ketamine infusion

[2ndtwin]

Does anyone out there know anything about ketamine infusions?
They want me to try this twice a week for 5-6 weeks. If it doesn't help then I will have to have a second spinal cord stimulator put in for my back. I already have one in my shoulder that was implanted in 2003. Any information, help or advice would be greatly appreciated.

[hlh]

My father had ketamine infusions while he was still in the acute injury phase - in the hospital with lots of nerve pain and pretty unbearable musculoskeletal pain (his legs had multiple fractures, deep tissue injuries with open wounds - just a mess). He had an order that they had to give him a ketamine infusion before every turn and dressing change for awhile, since these experiences were torture for him. It seemed to work quite well. It was somewhat sedating for him. He also would have some hallucinations and very vivid dreams. One night he woke up thinking he was in Australia..... He laughs about this now, and recalls extremely vivid hallucinations. This was very manageable in the hospital, and at the time it was good that he had this treatment option for his pain. It took weeks of poorly controlled pain, until the doctors consulted the Pain service doctors, and they titrated up his neurontin to 800mg TID, increased his morphine/dilaudid prn doses and added the ketamine. Pretty heavy duty regimen. There is supposed to also be a synergistic effect between ketamine and the morphine class of pain meds (i.e. their cumulative effects are higher when used together).

I suspect your dose will be lower then his, and everyone has different side effects. They will probably want to monitor you while you are getting the medication to see how you react.

[2ndtwin]

Thank you so much for the information. If this doesn't work or is not covered by insurance then I will need to have a second spinal cord stimulator for pain. How many days does it take for the side effects (hallucinations, dreams,etc.) to go away? I am crossing my fingers that this will work. Thanks again!

[hlh]

If I remember correctly, the reason they wanted to use ketamine IV for my dad is because it is supposed to "kick in quickly" (ex. within a few minutes) and also was supposed to be short lasting (ex. wear off in 30 minutes). So perfect for a quick treatment for a brief, very painful experience (eg. dressing changes of his wounds). Certainly, I don't think these times are completely correct, and I suspect they would vary depending up your other medicines, your kidney/liver function, age, dose etc... We noticed that he seemed to be more out of it/sedated for several hours after he was given a shot.

But remember, my dad was in a very different situation then you. He is a lot older, and at the time he was getting this treatment he had recently suffered a head injury/wasn't sleeping/had infections/was on multiple neuroactive medications that would also make him dopey. So your response would likely be very different.

Also, his hallucinations/bizarre dreams seemed to only occur at night - the night after he took a dose - and not every day. And they actually didn't bother him that much.

Who is trying this treatment for you? A pain specialist/anesthesiologist?

[2ndtwin]

I went to a pain specialist in Peabody, MA. First we have to see if my insurance will cover it or if they will consider it experimental. It has been shown to provide great pain relief to patients with RSD (which is my problem). It is either that or a spinal cord stimulator. Thanks so much. A few years ago I suffered severe hallucination due to a combination of 2 drugs. It was awful. I saw everything in neon colors. My husband said I would wake up screaming hysterically and climbing the walls asking him "to keep the scary clowns away from me".

[hlh]

It sounds like this could be an exciting medicine for you to try, since it has shown some benefit for RSD. Good luck! It would be wonderful to avoid placing another stimulator.

Yes, I realize that hallucinations can be very unsettling/disturbing at times. And if you have had an unpleasant experience before, I am sure that has stayed with you..... But I am hoping you will not let this potential side effect worry you too much.... or make you reconsider trying a treatment that could be very interesting.

I knew a woman who had pretty severe Parkinson's disease, and when I mentioned to her that a (less common) side effect of one of the medicines she could take for her symptoms was hallucinations, she refused to take the medicine. She had had a prior experience while hospitalized when she was put on several "neuroactive" drugs and had a hallucination that scared her. Worried she would relive that experience, she essentially refused to be treated for her Parkinson's disease. She suffered a lot as a result....

good luck!

[2ndtwin]

Thank you for all the information! Even though the hallucinations were definitely not fun, I am willing to give anything a try before surgery. The stimulator for my shoulder still works great after almost 5 years, but surgery is always a last option. Especially since alot of reoccurring RSD episodes happen after surgery; minor or major. I am just waiting for precertification from my insurance company (why does it seem like all insurance companies are "right up there with God). I have had really good luck with them so far but as all pain patients know, each day is like a month of waiting. If you hear anything else, please log back on. Thanks again!