In conclusion, it seems that the SCS for the treatment of the abdominal visceral pain may provide a positive patient long-term experience, significant improvements in pain scores and a decrease in opioid use.
This review demonstrates the acute safety of using cooled RF for L5DR denervation with no report of significant or unusual patient complications. To establish frequency of complication associated with the treatment, a larger registry is required.
Background and Objectives: Ketamine is opioid-sparing. It attenuates the onset
of opioid tolerance, and suppresses opioid-induced hyperalgesia. This study evaluated
whether or not repeated outpatient infusions of intravenous ketamine reduced the amount
of pain and the amount of opioid requirements for patients suffering with chronic, noncancerous pain.
Study Design: Retrospective study
Setting: Outpatient pain clinic
Methods: We reviewed the records of 18 patients taking high doses of opioids chronically
and nonetheless reporting poorly controlled pain. A comparison control group of 18 similar
patients with high opioid requirements who were not given ketamine were selected from
our clinic population.
Intervention: Intravenous ketamine infusions
Measurement: VAS pain scores and opioid use
Results: Morphometric and demographic characteristics, baseline opioid use, and pain
scores were similar in the ketamine and comparison groups. Five patients given ketamine
experienced no benefit and discontinued treatment after 1-2 infusions. One patient
developed a supraventricular arrhythmia which immediately resolved upon cessation of
the infusion. And another, despite pain relief, felt overly-anxious and opted out. Eleven
patients thus completed 3-6 weekly ketamine infusions. At 6 months, 5 patients maintained
less than 50% of their baseline opioid use, while the remaining patients returned to the
baseline opioid use or increased their requirements. There was no significant difference in
pain scores at 6 months in patients who received ketamine infusions and control group
patients.
Limitations: Retrospective nature of the study
Conclusions: Outpatient intravenous ketamine infusions did not improve long-term pain
scores in patients with high opioid requirements and only a few were able to substantially
reduce opioid use. Considering infusion risks and cost of such outpatient treatment,
ketamine infusions do not appear to be a feasible option for improving pain relief and
decreasing opioid use in high-opioid requirement patients.
Key words: Ketamine; anesthesia; chronic pain; opioids; continuous infusion; opioid
requirements
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