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Reflex Sympathetic Dystrophy (RSD) (CRPS) Message Board


Reflex Sympathetic Dystrophy (RSD) (CRPS) Board Index


good luck with the Dr Schwartzman visit. he required us to do a weeklong lidocaine infusion, before being put on the list for ketamine infusion. we were constantly reminded of his patient load, when asking "time consuming" medical questions. we crossed the line, when we called his office to ask a question about the amount of lidocaine my wife was receiving, that didn't follow the treatment plan. she was immediately "unplugged" 2days early, we were once again reminded about the question/patient load "ratio", and told to forget about the ketamine infusion, because we were no longer a patient of his,,,, nice guy
-Cindy, Perhaps you could ask Dr. Hasmi about all this & let us know his thoughts. I've read much of their stuff at their website, they seem to support sympathetic blocks (but vocally against sympathectomies unless your life expectancy is <5 yrs as they've seen permanent disruption problematic-e.g. denervation supersensitivity), some antidepressants & anticonvulsants. I haven't seen them update their site in a while on newer developments like the prolonged IV ketamine cocktails that have fully resolved some cases of long standing intractable RSD (but it's a relatively new development).

Ketamine has been around since the 60s but only more recently has the application of prolonged IV (e.g. 72 hours) low dose subanesthetic & high anesthethic doses to block the NMDA receptor (implicated in the maintenance of central sensitization/chronic neuropathic pain states after healing of original injury) been tried. The main side effect of ketamine was the psychomimetic effects (derivative of PCP-a.k.a. "angel dust") & memory impairment but apparently this can be limited-blocked by careful titration &several drugs like clonidine, anticholinergics, GABAergic antiepileptics & others. I believe a controlled study is underway as the results have been so promising (but since it's generic it will be harder to fund).

I currently take for the burning pain-worse at night: Klonopin 0.5 mg 2x/late in day-(the brand for clonazepam eventhough inexpensive clonazepam seemed to have worked-one reason because Dr. Hooshmond advocated only the brand-but I may try the generic again) & clonidine 0.05 mg 2x/day for the SNS symptoms/pain. I'm not sure if the clonidine is making my extremities colder so I actually have been trying to take less.

References:

- Water immersion wrinkling -

Wilder Smith EP. Water immersion wrinkling>physiology and use as an indicator of sympathetic function. Clin Auton Res. 2004 Apr;14(2):125-31.

Wilder Smith E, Chow A. Water immersion and EMLA cause similar digit skin wrinkling and vasoconstriction. Microvasc Res. 2003 Jul;66(1):68-72.

Wilder Smith EP, Chow A. Water-immersion wrinkling is due to vasoconstriction. Muscle Nerve. 2003 Mar;27(3):307-11.

Vasudevan TM, van Rij AM, Nukada H, Taylor PK. Skin wrinkling for the assessment of sympathetic function in the limbs. Aust N Z J Surg. 2000 Jan;70(1):57-9.

Alvarez G, Eurolo J, Canales P. Finger wrinkling after immersion in water. Br Med J. 1980 Aug 30;281(6240):586-7.

Bull C, Henry JA. Finger wrinkling as a test of autonomic function. Br Med J. 1977 Feb 26;1(6060):551-2.

- Ketamine -

Md RE, Correll GE. Successful treatment of a nine year case of complex regional pain syndrome type-I (reflex sympathetic dystrophy) with intravenous ketamine-infusion therapy Pain Med. 2002 Jun;3(2):147-55.

Maleki J. "Sensitization": is there a cure? Pain Med. 2002 Dec;3(4):294-7.

Kiefer RT, Rohr P, Ploppa A, Dieterich H, Schwartzman RJ et al. Ketamine-Midazolam Anesthesia for intractable Complex Regional Pain Syndrome-Type 1 (CRPS-1). IASP 2002 Conference

Ploppa A, Kiefer RT, Schwartzman RJ et al. - Skin Blood Flow Changes During Ketamine-Midazolam Anesthesia for Intractable CRPS1. IASP 2002 Conference

Olney JW, Farber NB. NMDA antagonists as neurotherapeutic drugs, psychotogens, neurotoxins, and research tools. Neuropsychopharmacology. 1995 Dec;13(4):335-45.

Handa F, Tanaka M, Nishikawa T, Toyooka H. Effects of oral clonidine premedication on side effects of intravenous ketamine anesthesia: a randomized, double blind, placebo-controlled study. J Clin Anesth. 2000 Feb;12(1):19-24.

Jevtovic-Todorovic V, Wozniak DF, Powell S, Nardi A, Olney JW. Clonidine potentiates the neuropathic pain relieving action of MK-801 while preventing its neurotoxic and hyperactivity side effects. Brain Res. 1998 Jan 19;781(1-2):202-11.

Olney JW et al. NMDA antagonist neurotoxicity: mechanism and prevention. Science. 1991 Dec 6;254(5037):1515-8.





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