Before and After the 3-day, 4-hour
Ketamine Infusion Treatment
January 7, 2011
1. Pain centered in the left shoulder which is greater than the pain distributed throughout the entire left upper extremity, which is greater than the pain in the left face region.
2. Left thigh pain which is greater than the pain in the entire left lower extremity.
3. Right shoulder pain which is greater than the pain distributed throughout the entire right upper extremity.
1. Complex regional pain syndrome type I (reflex sympathetic dystrophy) with the primary in the left shoulder region and left face region. The diagnosis is based on multiple objective findings including changes in sweating, swelling and temperature changes. I rate her physical impairment at the time of this examination as moderate.
2. Her complex regional pain syndrome is complicated by spreading to the left lower extremity and there is also evidence of generalized complex regional pain syndrome throughout her body.
3. This patient has undergone a relatively low dose ketamine infusion (50 mg/hr) for four-hour sessions with only slight benefit.
1. We discussed the risks, potential benefits, and alternatives to the ketamine coma study versus the three-day ketamine treatment. I have asked the patient to consider both options at this time after viewing some video material that is available on the website.
2. This patient would benefit from heated pool exercises three times a week as tolerated. We discussed the benefits of the heated pool exercises as it relates to her complex regional pain syndrome.
The patient was provided with a handwritten copy of my assessment and recommendations as noted above.
ADDENDUM POST TREATMENT:
The patient was able to obtain 200 mg an hour of ketamine with very stable vital signs, limited by dysphoria.
The significant linear improvement in the patient's pain thresholds suggests that the patient would have benefitted further with a 4th day.
The patient noted less tenderness in her posterior cervical spine.
Second Four-Day Ketamine Infusion
May 18, 2012
The patient tolerated up to 200 mg per hour of ketamine limited by deep anesthesia. The patient's nausea and vomiting were controlled with 24 mg of oral Zofran. Her vital signs remained stable. The patient did not experience any hallucinations.
The patient's pain thresholds showed improvement associated with improved range of motion and strength.
The patient declined follow up after fourth infusion.
3-Day Infusion Pre- and Post- Videos
Pre-Infusion Video - January 3, 2011.....CLICK HERE (10-Minute Video)
Post-Infusion Video - January 7, 2011....CLICK HERE (11-Minute Video)
MORE INFORMATION ... OTHER PATIENTS
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