Many medical disorders cause chronic pain. Many times, these disorders can be very difficult to treat, and pain relief may be difficult to achieve.
CRPS
One such disorder that causes chronic pain is Complex Regional Pain Syndrome (previously known as Reflex Sympathetic Dystrophy or RSD). This syndrome usually occurs as a result of an accident or injury and most often causes pain in the arms, legs, hands, and feet.
There is not an FDA-approved treatment for CRPS and many traditional pain medications do not help those who suffer from the syndrome. Also, the strong pain medications that are typically used to treat pain such as this have harsh side effects and can lead to pain medication addiction.
Complex regional pain syndrome (or RSD) is a neuropathic pain syndrome that is frequently diagnosed by persistent pain after a soft tissue injury that is out of proportion to what would normally be expected. It almost exclusively begins as the result of an extremity injury.
The pain varies in its severity from mild to debilitating. Various symptoms can be present and may include autonomic dysregulation (sweating, goose bumps, and initially a very warm extremity when compared to the other extremity). The extremity may also include a very deep red or ruddy appearance, a bluish or cyanotic appearance or present as a mottled look. The appearance can vary throughout the day.
Neurogenic edema (swelling), movement disorder (tremor), allodynia (pain produced in response to a non painful stimulus) and later findings of a cool/cold extremity and atrophy are also common findings. The syndrome can spread to involve the other extremity and possibly the torso resulting in widespread/generalized pain. Despite a multitude of treatments, some patients may not find relief with standard therapies. Severe disability can result.
Despite being described in biblical times, complex regional pain syndrome (CRPS) remains a difficult-to-treat condition. While there have been multiple therapies explored in CRPS treatment, NMDA antagonists such as ketamine continue to hold significant interest because of their potential ability to alter the central sensitization noted in chronic pain states.
The most common use is for those who have a definite neuropathic component. Ketamine is a N-methyl-D-aspartate receptor antagonist. Ketamine infusion can produce strong analgesia in neuropathic pain states presumably by inhibition of the N-methyl-D-aspartate receptor.
Other mechanisms are possibly involved including enhancement of descending inhibition and anti-inflammatory effects at central sites. Ketamine is an open-channel NMDA blocker that acts on those receptors whose Mg(2+) block has been lifted. It may be effective when standard treatments have failed. There is no standard dose, duration of treatment or frequency of infusions for ketamine.
Fibromyalgia
Fibromyalgia is another disorder that causes widespread pain throughout the body and affects an estimated 5 million people. The constant pain felt by many patients with fibromyalgia can cause fatigue, exhaustion, depression, and isolation and makes maintaining a regular routine or “normal” lifestyle very difficult.
The cause of fibromyalgia is not clear, but it appears that a combination of physical and emotional stressors can trigger the syndrome. For an unknown reason, it is also significantly more prevalent in women than in men.
It has been suggested that there is a relationship between complex regional pain syndrome (RSD) and fibromyalgia. Complex regional pain syndrome starts at the site of prior trauma or surgery. The pain of fibromyalgia usually is not preceded by an injury to the involved tissue. However, both disorders may share a common mechanism of pathologic sensitization of central nervous system mechanisms that integrate pain signals. Multiple altered pain pathways may be involved.
Studies have implicated increased sensitivity of central NMDA receptors as playing a primary role in fibromyalgia, as evidenced by a significant reduction in symptoms among patients in response to low doses of ketamine. Suppression of the normal activity of dopamine-releasing neurons within the limbic system has also been implicated.
Fibromyalgia has shown to respond to treatment with ketamine whose actions include blockade of N-methyl-D-aspartate receptors. For those patients who have failed to respond to conservative treatment, ketamine infusion may be beneficial.
Lyme Disease
Patients who have contracted Lyme disease at some point in their life may also suffer from pain that is similar to fibromyalgia or chronic fatigue syndrome. According to the Centers for Disease Control (CDC), some people who contract Lyme disease will have symptoms that persist after their treatment for Lyme disease ceases.
These symptoms, much like the symptoms of fibromyalgia, cause the patient to have chronic pain, feel fatigued or exhausted, and can cause depression or cognitive malfunction.
Ketamine Therapy Can Help
As we have all experienced, prolonged pain can cause significant emotional trauma. A feeling of helplessness and despair add to the discomfort already felt by the chronic pain. Ketamine therapy offers hope to patients who have found little or no reprieve from their pain, no matter the condition that is causing the pain.
If you or someone you love suffers from chronic pain, please contact us to discuss the possibility of receiving ketamine therapy. Life doesn’t have to be lived in pain. Contact us today.