Tough pain puts people at the end of the rope and at the end of the line. Doctors and patients alike grab at the knot at the end of the rope in a desperate attempt to hold onto some semblance of control over the toughest pain. When a person reaches the end of the line of treatment options, the biggest question is “What next?” What is next for those with intolerable and intractable painful conditions like fibromyalgia, phantom pain, complex regional pain syndrome (CRPS), and the entire quagmire of painful conditions that involve central sensitization of the nervous system. The answer for tough to treat pain might be a ketamine infusion.
Ketamine is an old drug typically reserved for the operating room to induce anesthesia. This potent blocker of the NMDA and NMDAR receptors is now being looked at as a viable end-of-the-rope option for those with severe pain that has been nonresponsive to all other traditional treatments. As the mechanism for central sensitization has become revealed, scientists have discovered that NMDA receptors increase in number as the pain intensifies like turning up the volume. This increased and enhanced pain signal transmission needs to be blocked and reset in order to stop the pain from these mysterious conditions like CRPS and phantom pain. After the discovery of this pain mechanism, the daring have taken a serious look at ketamine.
The first successful report of ketamine used to treat a person with CRPS came from Japan in 1995. Since then, more researchers looked at this old drug as a new treatment for previously untreatable pain. All through the late 1990’s and into the next decade, the Japanese were pioneering the use of ketamine to reset the nervous system and block chronic pain. All of these reports were just anecdotal evidence at best. In 2009, a pivotal study showed that without a doubt, ketamine works.
Used in anesthetic doses in the operating room or intensive care unit, infused ketamine reduces post-operative pain and analgesic consumption for various types of surgery. Used in sub-anesthetic doses within a hospital setting, a series of ketamine infusions has been shown to stop intractable pain. The medical evidence is weak. However, the evidence is there and it is getting stronger.
Is ketamine the ultimate reset button and knot at the end of the rope? Possibly, but with a high risk of death and at a high cost. At this moment in time, ketamine infusion is not for the faint at heart and only as a last option at the end of the line when one is at the end of his/her rope. If this treatment does go mainstream for the masses, the potential uses might be endless when it comes to dealing with tough chronic pain.
Specialist in Pain Management and Spine Rehabilitation