The use of ketamine in complex regional pain syndrome: possible mechanisms

  title={The use of ketamine in complex regional pain syndrome: possible mechanisms},
  author={Robert Jay Schwartzman and Guillermo M. Alexander and John R. Grothusen},
  journal={Expert Review of Neurotherapeutics},
  pages={719 - 734}
Complex regional pain syndrome is a neuropathic pain syndrome that is characterized by: severe pain beyond the area of injury; autonomic dysregulation; neurogenic edema; movement disorder; and atrophy and dystrophy. Ketamine is an open-channel NMDA blocker that only acts on those receptors whose Mg2+ block has been lifted. It is effective in the treatment of the syndrome when standard treatments have failed. Different protocols are utilized depending on the severity of illness. There have been… 
Systemic Complications of Complex Regional Pain Syndrome
How CRPS affects the systems of: cognition; constitutional, cardiac, and respiratory complications; systemic autonomic dysregulation; neurogenic edema; musculoskeletal, endocrine and dermatological manifestations; as well as urological and gastrointestinal function is examined.
The Use of Ketamine in Neuropathic Pain
The history, pharmacology, pharmacodynamics, clinical benefits, and limitations of ketamine for treatment of NP, and methods of administration and management of adverse effects are highlighted based on the clinical experience of the authors.
Ketamine infusions for refractory complex regional pain syndrome: a review
It is emphasized that evidence from high-quality trials is lacking and unresolved concerns over potenial neurotoxicity, urological toxicity, and hepatotoxicity of prolonged ketamine use remain, and the long-term use of ketamine questionable.
Complex regional pain syndrome type I: a comprehensive review
This topical review gives a synopsis of CRPS I and discusses the current concepts of the authors' understanding ofCRPS I in adults, the diagnosis, and treatment options based on the limited evidence found in medical literature.
Anesthetic Management of a Complex Regional Pain Syndrome (CRPS) Patient With Ketamine.
This case report provides a brief overview of CRPS pathophysiology and treatment including data supporting the use of ketamine infusions and a discussion regarding the anesthetic management of a patient with CRPS presenting for dental care under deep sedation utilizing high-dose intravenous ketamine.
Ketamine for Non-Neuropathic Pain
The present topic focuses specifically on the effect of ketamine on non-neuropathic pain conditions such as complex regional pain syndrome, fibromyalgia, headache, ischemic limb pain, etc.
Complex Regional Pain Syndrome: A Comprehensive Review
In conclusion, CRPS is a multifactorial condition that still requires further studying to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options.
Complex regional pain syndrome: a recent update
The aim of this review is to report on the recent progress in the understanding of the epidemiology, pathophysiology and treatment of CRPS and to discuss novel approaches in treating this condition.
Syndrome of Inappropriate Antidiuretic Hormone Release During Ketamine Infusion in Complex Regional Syndrome Patient Receiving Intrathecal Baclofen: A Case Report.
Prophylactic treatment with intravenous loop diuretics was successful in preventing the development of SIADH during ketamine infusion during subsequent infusions in this case.


Pathophysiology of complex regional pain syndrome
The role of the immune system and the sickness response is becoming clearer as microglia are activated following injury and can induce central sensitization while astrocytes may maintain the process.
An Update on the Pathophysiology of Complex Regional Pain Syndrome
  • S. Bruehl
  • Medicine, Psychology
  • 2010
Enhanced knowledge regarding the pathophysiology of CRPS increases the possibility of eventually achieving the goal of mechanism-based CRPS diagnosis and treatment.
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.
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.
The neurocognitive effects of 5 day anesthetic ketamine for the treatment of refractory complex regional pain syndrome.
  • S. Koffler, B. Hampstead, R. Schwartzman
  • Psychology, Medicine
    Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists
  • 2007
Mechanisms of neuropathic pain.
The majority of research into neuropathic pain mechanisms has concentrated on changes in the peripheral nerve or spinal cord after peripheral nerve injury and most available evidence relates to changes in these parts of the nervous system and the review will, therefore, focus on these aspects.