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.)

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