Intravenous ketamine infusions constitute a promising therapy, which appeared recently. Ketamine possesses properties of blocking central sensitization and development of neuropathic pain through its effect on NMDA receptor, a critical factor in this process...
2014: Polish Orthopedics & Traumatology
Johanna C M Schilder, Marnix J Sigtermans, Alfred C Schouten, Hein Putter, Albert Dahan, Lucas P J J Noldus, Johan Marinus, Jacobus J van Hilten
UNLABELLED: There are indications of motor circuit changes in patients with complex regional pain syndrome (CRPS). Nevertheless, although several studies have analyzed motor behavior in CRPS, a relation with pain could not be detected. This might be explained by the use of cross-sectional designs in these studies, in which pain is considered as a trait- rather than a state-dependent variable. We therefore studied the time-dependent relation between pain and motor function in affected arms of 29 CRPS patients during their participation in a placebo-controlled ketamine study...
November 2013: Journal of Pain: Official Journal of the American Pain Society
Erik Olofsen, Marnix Sigtermans, Ingeborg Noppers, Marieke Niesters, Rene Mooren, Martin Bauer, Leon Aarts, Elise Sarton, Albert Dahan
BACKGROUND: Ketamine is used as an analgesic for treatment of acute and chronic pain. While ketamine has a stimulatory effect on the cardiovascular system, little is known about the concentration-effect relationship. We examined the effect of S(+)-ketamine on cardiac output in healthy volunteers and chronic pain patients using a pharmacokinetic-pharmacodynamic modeling approach. METHODS: In 10 chronic pain patients (diagnosed with complex regional pain syndrome type 1 [CRPS1] with a mean age 43...
September 2012: Anesthesia and Analgesia
Ingeborg M Noppers, Marieke Niesters, Leon P H J Aarts, Martin C R Bauer, Asbjørn M Drewes, Albert Dahan, Elise Y Sarton
Studies on the efficacy of ketamine in the treatment of chronic pain indicate that prolonged or repetitive infusions are required to ensure prolonged pain relief. Few studies address ketamine-induced toxicity. Here we present data on the occurrence of ketamine-induced liver injury during repeated administrations of S(+)-ketamine for treatment of chronic pain in patients with complex regional pain syndrome type 1 as part of a larger study exploring possible time frames for ketamine re-administration. Six patients were scheduled to receive 2 continuous intravenous 100-hour S(+)-ketamine infusions (infusion rate 10-20mg/h) separated by 16 days...
September 2011: Pain
Kalpana R Kulkarni, Anita I Kadam, Ismile J Namazi
Stellate ganglion block (STGB) is commonly indicated in painful conditions like reflex sympathetic dystrophy, malignancies of head and neck, Reynaud's disease and vascular insufficiency of the upper limbs. The sympathetic blockade helps to relieve pain and ischaemia. Diagnostic STGB is usually performed with local anaesthetics followed by therapeutic blockade with steroids, neurolytic agents or radiofrequency ablation of ganglion. There is increasing popularity and evidence for the use of adjuvants like opioid, clonidine and N Methyl d Aspartate (NMDA) receptor antagonist - ketamine - for the regional and neuroaxial blocks...
November 2010: Indian Journal of Anaesthesia
Sharanya Nama, Daniel R Meenan, William T Fritz
Complex regional pain syndrome (CRPS) is a pain condition of the extremities that presents with pain and allodynia, decreased range of motion, swelling and skin changes. There are 2 forms of CRPS - Type I which does not have demonstrable nerve lesions and Type 2, which has evidence of obvious nerve damage. Management of refractory CRPS has been challenging. Some studies have revealed that the N-methyl-D-aspartic acid receptor (NMDAR) may be involved in the etiology of the pain in CRPS and perhaps that a NMDA receptor antagonist like ketamine is a potential treatment for CRPS...
July 2010: Pain Physician
Albert Dahan, Erik Olofsen, Marnix Sigtermans, Ingeborg Noppers, Marieke Niesters, Leon Aarts, Martin Bauer, Elise Sarton
AIMS: Pharmacological treatment of chronic (neuropathic) pain is often disappointing. In order to enhance our insight in the complex interaction between analgesic drug and chronic pain relief, we performed a pharmacokinetic-pharmacodynamic (PK-PD) modeling study on the effect of S(+)-ketamine on pain scores in Complex Regional Pain Syndrome type 1 (CRPS-1) patients. METHODS: Sixty CRPS-1 patients were randomly allocated to received a 100-h infusion of S(+)-ketamine or placebo...
March 2011: European Journal of Pain: EJP
Adam Everett, Brian Mclean, Anthony Plunkett, Chester Buckenmaier
OBJECTIVE: To successfully treat a patient with complex regional pain syndrome, refractory to standard therapy, to enable a rapid and full return to professional duties. SETTING: This case report describes the rapid resolution of an unusual presentation of complex regional pain syndrome type I after four days of treatment with a continuous sciatic peripheral nerve block and a concomitant parenteral ketamine infusion. The patient was initially diagnosed with complex regional pain syndrome (CRPS) I of the right lower extremity following an ankle inversion injury...
September 2009: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Marnix Sigtermans, Ingeborg Noppers, Elise Sarton, Martin Bauer, René Mooren, Erik Olofsen, Albert Dahan
AIMS: The aim of the study was to explore the analgesic effect of the N-methyl-d-aspartate receptor (NMDAR) antagonist ketamine in acute experimental versus chronic spontaneous pain in Complex Regional Pain Syndrome type 1 (CRPS-1) patients. METHODS: Ten patients suffering from chronic CRPS-1 and with a Visual Analogue pain Score (VAS) of >5 were recruited. Seven intravenous 5-min low-dose S(+)-ketamine infusions with increasing doses at 20-min intervals were applied...
March 2010: European Journal of Pain: EJP
Peyman Shirani, Alicia R Salamone, Paul E Schulz, Everton A Edmondson
In this case report, we describe the effect of ketamine infusion in a case of severe refractory complex regional pain syndrome I (CRPS I). The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments, including anticonvulsants, bisphosphonates, oral steroids and opioids, topical creams, dorsal column spinal cord stimulation, spinal morphine infusion, sympathetic ganglion block, and sympathectomy, failed to provide long-term relief from pain...
May 2008: Pain Physician
Jean-Marie Berthelot
Although no major advances have occurred in the curative treatment of reflex sympathetic dystrophy syndrome (RSDS), new pathogenic insights may soon lead to innovative approaches, which may also prove effective in alleviating some forms of neuropathic pain. Preventing nerve compression and ischemia-reperfusion injury constitute valuable measures for preventing RSDS. Vitamin C administration can also prevent RSDS, together with clonidine in high-risk patients. Short-term glucocorticoid therapy has been found effective in preventing RSDS after stroke but has not been evaluated in other situations...
October 2006: Joint, Bone, Spine: Revue du Rhumatisme
Ching-Tang Wu, Yu-Ming Fan, Chen-Ming Sun, Cecil O Borel, Chun-Chang Yeh, Chih-Ping Yang, Chih-Shung Wong
OBJECTIVE: Analyzing changes in regional cerebral blood flow (rCBF) with SPECT in complex regional pain syndrome type 1 (CRPS 1), formerly known as reflex sympathetic dystrophy, is an optimal method for evaluating effective pain relief. We attempted to investigate the correlation of changes in rCBF with pain relief during treatments of sympathetic blockade and multimodal epidural pain control. CASE REPORT: We describe a patient with severe CRPS 1 in whom conventional treatment failed to relieve the pain...
June 2006: Clinical Nuclear Medicine
Takahiro Ushida, Toshikazu Tani, Tetsuya Kanbara, Vadim S Zinchuk, Motohiro Kawasaki, Hiroshi Yamamoto
OBJECTIVE: Ketamine hydrochloride (KET), an agent used for general anesthesia, has local anesthetic effects and N-methyl-D-aspartate (NMDA) receptor antagonist action. Because recent studies emphasized the role of peripherally distributed NMDA receptors in processing the nociceptive information, we investigated whether peripheral application of the ointment containing KET is able to attenuate the symptoms of local neuropathic pain. CASE REPORTS: We applied ointment containing KET (0...
September 2002: Regional Anesthesia and Pain Medicine
T C Lin, C S Wong, F C Chen, S Y Lin, S T Ho
PURPOSE: There is considerable evidence that NMDA receptor antagonists can abolish nociceptor hypersensitivity in animals. In the present case report, two patients with reflex sympathetic dystrophy were treated with ketamine, a NMDA antagonist, morphine and bupivacaine. CLINICAL FEATURES: Two patients were referred suffering from severe pain, allodynia, hyperaesthesia, swelling and disability over their right lower legs, diagnosed as reflex sympathetic dystrophy...
February 1998: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
W S Kingery
The purpose of this review was to identify and analyze the controlled clinical trial data for peripheral neuropathic pain (PNP) and complex regional pain syndromes (CRPS). A total of 72 articles were found, which included 92 controlled drug trials using 48 different treatments. The methods of these studies were critically reviewed and the results summarized and compared. The PNP trial literature gave consistent support (two or more trials) for the analgesic effectiveness of tricyclic antidepressants, intravenous and topical lidocaine, intravenous ketamine, carbamazepine and topical aspirin...
November 1997: Pain
N Kishimoto, J Kato, T Suzuki, H Arakawa, S Ogawa, H Suzuki
A 74 year-old woman with a 6-month history of RSD following herpes zoster on her right arm was treated with stellate ganglion blocks (SGB), continuous epidural block (CEB) and continuous intravenous infusion of ketamine known as one of the NMDA receptor blockers. Of the symptoms of RSD, burning pain and hyperperspiration but allodynia disappeared after the treatment with SGB 8 times and CEB for 4 days. Allodynia disappeared completely after ketamine treatment, where ketamine was infused once using a subanesthetic dose for 2 hours...
December 1995: Masui. the Japanese Journal of Anesthesiology
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