HELP Ketamine infusions for chronic pain

[Runtoparadise]

Hi guys,

Just wondering if anyone has found ketamine infusions helpful for neuropathic pain?

As I mentioned briefly in another thread, my pain mgt specialist is a huge believer in these, I've now had five performed subcutaneously at increasingly high doses and requiring lengthy hospital stays.

I've never believed that these work too well for me, however I'm becoming despondent at the lack of options available for my kind of pain.

I understand ketamine works on NMDA receptors, and my last infusion my pain would not subside a bit until my dose was 1000mg/48hrs. Which was as high as my doctor was prepared to go. Even himself admitting that perhaps my pain had found a new pathways around other receptors.

Either way, for almost a decade I've had random bouts of neuropathic pain, sometimes my cns goes into overdrive resulting in central sensitisation.

You guys are a clever lot, I'm a long time lurker and hoping one of you more scientific types might come up with something even slightly plausible either to present to my pain mgt dr, or umm, otherwise stumble upon.

Thanks,

Rtp

 

[The Doc.]

If you don't mind me asking what condition dp you suffer from?
Does your doctor realise the lack of analgesic effect of ketamine in patients who have suffered neuropathic pain for several years shows that NMDA receptors are not always involved in the perception of all types of pain and indicates that NMDA receptors become less important for pain perception in older patients with a long pain history.

 

[Runtoparadise]

How lovely to get a response, an educated response, Trainspotter.

From my drs perspective I do believe he does know this. I asked him what is used when NMDA receptors aren't involved and he answered " it hasn't been discovered yet".

He has booked a phone consult with my GP, in regard to raising my opiates, which is in a wk or two. He'd told me I'd have to "earn my stripes" before that wd happen,- so I guess I have.

Just to clarify, I've had three different types of arthritis develop from when I was twenty, and the neuropathic pain seemed to develop as I went from dr to dr to specialist to specialist. I was "too young" to have pain in my back, hips, shoulders and hands that rendered me useless. My pain mgt dr says changes occurred in the wiring of my brain due to bring in constant, unremitting pain and it not being treated. Well, until imaging began..

So, I proceeded to develop crps, several other terms smtms appear on my paperwork, CNPD, one of them.

Any more input greatly appreciated, and thanks again.

Rtp

 

[The Doc.]

Ouch I'm so sorry your in so much pain you mist be really strong to deal with that daily.

How well do the opiates help? Do they have you on fairly low doses or are you up pretty high in dose already?
Opiates can also make pain seem like its worsening or more so your tolerance to pain goes down when compared to how you were before opiates. That could be another option sometimes they can turn against us its called opioid induced pain.
Over time individuals taking opioids can develop an increasing sensitivity to noxious stimuli, even receiveing a painful response to previously non-noxious stimuli. Some studies on animals have also demonstrated this effect occurring after only a single high dose of opioids.

Has your doctor tried any non narcotic medications with you? I can do some research later on my laptop and see if there are any good options for you I can't think of any of the top of my head.

 

[pasha]

homeless -> other drugs

 

[HdoubleODeezy]

Have you tried anything like Lyrica or gabapentin?

 

[The Doc.]

Have you tried anything like Lyrica or gabapentin?

I was the wondering that myself you would think these would be one of the first options a doctor would try before narcotics anyways.

 

[Runtoparadise]

Thanks guys,

Yes, I began with NSAIDs, and cortisone etc before beginning low dose opioids, which quickly escalated as they were helping a tiny bit, but not enough - & I had a freely prescribing GP.

Once I discovered the wrld of pain mgt, I was told, oh no, I don't have bone pain, by a prick of a dr, & that Gabapentin would cure all.

A cpl of yrs on, no Gabapentin hadn't done it's job. Along with my then gp, & rhuemy, we were always butting heads over whether my opiod tolerance was growing or if my conditions were wrsng. I was on moderate opioids by then, & drs here r v.cautious w/imaging.

Many nuclear & CT's had been performed, every one shwng ongoing bone dmg, amongst odd fndngs, eg: bone marrow changes although my bloods r almost perfect.

So my gp escalated me to fent patches, higher oral opioids.

I researched a new pain mgt dr, and also changed gp. My gp of the past two yrs is an incredibly knowledgeable German lady, but any changes to my care must come from my pn mgt dr.

Having just said that, I actually asked to change to lyrica about two mths ago, having read a lot about it here,- mainly in helping with opioid wds.

So, I'm prescribed 200mg oxy/oxycodone per day. That doesn't really take the edge off, so sme mrngs it's really 200-500mg then it helps. I can get anything done. Housework, physio, etc. I'm not new to playing around with my doses, so my tolerance is uh,- kinda crazy.

So, short answer, opioids wrk for my arthritic and bone pain. They're not causing me pain,- I also take amytriptyline, Diaz, lyrica.

Obviously I run out early, and do suffer, but I've found the Lyrica to help most wd symptoms. Here in oz u can get ur scripts btwn 21& 28 days, tomorrow is day 22,- wish me luck boys

Thanks again,

Rtp

 

[Runtoparadise]

^Trainspotter,

Neuroplasticity sp? Is a v.new word over here. I discovered (googling in my docs waiting rms lst time), chronic pain causes the Hippocampus to shrink over time. Exercise can reverse this and the pain over time. Thoughts appreciated.

Rtp

 

[Runtoparadise]

Trainspotter,

If not NMDA, then what other receptors amplify pain?

Btw, thanks for ur kind comments, I'm prob stronger than I realise. And, yes I'm always in varying levels of pain, but I'm v.good at hiding it!

As in, not many ppl even know I've got this bullshit thing going on. It's a pride and vanity thing

Rtp

 

[HdoubleODeezy]

Norepinephrine, opiate and dopapine receptors all affect pain perception.
As do alpha receptors in my opinion.

Putting it short.. almost all receptors affect pain one way or another.

-HOOD

 

[Runtoparadise]

^Hood,

Thanks for the input,

Sorry for the double posts,- getting there

Rtp

 

[The Doc.]

Hi there sorry I got busy with work so I'm just peeking my head back in the thread now.

There are many places for pain to originate from its very hard to tell exactly what receptors are causing you pain as HOOD says there are many reasons for chronic pain and unfortunately for patients like you chronic pain isn't fully understood yet. I would like to make it my life mission to better understand chronic pain syndromes so patients like you can live a happier life.
Pain experience is strongly modulated by interactions of ascending and descending pathways. Having a doctor that Understands these modulatory mechanisms in health and in disease is critical for developing effective therapies for the treatment of chronic pain conditions.
For instance In some neuropathic pain syndromes, "crosstalk" occurs between descending sympathetic nerves and ascending sensory nerves. Increases in sympathetic nervous system activity can result in an increase of pain this is known as sympathetically mediated pain.
I would see what your doctor has to say but there are many many very different treatmemt options out there I bet he hasn't tried yet.
Topical applications such as lidocaine are out there that show effectiveness at treating sympathetically mediated pain. Anti depressants are shown to work on treating some pain in patients who are not depressed. Spinal cord stimulators and implanted spinal pumps,Motor cortex stimulation,deep brain stimulation, Neuromodulators, Cannabis, botox, and I supose you've already tried anti convulsents lyrics gabapentin etc. But you can see there are a wide range of significantly different treatment options for you but even so studies show only 40-60% of patients like you even achieve partial relief from their symptoms.

And yes exercise can help a ton its great for mental and physical disorders as long as you keep it up and follow it with a healthy lifestyle. Its not like you go run around the block and your feeling better as you probably know haha yea I know duh but you'd be surprised many give it up before it even gets a chance to work.

 

[Runtoparadise]

Thx Trainspotter,

I guess that's why I get so frustrated with all of this, like, ffs, I'm not & never will be the person in the most pain.

Thanks for the msg. Once again,-under duress, I had my pain mgt dr prescribe lidocaine patches, but as he said, " there won't be enough to cover ur pain areas".

I'm forever researching new treatments, and presenting new options to my doctors,- but it just comes down to what legal here, lol, obv, and what's been proven in crossover randomised trials.

I'm so plsd to hear that ur on ur life's journey, and u want to learn to help make others life's better. Don't give up,

Thx again for ur response,

Rtp

 

[Runtoparadise]

M'k, so it'd seem I'm dbl posting again, I'm on my ph, sorry.

I appreciate anyone's thoughts on this, I'm mebbe ftftiml a lil scared.

In light of what I've written prev re: ketamine infusions,- it's been over three mths since my last where, being my highest dose ever, (1000mg/24hr x2), I thought I really was wasting everyone's time when it still only reduced my flare up of neuropathic pain moderately. Still enough for me to return to my day to day biz.

For the most part of a week I've been in self inflicted wds, (from opiates), & whilst I was amazed at how well I was doing, the pain has risen out of my control once again.

My pain mgt doc is away but returns Monday, however if I choose to/absofuckingneedto be admitted another consultant at the practice has written me up a starting dose of 1000mg.

I believe my dr has always treated my pain aggressively, in many varying methods, and I trust his methods, but that's one hell of a loading dose and I have concerns.

Valid? Idk, but if anyone reading has experience I'd Realllllly love some input. I'm aware of kidney probs.

Lastly, I've known about these for a number of yrs and again, if we're not hitting the correct receptors, it'd be rendered useless... Ketamine induced comas to " rewire" my brain? In Germany.

Trainspotter,

I'll brb to chat, nice bio

Rtp

 

[HdoubleODeezy]

Holy shit.. im staying outta this but wish i had a dr rx me ketamine for my pain. even though i love opiates, they're a no go for me cuz im flagged in the system.
(stupidly being honest with my drs bout drug use, DONT DO IT PEOPLE lol honestly is the best policy for everything in life BESIDES when it comes to pain management lol)

I skimmed the thread once more, what opiates are you prescribed?

-HOOD

 

[Runtoparadise]

I'm prescribed 200mg oxy per day. 60mg b.i.d. 40mg once a day & oxycodone 20mg x2 for bt pain. Along with 150mg Lyrica b.i.d. Amytriptyline 20mg q.i.d, & diazepam 2mg prn, & a new one,- Mirtazapine, for sleep.

So, yeah Hood, the ketamine makes the world a bit rosier,- but most of the time I'm in all over agony, so don't get to enjoy it,- most of the time

I have it in a Niki pump and receive it subcut, usually it takes ten to fourteen days, but my dr hopes to get it down to four. That was the idea with my last infusion,- admitted fri & home by mon night,- but he said in hindsight he'd started me off too low. Which is why I was mind blown at 1000mg from the get go.

Once at the public hospital, (local ED), they gave me an iv shot. Holy shit, the world spun, didn't do nada for the pain, I was like "don't EVER do that again"!! That's why I don't enjoy it for any rec value!

R u in oz Hood? Only curious, bcos I've been flagged as a "dr shopper", twice. At my own GP clinic where my permits held while she was on holls. My pain mgt dr had a crack at them for not being educated in the regulations, it's apparently bcos of the "high doses" I require. If only they knew what I Really "required". Agree with u on that one, dishonesty IS the best policy.

So urself, chronic pain too? I shall try to find a thread or two to have a peek. Unless ud like to share?

Be good.

Rtp

 

[HdoubleODeezy]

Ive just had mental disorders and bad back and leg pain my whole life (well since about 13-15 years old)
Im in the US and they just laugh at me when i try to get into pain mgt they think i just want the drugs.. which is half true but only because im in pain! lol makes sense to me!
Ever since i told a Dr i was on Suboxone (when i was on it way back then) i havent been able to get any opiates rx'd to me unless obviously needed. I can get benzos from one of my drs but no opiates unless i get injured (they wont help my chronic pain and it pisses me off because i live with it daily) like last winter i got a boxers fracture (broke my hand) and it was physically disformed and needed to be reset so they did so and it hurt, i walked out with a rx for 45 5mg vics i was like yeah this will last 2 days.
Called the doctor to explain my situation with opiate tolerance and received 10 5mg vixodin (keep in mind before he knew about it he gave me 45) and was cut off after that.
The doctor said, the computer said i was taking a chance giving you narcotics and obviously it was right. i said well than ask the computer how much it hurts to have your right hand broken when you are a righty.
they never get it.. just because i have abused pain meds in the past, i have been through treatment and am off them BUT IT DOESNT MEAN IM NO LONGER ABLE TO FEEL PAIN lol. Shits just retarded and unfair, i only abused opiates when i was younger because of my back and leg pain and no dr wanting to rx to a 13 year old.. so i turned to the streets, when i told the doctors that i knew immediately i made a mistake and should have kept my mouth shut.

Anyways life goes on
and on.

-HOOD

 

[Runtoparadise]

Do u know why u have back and leg pain? I could see that getting passed off as growing pains in a male teen, but for it to remain with u ten+ yrs? Or maybe to ur drs it wouldn't matter any which way.

I hope ur mental disorders r being treated and taken seriously, & that benzos help u in that area & it's relatively under control?

I was on high dose anti depressants pretty much from the start of my pain,(diff to now, where my endep is an adjunct pain therapy), told by my then GP everyone with pain gets major depression. I ran out one day and never filled the next script, soon realising weeks had passed and my mood was still pretty good.

My pain dr & gp have a conference call booked this week regarding increasing my oxy. I've spent the last twelve mths literally being a guinea pig to pain mgt. I think in one thread I've mentioned my pain dr said I had to earn my stripes & that an increase in meds is last resort.

Pretty much every week I want to scream at my drs, saying it's just not enough, I'm too tolerant to my current dose, this is how I'm fucking managing my pain, a box of oxycodone is ONE dose to enable me to move freely and not close to pain free!!! Therefore I go thru a few days of wds each mth, and am so bloody tired of attempting to calculate which days they'll best be. As every addict or psuedo-addict knows, the emotional recourse of drugs/wds, drugs/wds eventually sets in.

But I can't, for worrying I'll be branded an addict, and justifiably so, as ur story is not a new one my friend.

Rtp x.

 

[edgewise1]

You think by being honest the dr will understand that you are aware of the problems of addiction and that you are actually in pain! But I agree 100%, you can't tell the truth if you have addiction problems in your past. I had one gp tell me I was addicted to opiates, another to kick me out of his practice with a certified letter informing me I was a narcotic drug addict. All of this happened before the age of computers and my present dr knows nothing of the former doctors. But now I pretty much use my pain meds the correct way because I am in constant pain! I still play around 3, maybe 4 times a month and that means I have to do with less for a few days but at least I have some to cover me until my next dr visit. It is only my lyrica that I seem to run out of early.

Runtoparadise, I hate to hear how much pain you are in. I will keep you in my thoughts my friend.