Racemic ketamine 4.5-day infusion treatment of long-standing complex regional pain syndrome—a prospective service evaluation in five patients

Göebel, Andreas; Jayaseelan, Senthil; Sachane, Kiran; Gupta, Manish; Frank, Bernhard

doi:10.1093/bja/aev183

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…One observational study by Goebel et al evaluated the short-and long-term analgesic effects of 4.5-day, low-dose (0.9mg/kg/hr) racemic ketamine (RK) infusions in five patients with refractory CRPS. 37 The study authors found that intravenous infusion of low, subanesthetic doses of RK over a 4.5-day period can substantially reduce pain in patients with CRPS with 60% of patients reporting substantial pain relief during the treatment period. 37 The median pain intensity at the beginning of the treatment period was NRS 8.5, and was reduced to NRS 5 on the last treatment day.…”

Section: Discussionmentioning

confidence: 93%

“…37 The study authors found that intravenous infusion of low, subanesthetic doses of RK over a 4.5-day period can substantially reduce pain in patients with CRPS with 60% of patients reporting substantial pain relief during the treatment period. 37 The median pain intensity at the beginning of the treatment period was NRS 8.5, and was reduced to NRS 5 on the last treatment day. 37 The authors concluded that low-dose RK infusion over the duration of 4.5 days provided beneficial analgesia for short durations, but further prospective trials are needed to understand long-term pain control with multiple repeat ketamine infusions.…”

Section: Discussionmentioning

confidence: 93%

“…37 The median pain intensity at the beginning of the treatment period was NRS 8.5, and was reduced to NRS 5 on the last treatment day. 37 The authors concluded that low-dose RK infusion over the duration of 4.5 days provided beneficial analgesia for short durations, but further prospective trials are needed to understand long-term pain control with multiple repeat ketamine infusions. 37 Koffler et al conducted an observational study to understand pain control and neurocognitive effects of a 5-day anesthetic ketamine infusion in patients with CRPS.…”

Section: Discussionmentioning

confidence: 93%

“…37 The authors concluded that low-dose RK infusion over the duration of 4.5 days provided beneficial analgesia for short durations, but further prospective trials are needed to understand long-term pain control with multiple repeat ketamine infusions. 37 Koffler et al conducted an observational study to understand pain control and neurocognitive effects of a 5-day anesthetic ketamine infusion in patients with CRPS. 32 The study evaluated intellectual and academic abilities, executive functioning and processing speed, attention, learning, memory, and motor functioning in nine patients pre-treatment and 6-weeks post-treatment.…”

Section: Discussionmentioning

confidence: 99%

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Use of Ketamine Infusions for Treatment of Complex Regional Pain Syndrome: A Systematic Review

Patil

Chitneni

Dalal

et al. 2021

Preprint

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BackgroundThis systematic review aims to review clinical studies on the use of ketamine infusion for patients with treatment-resistant Complex Regional Pain Syndrome (CRPS).MethodsThe following systematic review was registered on PROSPERO (CRD42021228470). Studies for the systematic review were identified through 3 databases; PubMed, CINAHL, and Cochrane Review. Inclusion criteria for studies consisted of randomized clinical trials or cohort studies that conducted trials on the use of ketamine infusion for pain relief in patients with Complex Regional Pain Syndrome (CRPS). Exclusion criteria for studies included any studies that were systematic review, meta-analyses, case reports, literature reviews, or animal studies. In the included studies, the primary outcome of interest was post drug administration pain score.ResultsIn this systematic review, 14 studies met the inclusion criteria and were reviewed. In these studies, the dosage of ketamine infusion used ranged from 0.15 mg/kg to 7mg/kg with primary indication being treatment of Complex Regional Pain Syndrome (CRPS). In 13 of the studies, ketamine infusion resulted in a decrease in pain scores and relief of symptoms.ConclusionsPatients who received Ketamine infusion for treatment-resistant CRPS self-reported adequate pain relief with treatment. This suggests that ketamine infusion may be a useful form of treatment for patients with no significant pain relief with other conservative measures. Future large-scale studies, including randomized double-blind placebo-controlled trials on the use of ketamine infusion for CRPS must be conducted in a large-scale population to further assess the effectiveness of ketamine infusion in these populations.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Use of Ketamine Infusions for Treatment of Complex Regional Pain Syndrome: A Systematic Review

Patil

Chitneni

Dalal

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Low‐dose ketamine infusion treatment is, to our knowledge, the only pharmacological option that has been shown to achieve temporary pain relief in this group. However, unlike with neuromodulation, data about efficacy and risks of repeated administrations are not available; in a U.K. setting the cost effectiveness of this treatment, which requires regular repeat infusions, has not been established, and we have abandoned its use at our center . The primary surgical trial of spinal cord stimulation (ie, asleep surgical insertion) is a technique in keeping with international guidelines, but uncommonly used nowadays .…”

Section: Discussionmentioning

confidence: 99%

Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome (CRPS) Recurrence after Amputation for CRPS, and Failure of Conventional Spinal Cord Stimulation

et al. 2017

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Background: Limb amputation is sometimes being performed in long-standing complex regional pain syndrome (CRPS), although little evidence is available guiding management decisions, including how CRPS recurrence should be managed. Methods: This report details the management of a young soldier with CRPS recurrence 2 years after midtibial amputation for CRPS. Results: Conventional spinal cord stimulation did not achieve paraesthetic coverage, or pain relief in the stump, whereas L4 dorsal root ganglion stimulation achieved both coverage and initially modest pain relief, and over time, substantial pain relief. Conclusions: Current evidence does not support the use of amputation to improve either pain or function in CRPS. Before a decision is made, in exceptional cases, about referral for amputation, dorsal root ganglion stimulation should be considered as a potentially effective treatment, even where conventional spinal cord stimulator treatment has failed to achieve reliable paraesthetic cover. Furthermore, this treatment may provide pain relief in those patients with CRPS recurrence in the stump after amputation. &

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The Effect of Ketamine Infusion in the Treatment of Complex Regional Pain Syndrome: a Systemic Review and Meta-analysis

Zhao

Wang

2018

Curr Pain Headache Rep

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A search of Embase, Pubmed, Web of Knowledge, Cochrane, Clinical Trial.gov , and FDA.gov between Jan 1, 1950, and August 1, 2017, was conducted to evaluate ketamine infusion therapy in the treatment of CRPS. We selected randomized clinical trials or cohort studies for meta-analyses. I index estimates were calculated to test for variability and heterogeneity across the included studies. The primary outcome is pain relief. The effect of ketamine treatment for complex regional pain syndrome was assessed by 0-10 scale numerical rating pain score. The secondary outcome is the pain relief event rate, which is defined as the percentage of participants who achieved 30% or higher pain relief in each of the qualified studies. Our meta-analysis results showed that the Ketamine treatment led to a decreased mean of pain score in comparison to the self-controlled baseline (p< 0.000001). However, there is a statistical significance of between-study heterogeneity. The immediate pain relief event rate was 69% (95% confidence interval (CI) 53%, 84%). The pain relief event rate at the 1-3 months follow-ups was 58% (95% CI 41%, 75%). The current available studies regarding ketamine infusion for CRPS were reviewed, and meta-analyses were conducted to evaluate the efficacy of ketamine infusion in the treatment of CRPS. Our findings suggested that ketamine infusion can provide clinically effective pain relief in short term for less than 3 months. However, because of the high heterogeneity of the included studies and publication bias, additional random controlled trials and standardized multicenter studies are needed to confirm this conclusion. Furthermore, studies are needed to prove long-term efficacy of ketamine infusion in the treatment of CRPS.

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Racemic ketamine 4.5-day infusion treatment of long-standing complex regional pain syndrome—a prospective service evaluation in five patients

Cited by 8 publications

References 5 publications

Use of Ketamine Infusions for Treatment of Complex Regional Pain Syndrome: A Systematic Review

Use of Ketamine Infusions for Treatment of Complex Regional Pain Syndrome: A Systematic Review

Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome (CRPS) Recurrence after Amputation for CRPS, and Failure of Conventional Spinal Cord Stimulation

The Effect of Ketamine Infusion in the Treatment of Complex Regional Pain Syndrome: a Systemic Review and Meta-analysis

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