Efficacy and Safety of Ketamine in Patients with Complex Regional Pain Syndrome

  title={Efficacy and Safety of Ketamine in Patients with Complex Regional Pain Syndrome},
  author={Pari Azari and David R. Lindsay and Dean Briones and Collin Clarke and Thomas Buchheit and Srinivas Pyati},
  journal={CNS Drugs},
Despite being a recognized clinical entity for over 140 years, complex regional pain syndrome (CRPS) remains a difficult-to-treat condition. While there have been multiple therapies explored in the treatment of CRPS, 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 objective of this review is to identify published literature for evidence of the efficacy and safety of… 
Effectiveness of complex regional pain syndrome treatment: A systematic review.
Role of Ketamine in Acute Postoperative Pain Management: A Narrative Review
In a number of limited situations, ketamine has shown some efficacy in controlling postoperative pain and decreasing opioid consumption, but these effects are dose-dependent.
Treatment of Neuropathic Pain
Evidence supports first-line trials of anticonvulsants, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors, alone or in certain combinations, and palliative care principles are highly applicable in the treatment of chronic neuropathic pain.
Complex Regional Pain Syndrome: A Quantitative Review of Current Treatments
The pathophysiology of CRPS is described and the efficiency of new treatments against pain caused by the disease is analyzed to quantitatively analyze the effectiveness of current treatments.
Enhancing Choice and Outcomes for Therapeutic Trials in Chronic Pain: N-of-1 + Imaging (+ i).
Ketamine for Pain Management—Side Effects & Potential Adverse Events
Challenges and Controversies in Complex Regional Pain Syndrome (CRPS) Treatment
This work discusses sympathetic block, intravenous (IV) ketamine infusion, and peripheral nerve stimulation (PNS) in CRPS treatment and suggests PNS may help patients with CRPS pain limited to single nerve distributions.
Complex regional pain syndrome: From diagnosis to rehabilitation
Among rehabilitation interventions, the rehabilitation modality that seems the most promising according to the actual literature is graded motor imagery, which can help to reverse the maladaptive neuroplasticity occurring in CRPS.
Central Sensitization in Functional Chronic Pain Syndromes: Overview and Clinical Application.
  • L. BettiniKi Moore
  • Medicine, Psychology
    Pain management nursing : official journal of the American Society of Pain Management Nurses
  • 2016


Treatment of complex regional pain syndrome: a review of the evidence
The available evidence does not support the use of calcitonin, vasodilators, or sympatholytic and neuromodulative intravenous regional blockade, and clear benefits have not been reported with stellate/lumbar sympathetic blocks, mannitol, gabapentin, and physical/occupational therapy.
Multi-day low dose ketamine infusion for the treatment of complex regional pain syndrome.
A four-hour ketamine infusion escalated from 40-80 mg over a 10-day period can result in a significant reduction of pain with increased mobility and a tendency to decreased autonomic dysregulation.
Efficacy of ketamine in anesthetic dosage for the treatment of refractory complex regional pain syndrome: an open-label phase II study.
Benefit in pain reduction, associated CRPS symptoms, improved quality of life and ability to work following anesthetic ketamine in previously refractory CRPS patients is suggested, however, a randomized controlled trial will be necessary to prove its efficacy.
Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome.
This retrospective review suggests that limited subanesthetic inpatient infusions of ketamine may offer a promising therapeutic option in the treatment of appropriately selected patients with intractable CRPS.
Ketamine in Chronic Pain Management: An Evidence-Based Review
The evidence for efficacy of ketamine for treatment of chronic pain is moderate to weak, however, in situations where standard analgesic options have failed ketamine is a reasonable “third line” option.
A pilot open-label study of the efficacy of subanesthetic isomeric S(+)-ketamine in refractory CRPS patients.
There was no pain relief or change in QST measurements in this series of long-standing severe CRPS patients, suggesting S(+)-ketamine can be gradually titrated to large doses (500 mg/day) without clinically relevant side effects.
NMDA receptor antagonists for the treatment of neuropathic pain.
No conclusions can yet be made about the efficacy of NMDA receptor antagonists on neuropathic pain, and additional RCTs in homogenous groups of pain patients are needed to explore the therapeutic potential of NMda receptor antagonists in neuropathicPain.
The neurocognitive effects of 5 day anesthetic ketamine for the treatment of refractory complex regional pain syndrome.
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  • Psychology, Medicine
    Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists
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The use of sub-anesthetic intravenous ketamine and adjuvant dexmedetomidine when treating acute pain from CRPS.
The synergistic effect of the ketamine and dexmedetomidine together is shown to provide excellent symptom relief while decreasing the total ketamine administered, which minimized unwanted side effects and eliminated the need for intensive care unit admission secondary to anesthetic doses of ketamine.