Before and After the 4-day, 4-hour

Ketamine Infusion Treatment

November 15 , 2010

 

CHIEF COMPLAINT:

CHIEF COMPLAINT:

1.  Pain centered in the left hand which is greater than the pain distributed throughout the entire left upper extremity.

2.  Right face pain.

3.  Pain distal to the left knee which is greater than the pain distributed throughout the entire left lower extremity.

4.  Right upper extremity pain.

5.  Right lower extremity pain.

ASSESSMENT:

1.  Primary complex regional pain syndrome probably initiating in the left lower extremity which is now spread especially to the left upper extremity and right face.  The diagnosis is based on multiple objective findings including skin ulcers, temperature changes, color changes, and increased spreading.  The disease appears to be progressive at this time and he suffers from a severe physical impairment as well as emotional impairment as a result of the chronic pain.

2.     This patient’s complex regional pain syndrome is complicated by poor IV access, increased blood pressure as well as sleep apnea, all of which contribute significantly to his risk.

RECOMMENDATIONS:

We discussed the risks, potential benefits for the three day ketamine treatment which, in my opinion is his best option at this time.  The patient understands that the dosages and route of administration of ketamine will be given according to the recommendations of the Food and Drug Administration.  He also understands that there are at least two well-controlled clinical trials in and outside of the United States indicating the safety and efficacy of using ketamine as an outpatient treatment for complex regional pain syndrome.  The patient understands that heated pool exercises three times a week, as tolerated, will be an important part of his overall rehabilitation.  The patient also understands that management of his emotional status is going to be an important part of his rehabilitation. The patient understands that high blood pressure, obesity and sleep apnea are significant risk factors. Patient agrees that he must remain awake through out the 4-hour infusion each day.

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

ADDENDUM POST TREATMENT:

The patient had no problem with sleep apnea up to 250 mg an hour because the patient was kept awake.  The patient had no nausea/vomitting and no adverse hallucinations.  The patient had overall improvements in pain thresholds, allodynia and range of movement.  The patient also noticed an improvement in his sleep.  

 

 

Second Infusion - 4 day

July 11, 2011

ADDENDUM POST TREATMENT:

The patient tolerated up to 200mg an hour with stable vital signs while awake.

There was an improvement in pain thresholds throughout body and a decrease of swelling in the lower extremeties.

The patient had a video of function as well as face photos performed today.

 

 

 

Third Infusion - 4 day

March 19, 2012

ADDENDUM POST TREATMENT:

The patient tolerated up to 200mg of ketamine an hour with stable vital signs, no nausea or vomiting, and no hallucinations.

The patient showed improvement in pain thresholds by 10 times associated with an improved range of motion and strength in all extremities - which is documented on video. 

The patient should return for re-evaluation in 4 months.

 

 

 

 

Fourth Infusion - 4 day

October 1, 2012

 

ADDENDUM POST TREATMENT:

The patient tolerated up to 200mg of ketamine an hour  limited by history of sleep apena.  The patient experienced no hallucinations and his vital signs were stable.

The patient showed improvement in pain thresholds associated with an improved range of motion and strength - which is documented on video. 

 

 

 

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