Does ketamine therapy for CRPS pain help when the pain is worse at night, making sleep impossible?
The CRPS we are discussing is complex regional pain syndrome type 1, a condition that was once known as reflex sympathetic dystrophy, or RSD. There are few medical therapies that offer relief from persistent severe pain, but ketamine infusion therapy works, and it may soon become the gold standard for CRPS pain care.
The chronic pain condition caused by CRPS can be excruciating. There are many different descriptions of CRPS symptoms. CRPS type 1 is often the result of an old injury to an arm or leg, such as a crush injury. It is likely due to a nerve injury, nerve damage, and central pain sensitization.
CRPS can be thought of as involving nerve dysfunction. When a pain signal is sent to the pain center of the brain when there is no ongoing injury, over time, a chronic pain syndrome can develop.
What makes CRPS pain worse at night? Most likely, the reason is that we are quiet and still at night, and we are able to focus more on issues of pain and discomfort. CRPS makes it very difficult to get to sleep and stay asleep.
Some people describe it as a burning pain or a constant ache in the affected limb, with increased pain sensitivity. Others feel bolts of electricity, electric shock pain or cold pain, like frostbite or an ice pick. Imagine sudden jolts, as if being struck by lightning, just out of the blue, without any particular activity or movement causing the exacerbation.
Whether CRPS causes a shooting pain, crushing pain, throbbing pain, or a stabbing pain, the thing each CRPS patient has in common is that the discomfort is relentless and intractable. Imagine a severe toothache that nothing can relieve, other than pulling the tooth.
Yet, in the case of CRPS, there is no tooth to pull to end the suffering. The patient experiences poor sleep, because CRPS pain is often worse at night.
Traditionally, doctors have prescribed opioid pain medication for pain management for RSD or CRPS. While an opioid might not eliminate the feeling of being scalded with hot water, or stabbed by a hot poker, it can make the sensation more tolerable.
Unfortunately, opioids carry a risk of long-term dependence, and addiction. Other treatments include physical therapy or nerve block, which are often ineffective.
Does ketamine for CRPS only work during the ketamine session, or does it continue helping afterwards?
Ketamine is a dissociative anesthetic, so it makes sense that CRPS pain would be made more tolerable during an IV infusion session. While the patient might still be aware of the pain, their awareness and consciousness would feel separated from the experience of pain.
But, what happens after the session is over, and the ketamine wears off? Fortunately, the effects of ketamine are long-lasting for chronic pain, neuropathic pain, peripheral neuropathy, trigeminal neuralgia, and cancer pain.
Ketamine has been used for myofascial pain syndrome, rheumatoid arthritis, fibromyalgia, amplified pain, thoracic outlet syndrome, and low back pain. Ketamine infusions also help with the pain caused by complex regional pain syndrome, improving the lives of CRPS patients.
Ketamine blocks NMDA receptors, altering the actions of neurotransmitters glutamate and GABA. While the full mechanism of ketamine for pain is not completely understood, it is believed that ketamine resets the altered pain response in the central nervous system.
Additionally, ketamine does have activity in the spinal cord that is similar to the effects of opioids. However, ketamine’s opioid effect does not lead to long-term dependence or addiction.
Another contribution to improving the CRPS pain situation may be related to ketamine’s anti-inflammatory effects. The dissociative anesthetic is known to reduce inflammation in the central nervous system.
Ketamine infusion therapy can relieve the feeling of dipping your arm or leg in boiling oil, caused by CRPS.
In most cases, a series of ketamine infusions includes six sessions. If the chronic pain syndrome is particularly severe, the clinic may schedule additional sessions.
Fortunately, ketamine for pain provides long-lasting results for many patients. There is no need to continue taking ketamine on a regular basis.
After a series of infusions, the patient will have less of a need to take additional medications to control the pain. In many cases, the patient is able to function better and tolerate CRPS without any additional medication for pain.
CRPS can also make a person very sensitive to a light breeze or gentle touch. Being touched lightly may feel like pin pricks, or even being cut with a sharp blade or stabbed with a knife. Ketamine therapy can greatly reduce this sensitivity.
Other patients may have an ongoing feeling of a sunburn or squeezing sensation, which becomes intolerable, because it is constant. Ketamine therapy also reduces these sensations, making life more pleasant.
Sleep quality also improves with an improvement in pain levels and pain sensations after IV ketamine infusion treatments. Improving sleep quality is critical to long-term healing and quality of life.
Ketamine infusion therapy can make your CRPS pain more tolerable, and it can greatly improve your quality of life and your sleep quality. If you suffer from CRPS type 1, you may want to consider getting a consultation for ketamine treatments.