Have you heard about the controversial treatment available in Germany for severe pain? Patients are put under anesthesia to the point of being in a coma with Ketamine. For many, their pain improves.
(Ketamine)
However, there’s been concern that significant cognitive (how you think) side effects would occur – and there were no studies to say to patients “it’s safe,” or “forget about it!”
Until now.
The lead author Dr. Sandra Koffler and colleagues at Drexel University in Philadelphia looked at how 5 days of Ketamine worked for a severe pain disorder Complex Regional Pain Syndrome. And they looked at both how it affected pain, as well as thinking processes – attention, memory, etc.
Ketamine is an anesthetic that’s an NMDA-receptor blocker, and studies show that these receptors are important in many nerve pain conditions. However, the fear was that while it helped pain, it had short term and long term side effects.
In addition to the unpleasant idea of a “coma,” the short term side effects of hallucinations and anxiety often made patients quite nervous about using Ketamine. No one wants to have scary visions and hear voices! However, I’d always been more concerned about long term side effects of thinking problems - and the fact that there’s been no research on how safe or unsafe Ketamine is related to your thinking.
The study included 9 patients, whose usual pain was 8 – 10 out of 10 on a pain scale. Side effects from the Ketamine treatment included muscle weakness, dizziness, fatigue, episodes of sweating, and feeling hot and slightly anxious. These resolved within 2–4 weeks. 2 patients had mild unsettling flashbacks at 4 weeks that were successfully treated with Ativan, a medication for anxiety.
Related to pain, the results were great. In 8/9 patients, pain was decreased, and they were able to come off narcotics and other pain medicine at the 6-week follow-up. 1 patient experienced slightly more pain, and considerably more depression and anxiety following treatment.
What was encouraging about this study was that Ketamine appeared to have no bad effects on thinking at the 6-week follow-up. Patients performed the same or better on tests including attention, learning, and memory.
The authors concluded that Ketamine doesn’t hurt your thinking. Patients’ thinking may have improved because their pain was much less, or they no longer had the well-know “fuzzy thinking” side effect of medications.
(Although this study didn’t say, in previous Ketamine studies, patients also took medication that protects nerves from being hurt by Ketamine.)
The study was small, but its results are encouraging. Obviously a coma isn’t the treatment you’d turn to first. But as Ketamine, and medications like it, are studied more, we may have another remedy to offer patients with severe pain who don’t respond to anything else.
And that’s good news - (news that even Robin Cook would like).
So… would you ever use this treatment? Leave your thoughts in the comments section. You might also like to read: Medications for Pain series- Ketamine. (This study is currently in press in the Archives of Clinical Neuropsychology, 2007.)
And coming next month … contests for you to enter to win prizes, including The Most Creative Way To Relax Contest. Look for more details soon…
30 responses so far ↓
Joanna // Jul 24, 2007 at 3:17 pm
Wow.. I don’t think that I would consider doing this unless it was one of the last treatments on the list for me. There are things that can go wrong when you’re in that state, from what I’ve heard, so it just seems like it would be one of the riskier things to try. The fact that the Ketamine doesn’t seem to have any negative cognitive effects is definitely a plus, however, because of all of the meds that do (ie. Topamax, which I’m currently going off of because of the memory issues I’ve had with it).
HtCwP // Jul 24, 2007 at 4:35 pm
I’d agree that this should be one of the very last things tried, and even then, considered very carefully. Reassuring, however, if you decide to do it.
Unfortunately, many of the medications used for pain have cognitive side effects.
W.H. // Jan 16, 2008 at 3:20 pm
I’d like to contact someone who can help me get this treatment. I am desperate, and I have nothing left to lose.
How to Cope with Pain // Jan 16, 2008 at 4:45 pm
Dr. Schwartzmann in Neurology at Drexel Univ College of Medicine is the best resource I know. Good luck, and don’t give up!
L. G // May 12, 2008 at 10:30 am
My finacee is on the list for the trip to have the Ketamine coma. I am very scared, for all of us, the cost is out of reach and I could not imagine him being there without me. I know how much he is suffering and that is the only reason I will consider this for him. It is breaking the man I knew and making him into something he is not. RDS is a nasty disorder and I wish that he had never had to experience it. Does anyone know if a person who undergoes the Ketamine coma has ever not come out of it?
How to Cope with Pain // May 12, 2008 at 10:35 am
LG, I don’t know the answer to that question. I’d suggest talking again with his doctor here, to discuss all the risks. Let us know. And good luck!
secr // Jun 16, 2008 at 10:40 pm
I’m on the list for the ketamine coma as well. Having lived with this disorder, I don’t doubt for one second or question my decision to go ahead with the treatment. The devestating effects of living with the disease, to me far outwiegh any risks- which are well worth taking at this point. Even considering worst case scenario, I’d still rather be with Jesus in heaven with new bodies and no pain, then live with the disease for the rest of my life.
How to Cope with Pain // Jun 17, 2008 at 4:09 pm
You’re right, that as some point – probably a different point for each person – trying something with risk is worth it, if the potential benefit is to greatly reduce pain.
Good luck! Let us know how it goes!
momof4 // Nov 10, 2008 at 1:27 am
does anyone know if there are any other disorders or conditions that they will consider adding you to the list for? I don’t have RDS, but I do I have chronic pain that is ruining my life – and my children are suffering for it. I’d pretty much go anywhere and do just about anything if I believed it would give me back to them and my husband. And somehow living half-a-life drugged on pain medication for the rest of my life just doesn’t seem like the right answer. It just isn’t good enough.
How to Cope with Pain // Nov 10, 2008 at 7:32 am
Mom of 4-
I’d suggest you call Dr. Schwartzmann’s office at Drexel Neurology to inquire. You should also talk to your pain management doctor about trying other options, or consider a 2nd opinion, if you’re not yet satisfied with your treatment.
Good luck! HtCwP
jafraldo // Nov 14, 2008 at 5:12 am
If you are worried about the safety of ketamine, then Look it up on Google.
In a miraculous stroke of luck, Ketamine is one of the safest if not the safest anesthetic known to man.
Ketamine is the only drug they will give to children to put them under, because it doesn’t depress the breathing at all, and the difference between the anesthetic dose and a lethal dose is about two orders of magnitude- a lot of room for error.
How to Cope with Pain // Nov 14, 2008 at 8:02 am
I’d respectfully disagree with Jafraldo’s comment above on 2 things…
1. Getting info online can be good or bad – you have to know what source you’re looking at. So be careful when you “google” something, and be sure to check the source of what you’re reading.
2. Ketamine has known significant side-effects, even at anesthestic doses that are used. We are learning about how to protect the nervous system when it’s used, but we don’t know how to do that perfectly yet. So I’d say it’s definitely not risk-free – yet!
Betty // Mar 4, 2009 at 4:24 pm
I don’t know much about this drug. My son who is a Paramedic recommended this site to me. I live with chronic pain all the time. I have arachnoiditis that a doctor very likely caused due to having two failed back surgeries. There is no hope for me or others that have this dreadful disease. The doctors cannot go in and try to reverse this because then
we could for sure end up paralzyed. I wear a pain patch and of course it has powerful narcotics in it and I also take narcotics orally as well. Depending on what stage I will get to, is whether I will end up in a wheelchair or bedridden.
I just try to keep positive and if I am having a fairly good day I go out and have a small walk or have my husband take me out for a drive or I have him take me to the mall to walk around to try and take my mind off the pain. It is hard when every inch of my body is burning, hurting including my insides and female parts and stomach. What I also use for pain control is massage therapy which helps me quite a bit. I also see a chiropractor that does not do chiropractic twisting and any kind of manipulation on me. What he does is called A.R.T. which stands for Active Release Therapy. Look it up on the computer and you will see what it all involves. He stretches, and uses his thumb on me in the areas to loosen up my muscles. He also uses his activator a little gun like thing and hits my tight muscles that causes a lot of the pain a person is in. Due to the pain, my muscles tighten up and causes spasm and knots but these two people that do the massage and A.R.T. on me, keep me going. I have seen so many doctors, neurologists, and neurosurgeons that nothing helps but this A.R.T. is free of drugs and helps a lot including the massage therapy. It is not the answer but for a little while the pain is not so bad.
To even have a few hours of relief of pain to me is worth anything when a person’s life is filled with pain all the time. I try to do things that free my mind of thinking of pain all the time and another thing that helps is my grandkids. Their hugs and kisses are like a shot of what the powerful drugs do to me. It all helps and when I need some pain relief because it is getting too bad, I phone my grandkids and they say Grandma do you need us for pain relief and I tell them you betcha and off we go to meet to have our hugs and outings with them. Anything to keep your mind off the thinking. Thinking about the pain and how bad it is, does not help anyone.
How to Cope with Pain // Mar 4, 2009 at 4:47 pm
Betty, I love what your grandkids say – “Do you need us for pain relief?” How wonderful that you get benefit from hugging them and that they know they make a difference!
Thanks for writing in.
Richard // Apr 22, 2009 at 9:02 am
I’ve recently read about this ketamine experience by the Drexel University people. Being a physician (anesthesiologist and pain management), I’m very familiar with the drug and it’s effects; having used it for near 30 years.
It is a very powerful analgesic at low doses and the idea of a prolonged experience with it for refractory pain pomises to be a real advancement for people where all other modes of treatment have failed. My understanding of it is that it is most effective in neuropathic (nerve) pain. Fortunately most of the current meds( gabapentin, pregabalin, etc) are moderately effective in managing those types of pain. However, there are some, eg post herpetic neuralgia that are not very amenable to themfor some patients an something like this ketamine coma treatment might be a breakthrough treatment for them. In the elderly, post herpetic neuralgia is responsible suicide in those unfortunate patients. I have found it very useful in very low doses in post operative pain where the usual narcotics have failed. The ketamine seems to somehow reset a “allostat” so that the subsequent narcotics work effectively again.
How to Cope with Pain // Apr 22, 2009 at 11:31 am
Richard, thanks for your input. I think researching how to use Ketamine safely could help a lot of people.
John // May 6, 2009 at 12:06 am
anyone with RSD hit me up. If you had the coma treatment let me know.
Rachael // Jul 9, 2009 at 8:48 pm
I would do this. I’m trying to finda doctor who will recomend a doctor or someone who will perform this, because I cant handle the pain anymore.I hope this study becomes more popular for those of us who try dail pain meds that just dont do anything.
Thank you for the reasearch.
Nina Richie Soneja // Aug 20, 2009 at 6:43 am
Hi, have been diagnosed with RSD after suffering a terrible karting accident which broke my right foot and knee bone to several pieces. The pain that Iam experiencing is really terrible. I wish I would wake up from this nightmare but until this very day after a month from that tragic accident, I still find myself in pain. I will be operated again on Wednesday, Aug 26, to correct my Ilizarov, align my bones and to ankle fusion. Im in stage 1 of RSD, redness & pain are the symptoms Iam feeling and everytime I stand with my left foot and feel the blood rushing to my right foot, I feel in terrible pain. I would like tp know if the ankle fusion will not make my situation worse?
thanks
Nina Richie Soneja // Aug 20, 2009 at 6:44 am
To add up, it’s only now that I have heard of this disease here in the Philippines, please help.
How to Cope with Pain // Aug 20, 2009 at 7:53 am
Hi Nina,
As you might guess, I can’t make treatment recommendations. But I suggest talking to your doctors about your concerns. And be sure that your team is knowledgeable about RSD.
Good luck!
Bernie // Oct 13, 2009 at 1:48 pm
Hi ,
I am currently on Ketamine oral at home now 2mg a day. I had 3 ketamine infusions at my pain clinic in Sacramento California after many other drugs and infusions. I have lived with RSD for 3 years now and it has spread full body after 2 consecutive foot surgeries for tarsal tunnel and ankle stablazation. I do have memory loss and fatigue My cognitive is impaired but I have now at least got my pain level down to 10…. Thank God for ketamine. I have decided not to do the Infusion after a K-Hole experience. It was the most scary time of my life. I do have hair loss and weight loss….and still deal with the headach everyday. I still feel blessed for the drug tho.
Dede M. // Nov 5, 2009 at 2:49 pm
I have had severe RSD, with chronic pain, shingles, Epstein Barr Virus and Hepatitis B all
by age 17…PAIN,PAIN,PAIN! I’ve had an implanted Intrathecal Pain Pump since 94′,and a few oral medications. I decided to not let RSD win and began workingout 2 hours daily; as I used to run Health Clubs for a living-ironic!
Unfortunitely, in the last 9 months, I started to develop severe pain again as well as unbearble Body Spasms. We thought that it was due to a malfunctioning in my pump! After 7 months of adding oral meds and going in and out hospitals, I was diagnosed with Hypersensitivity Disorder to Opiates and need to start Detox and start again with my pump. Does anyone know anyone that can help me? Has anyone done the Waismann ROD Method? I need help, I’m only 49 and this detox needs to be done ASAP?
How to Cope with Pain // Nov 5, 2009 at 5:19 pm
Hi Dede,
An article in the Medication for Pain series on opiates might be helpful. I can’t give you specifics about medication regarding your individual case, but I’d definitely suggest talking directly to your pain medicine doctor about how to taper opiates, to be sure you get correct information. Good luck!
Alina // Nov 21, 2009 at 11:50 pm
I have had an oxygen cylinder fall on my strenum,I have had radio fequencys and I’m on lyrica three times a day and two ultram three times a day. my Doctors say I have intercostal neurapthy . the Cleveland clinic. Dr. M. Stanton Hicks diagonsed my chronic pain… my husband is a certified registered nurse anesthetis.he is the one that mentioned to me about this research ketamine coma.I would like to know if there is another strong pain medication out there for my situation.thank you for your time.Alina from Battle creek michigan
How to Cope with Pain // Nov 22, 2009 at 12:40 am
Alina, while I can’t make specific recommendations for medications, you might be interested in the Monday series on different pain medications.
Vincent Gonzalez // Nov 28, 2009 at 2:12 am
I have been suffereing from Fibromyalgia and neuropathic pain for 14 years after having 6 surgeries and excessive stress , My pain has gotten
worse.I have tried everything from a-z. Has anyone had anyone had sucess with the ketamine infusion for Fibromyalgia and neuropathic pain (rsd)
Always in pain.
Vincent
julie // Dec 11, 2009 at 4:50 pm
Dr. Schwartzmann DOES NOT DO KETAMINE COMAS!!!!!!! He does ketamine infusions, which is similar, but certainly, not the same at all! There is another Dr. in Tampa who also does ketamine infusions. There are NO doctors except in Germany and Mexico who do Ketamine COMAS. I have researched this a lot, so if I am wrong please let me know, but I don’t want people getting the wrong information. Sincerest best wishes to everyone, and prayers for a pain-free tomorrow. Julie
How to Cope with Pain // Dec 11, 2009 at 8:27 pm
I believe Dr. Schwartzmann is involved in both the Germany and Mexico ketamine comas protocols. Ketamine comas are not approved in the US.
Theresa // Dec 17, 2009 at 2:01 pm
I have RSd in both hands…I have tried alot of medications to control my pain. Alot of times it isn’t under control. I have a spinal cord stimulator..take 2400mg of gabapentin..cymbalta..morphine..percocet”10/325..coming off lyrica-side effects too much. Also have lidoderm pain patches for implant site pain…I could write a book on side effects. I am constantly tired..gained around 50lbs…If I had the chance to try ketamine infusion…I would. Anything to get off some of these medications.
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