Ketamine is a potent anesthetic that has been used as an experimental and controversial treatment for Complex Regional Pain Syndrome.
This was conceptualized by neurologist Dr Robert J. Schwartzman
The basis for using it to treat CRPS may reside in its strong ability to block N-methyl D-aspartate (NMDA) receptors.There is sufficient evidence to suggest that a intense or prolonged painful stimulus causes an extraordinary release of glutamate from peripheral nerve fibers that carry pain information.
This glutamate stimulates NMDA receptors on second-order neurons that produce the phenomena central sensitization.
Thus it seems reasonable that by blocking NMDA receptors, one might also be able to block cellular mechanisms supporting windup and central sensitization.
Ketamine is a potent NMDA-blocking drug and prolonged infusion of ketamine appears to maintain a level of ketamine in the central nervous system long enough to reverse the effects of the sensitization process and associated pain.
The ketamine therapy can be done by a low dose ketamine infusion of between 10–90 mg per hour over several days.
The second treatment modality consists of putting the patient into a medically-induced coma, then administering an extremely high dosage of ketamine; typically between 600–900 mg.
However, the ketamine thearpy does not have final word on it yet. There are no credible reports in the peer-reviewed literature of such immediate and long lasting effects from this treatment.
Proper clinical trials are required before we know the effects and the risks of this procedure.
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