About IV Ketamine Treatments

Most chronic pain results from tissue injury, and treatment is aimed at targeting the tissue involved and the nature of the injury. Think of it this way: the existing nerve endings are traumatized and irritated, and this results with the nerves constantly sending burning, searing pain signals directly to the brain. What IV Ketamine treatments do is to extinguish these ‘bad’ nerve pulses and begin to grow new pathways. These new, fresh nerve endings create new pathways to the brain. Since they do not have a history or ‘baggage’ of the old trauma, they only send healthy signals to the brain.

CBS Features Dr. Ashraf Hanna with a Breakthrough Lyme Disease Treatment with IV Ketamine. Dr. Hanna’s patient, Krysten Fernandez tells her amazing recovery after IV Ketamine treatments for her late stage Lyme Disease.

Karen Mullins was diagnosed with Fibromyalgia after a car accident left her in severe chronic pain. Karen was one of the first patients in Dr. Hanna’s clinical study for Fibromyalgia pain utilizing IV Ketamine Infusion Therapy. Her results are extremely positive and she now has a much better quality of life.

 

Introduction

Intravenous (IV) ketamine infusion therapy has emerged as a treatment option for a variety of chronic pain conditions including fibromyalgia, small fiber neuropathy, complex regional pain syndrome (CRPS), reflex sympathetic dystrophy (RSD) and psychiatric conditions including depression, post-traumatic stress disorder (PTSD), suicidal ideation, and obsessive-compulsive disorder (OCD). Dr. Hanna is America’s top doctor offering IV Ketamine Infusion treatment, with over 1,000 treatments performed. Patients are reporting amazing, miraculous results with only a few treatments.

History of Ketamine

Ketamine is not a new drug. It has been used for five decades in human and veterinarian medicine. Ketamine is an anesthetic drug that was introduced into clinical practice in 1970.1  At anesthetic doses it results in a complete loss of consciousness while preserving certain protective reflexes. That has made it attractive to anesthesiologists in selective patients. While it does stimulate opiate receptors, much like morphine, its NMDA receptor antagonism at subanesthetic doses is thought to be much more important in the treatment of chronic pain and psychiatric disorders. Blocking the NMDA receptor and preventing the passage of ions through the channel interrupts pain signal transduction, giving central pain centers a chance to “reboot”. This often requires that a patient undergo a series of low dose ketamine infusions for dramatic or complete elimination of their chronic pain. Ketamine infusions have been most often used when other treatment modalities have failed. Certain types of pain considered to be “neuropathic” in origin have been most studied and are considered to be most responsive to ketamine therapy.

Science

The primary and most well known pharmacological action of ketamine is NMDA antagonism.  This is the main rationale for the use of ketamine infusions to treat chronic pain and psychiatric IV Ketamineconditions that are not responsive to conventional therapeutic options.  Many studies have shown increased NMDA expression and activity in animal models of chronic pain.2-4  Further, subsequent studies have shown that NMDA antagonism is useful in these same models of chronic pain.5-8  The most studied of these NMDA antagonists is ketamine and is the subject of many current CRPS research endeavors.9-12 Ketamine exhibits extensive polypharmacology that has yet to be fully understood in the context of CRPS.13  This has led some to regard the drug as “a pharmacologist’s nightmare” because there is not one clear defining mechanism of action.13  However, we believe that the multiple pharmacological actions of ketamine may produce an “entourage effect” that is uniquely beneficial for the management of many treatment-resistant psychiatric conditions, CRPS and other pain conditions that are refractory to opiate therapy or in patients where opiate narcotics are contraindicated.

IV Ketamine Procedure

At the Florida Spine Institute, treatment protocols are individually planned depending on the nature of your pain and your responsiveness to initial sessions. Infusion cocktails are prepared in house so that they can be tailored to each patient’s therapeutic needs.  A variety of medications are often used:

  • Lidocaine
  • Ketamine
  • Magenesium

These medications are typically mixed with saline in an IV bag and infused slowly over several hours, depending on the medication and/or protocol being used.  Usually, a series of treatments will be recommended daily for a period of a week or more. The duration of pain relief following one or more ketamine infusions cannot be predicted. The goal is to achieve lasting relief as measured in weeks or months following the last treatment. Most patients who enjoy prolonged pain relief will need to return on occasion for a booster infusion, or continue to take low dose intranasal ketamine at home.

Risks

Ketamine infusion therapy is generally well tolerated and, as such, very few patients need to terminate treatment due of side effects. Still, ketamine is a derivative of phencyclidine (PCP) a known psychedelic and if not combined with sedation can cause hallucinations in many patients. You will be given a benzodiazepine to control this dysphoria. Other possible side effects include nausea and rarely a headache. These side effects can also be managed and often eliminated during the infusion therapy. Following the completion of a daily infusion regimen, patients are usually tired for several hours and need to be accompanied home by a responsible adult. We have yet to observe any long-term side effects that can be attributed to low dose intravenous ketamine therapy. Furthermore, ketamine is not highly addictive like more common FDA approved analgesics like opioids.

References

1.         Domino EF. Taming the ketamine tiger. 1965. Anesthesiology. 2010;113:678-684.

2.         Da Silva LF, Walder RY, Davidson BL, Wilson SP, Sluka KA. Changes in expression of NMDA-NR1 receptor subunits in the rostral ventromedial medulla modulate pain behaviors. Pain. 2010;151:155-161.

3.         Hummel M, Strassle B, Miller S, Kaftan E, Whiteside G. Anatomical localization and expression pattern for the NMDA-2D receptor subunit in a rat model of neuropathic pain. Neuroscience. 2008;155:492-502.

4.         Chapman V, Honore P, Buritova J, Besson JM. The contribution of NMDA receptor activation to spinal c-Fos expression in a model of inflammatory pain. British journal of pharmacology. 1995;116:1628-1634.

5.         Wang Y, Guo Q, Wang M, Wang E, Zou W, Zhao J. [Effect of intrathecal sufentanil and protein kinase C inhibitor on pain threshold and the expression of NMDA receptor/ CGRP in spinal dorsal horn in rats with neuropathic pain]. Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences. 2012;37:783-789.

6.         Hudspith MJ, Harrisson S, Smith G, Bountra C, Elliot PJ, Birch PJ, et al. Effect of post-injury NMDA antagonist treatment on long-term Fos expression and hyperalgesia in a model of chronic neuropathic pain. Brain research. 1999;822:220-227.

7.         Munglani R, Hudspith MJ, Fleming B, Harrisson S, Smith G, Bountra C, et al. Effect of pre-emptive NMDA antagonist treatment on long-term Fos expression and hyperalgesia in a model of chronic neuropathic pain. Brain research. 1999;822:210-219.

8.         Chu YH, Wong CS, Ho ST, Watkins WD. Epidural coadministration of ketamine and morphine attenuates the neuropathic pain: A case report. Pain Clinic. 1995;8:263-267.

9.         Shirani P, Salamone AR, Schulz PE, Edmondson EA. Ketamine treatment for intractable pain in a patient with severe refractory complex regional pain syndrome: a case report. Pain physician. 2008;11:339-342.

10.        Kiefer RT, Rohr P, Ploppa A, Nohe B, Dieterich HJ, Grothusen J, et al. A pilot open-label study of the efficacy of subanesthetic isomeric S(+)-ketamine in refractory CRPS patients. Pain medicine. 2008;9:44-54.

11.        Kiefer RT, Rohr P, Ploppa A, Altemeyer KH, Schwartzman RJ. Complete recovery from intractable complex regional pain syndrome, CRPS-type I, following anesthetic ketamine and midazolam. Pain practice : the official journal of World Institute of Pain. 2007;7:147-150.

12.        Pickering AE, McCabe CS. Prolonged ketamine infusion as a therapy for complex regional pain syndrome: synergism with antagonism? Brit J Clin Pharmaco. 2014;77:233-238.

13.        Potter DE, Choudhury M. Ketamine: repurposing and redefining a multifaceted drug. Drug discovery today. 2014.

Great News! Dr. Hanna now is now accepting most insurance for his IV Ketamine Infusion Treatments!

 

 

 

 

 

 


In February 2015, The National Institute of Health recommends Ketamine as a viable treatment for CRPS / RSD, Chronic Pain and PTSD Depression

CRPS

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