Treating Pain NYC

Symptoms

Many people, even those without symptoms, may have evidence of spinal stenosis on an MRI or CT scan. When they do occur, they often start gradually and worsen over time. Symptoms vary depending on the location of the stenosis and which nerves are affected.

How Does it Work?

The procedure itself could not be simpler. An IV line is placed in the patient’s arm and the medication is flows in.
A variety of different medications can be used:

The most effective medications for neuropathic pain are KETAMINE AND MAGNESIUM. Depending on what your specific needs are, the medications are typically mixed with saline in an IV bag and infused slowly over minutes to hours, depending on the medication and/or protocol being used.

Consensus Guidelines on Ketamine

The American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists published consensus guidelines on the use of IV ketamine for chronic pain in the journal of Regional Anesthesia & Pain Medicine.

The authors created guidelines for indications; contraindications; whether there was evidence for a dose-response relationship, or a minimum or therapeutic dose range; and what constitutes a positive treatment response.

Ketamine Nasal Spray

Ketamine is most effective when given through an IV. Unfortunately, not every patient has the time to get an infusion or get them as often as they need to keep their pain under control. That’s where ketamine nasal spray comes in handy – it comes in a small nose spray container like any other nasal mist medication that one would use for sinus congestion or allergies and works the same way. The medication is made by a specialty pharmacy upon request from your doctor. Low doses of ketamine from a nasal spray has shown to be an effective treatment unto its own for chronic pain and several mood disorders such as chronic depression – when used in conjunction with IV ketamine infusions, one can improve their pain control in the interim between their infusions and improve their overall quality of life!

What is Ketamine Nasal Spray?

Ketamine is a complex molecule – while it can be taken orally, it decreases the efficacy considerably by traveling the through the stomach and the rest of the gastrointestinal (GI) track and is why it is almost always given through an IV or infusion. Unfortunately, getting an IV every time a person is in pain is not a realistic solution…this is where intra-nasal ketamine (aka ketamine nose spray) comes in handy. It is virtually the same exact medication, just reformulated to be able to be given through a spray in the nose the same way a cold or allergy medication would be used. This treatment requires a doctor’s prescription and usually requires the medication to be filled by a specialty pharmacy.

Postpartum Depression

Ketamine not only treats postpartum depression (PPD), but it can even prevent it

Mast Cell Activation Disorder

Ketamine has a profound inhibitory effect on mast cells

Opioid Dependence

Ketamine can simultaneously relieve pain & decrease dependency on opioids

Pain

Ketamine is a powerful treatment for many types of chronic neuropathic pain

Major Depression

Racemic ketamine is FDA approved for treatment resistant depression (TRD)

PTSD

Stellate ganglion blocks & ketamine nose spray are proven & effective treatments for PTSD

References

[1] Bartlett EE, Hutaserani Q. Lidocaine (xylocaine) for the relief of postoperative pain. J Am Med Womens Assoc. 1962;17:809-15. Boas RA, Covino BG, Shahnarian. Analgesic responses to i.v. lignocaine. Br J Anaesth 1982;86:235-239.
[2] Kosharskyy B, Almonte W, Shaparin N, et al. Intravenous Infusions in Chronic Pain Management. Pain Physician 2013; 16:231-49.
[3] Wechsler RJ, Frank ED, Halpern EH, et al. Percutaneous lumbar sympathetic plexus catheter placement for short- and long-term pain relief: CT technique and results. J Comp Assisted Tomography 1998; 22:518-23.
[4] Viola V, Newnham H, Simpson R. Treatment of intractable painful diabetic neuropathy with intravenous lignocaine. J Diabetes Complications. 2006; 20:34-9.
[5] Kastrup J, Petersen P, Dejgard A, et al. Intravenous lidocaine—a new treatment of chronic painful diabetic neuropathy? Pain 1987; 28:69-75.
[6] Williams DR, Stark RJ. Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse 2003; 23:963-71.
[7] Tretmont-Lukats IW, Challapalli V, McNicol ED, et al. Systemic administration of local anesthetics to relieve neuropathic pain: A systemic review and meta-analysis. Anesth Analg 2005; 101:1738-49.
[8] Rowbothman MC, Reisner-Keller LA, Fields HL. Both intravenous lidocaine and morphine reduce the pain of post-herpetic neuralgia. Neurology 1991; 41:1024-8.
[9] Sorensen J, Bengtssn A, Backman E, et al. Pain analysis in patients with fibromyalgia, effects of intravenous morphine, lidocaine and ketamine. Scan J Rheumatol 1995; 24
[10] Grigoras A, Lee P, Sattar, et al. Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery. Clin J Pain 2012; 28:567-72.
[11] Reuben SS, Sklar J. Intravenous Regional Anesthesia with Clonidine in Management of Complex Regional Pain Syndrome of the Knee. J Clin Anesth. 2002;14:97-91.
[12] Nama S, Meenan DR, Fritz WT. Ketamine and Adjuvant Demedetomidine when Treating Acutre Pain from CRPS. Pain Physician. 2010;13:365-68.
[13] Fischer SG, Collins S, Boogaard S, et al. Intravenous Magnesium for Chronic Complex Regional Pain Syndyome Type 1 (CRPS-1). Pain Medicine 2013; 14:1388-99.
[14] Kubalek I, Fain O, Paries J, et al. Treatment of reflex sympathetic dystrophy with pamidronate: 29 cases. Rheumatology (Oxford) 2001; 40:1394-7.
[15] Quibell, Rachel; Prommer, Eric E., Mihalyo, Mary, Twycross, Robert, Wilcock, Andrew (1 March 2011). “Ketamine*”. Journal of Pain and Symptom Management 41 (3): 640–649.
[16] Eide PK, Stubhaug A, Stenehjem AE. Central dysesthesia pain after traumatic spinal cord injury is dependent on N-methyl-D-aspartate receptor activation. Neurosurgery 1995; 37:1080-7.
[17] Eichenberger U, Neff F, Sveticic G, et al. Chronic phantom limb pain: The effects of calcitonin, ketamine, and their combination on pain and sensory thresholds, Anesth Analg 2008; 106:1265-73.
[18] Schwartzman RJ, Alexander GM, Grothusen JR, et al. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo controlled study. Pain. 2009;147:107-15.
[19] Mercadante S, Arcuri E, Tirelli W, et al. Analgesic effect of intravenous ketamine in cancer patients on morphine therapy: A randomized, controlled, double-blind, crossover, double-dose study. J Pain Symptom Manage 2000; 20:246-52.
[20] Graven-Nielsen T, Aspegren Kendall S, Henriksson KG, et al. Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients. Pain 2000; 85;483-91.
[21] Goebel A, Baranowski AP, Maurer K, et al. Intravenous immunoglobulin treatment of complex regional pain syndrome: a randomized, controlled trial. Ann Intern Med. 2010; 152:152-8.
[22] Goebel A, Netal S, Schedal R, et al. Human pooled immunoglobulin in the treatment of chronic pain syndromes. Pain Med. 2002; 3:119-27.
[23] Medlin F, Zekeridou A, Renaud S, et al. Favorable outcome of an acute complex regional pain syndrome with immunoglobulin infusions. Clin J Pain 2013; 29:e33-4.
[24] Wallace MS, Ridgeway BM, Leung AY, et al. Concentration effect relationship of intravenous lidocaine on allodynia of complex regional pain syndromes I and II. Anesthesiology 2000; 92:75-83.
[25] Varenna M, Adami S, Rossini M, et al. Treatment of complex regional pain syndrome type I with neridronate: A randomized, double-blind, placebo-controlled study. Rheumatology (Oxford) 2013; 53:534-42.
[26] Jorum E, Warncke T, Stubhaug A. Cold allodynia and hyperalgesia in neuropathic pain: The effect of N-methyl-D-aspartate (NMDA) receptor antagonist ketamine-a double blind, cross-over comparison with alfentanil and placebo. Pain 2003; 101:229-35.
[27] Gottrup H, Bach FW, Juhl G, et al. Differential effect of ketamine and lidocaine on spontaneous and mechanical evoked pain in patients with nerve injury pain. Anesthesiology 2006; 104:527-36.