Before and After the 3-day, 4-hour

Ketamine Infusion Treatment

April 19, 2010

CHIEF COMPLAINT:

CHIEF COMPLAINT:

1.  Pain centered in the left foot which is greater than the pain distributed distally from the left knee to the foot.

2.  Right foot pain which is greater than the pain distributed distally from the left knee.

3.  Bilateral hand pain with the right being equal to the left.

 

ASSESSMENT:

1.  Primary complex regional pain syndrome (RSD) of the right lower extremity.  The diagnosis is based on multiple objective findings including swelling as well as color changes.  I rate her physical impairment at the time of this examination as severe.

2.  Her CRPS is complicated by generalized spreading, high-dose opioid use, chronic smoking, and overweight.

3.  She has had lumbar sympathetic blocks and spinal cord stimulation without lasting benefit.

 

RECOMMENDATIONS:

This patient wants to proceed with a three-day ketamine treatment.  The patient understand she is at increased risk for respiratory arrest due to her history of smoking as well as being overweight.

 

The patient was provided with a handwritten copy of my assessment and recommendations as noted above.

 

ADDENDUM POST TREATMENT:

The patient's vital signs showed hypoventillation at 200 mg an hour. There were improved pain thresholds in the extremities.  The patient was able to walk for the first time without a limp. There was a decrease in allodynia.

There appears to be a significant decrease in facial swelling -- SEE ABOVE "BEFORE" AND "AFTER" PHOTO

The patient’s clinical outcome and treatment plan was document in a video recording. The patient was provided a copy of the pre-treatment and post-treatment videos.

 

 

 

 

PAIN THRESHOLDS FOR NORMAL SUBJECTS

MORE INFORMATION ... OTHER PATIENTS

 

 

 

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