Ketamine infusions for refractory complex regional pain syndrome: a review

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Published: May 11, 2016
DOI: https://doi.org/10.18192/uojm.v6i1.1508

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Jordon Lui
UBC

Abstract

Complex regional pain syndrome (CRPS) is a debilitating pain disorder that is often resistant to conventional treatment options. Al­though the precise pathophysiology of CRPS has not yet been fully elucidated, it is thought that central sensitization through the proliferation of N-methyl-D-aspartate (NMDA) receptors leads to the amplification of pain transmission within the central nervous system. Accordingly, the NMDA antagonist ketamine has been employed for its potential ability to reverse central sensitization and provide analgesia. Promising studies have shown that ketamine, when administered through prolonged intravenous infusions, may be effective for relieving pain in cases of refractory CRPS. Currently, ketamine infusions for CRPS are offered at select pain clinics in North America. However, it should be emphasized that evidence from high-quality trials is lacking and unresolved concerns over potenial neurotoxicity, urological toxicity, and hepatotoxicity of prolonged ketamine use remain. These concerns render the long-term use of ketamine questionable. Therefore, ketamine infusions should be used with caution, and may be a reasonable therapeutic option only for refractory cases of CRPS. Proper monitoring for signs of toxicity must be ensured. In addition, a physical intervention program should be used in conjunction with ketamine to fully restore function and quality of life for refractory CRPS patients.

  

Le syndrome douloureux régional complexe (SDRC) est un trouble de douleur débilitante qui est souvent résistant à des options de traitements conventionnels. Malgré le fait que la pathophysiologie précise du SDRC n’a pas encore été confirmée, certains chercheurs pensent qu’il y a une sensibilisation centrale par l’intermédiaire de la prolifération de récepteurs N-méthyl-D-aspartate (NMDA) qui conduisent à l’amplification de la transmission de la douleur dans le système nerveux central. En conséquence, l’antagoniste-NMDA, la kétamine, a été utilisé pour sa capacité de renverser la sensibilité centrale en créant un effet analgésique. Des études prometteuses ont démontré que la kétamine, lorsqu’administrée par des infusions intraveineuses prolongées, pourrait s’avérer efficace pour apaiser la douleur dans des cas de SDRC réfractaires. Des infusions de kétamine pour le SDRC sont offertes actuellement à des cliniques de douleur spécifiques en Amérique du Nord. Toutefois, il manque d’essais randomisés de qualité pour démontrer clairement l’efficacité de ce traitement. Des connaissances plus approfondies sur le potentiel neurotoxique, la toxicité urologique, et l’hépatotoxicité de l’utilisation prolongée de kétamine sont nécessaires. Ainsi, les infusions de kétamine doivent être utilisées avec précaution et ont un potentiel thérapeutique seulement pour les cas réfractaires de SDRC. Il est important d’assurer un suivi adéquat pour des signes de toxicité. De plus, un programme d’intervention physique devrait également être offert en plus des traitements de kétamine pour op­timiser la fonction et la qualité de vie des patients avec un SDRC réfractaire.

Article Details

Issue
Vol. 6 No. 1: Preventative and Personalized Medicine
Section
Review & Clinical Practice
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