Ketamine PDF Print E-mail
What is ketamine?
Ketamine is a dissociative anesthetic, or an anesthetic that blocks signals to the conscious mind from other parts of the brain. It can cause a dreamlike state of mind or hallucinations. It is often used for minor surgery and for animals. It is a powerful medication; its use is tightly controlled by the U.S. Food and Drug Administration.

How can ketamine help people with RSD/CRPS?
Ketamine blocks neurons in the brain that release pain signals, which means that the patient feels decreased or no pain when under its influence. It also allows damaged nerve cells to heal, including those that contribute to the muscle spasms, inflammation, and other affects of RSD.

How is ketamine used to treat RSD/CRPS?
There are currently three kinds of ketamine treatments:

- Awake technique (continuous low dosage for 4-5 days),
- Outpatient low-dose infusion (4-5 hours a day for two weeks, then gradually-lower doses), and
- Coma technique (continuous high dosage for about a week).

Brandy completed the outpatient low-dose ketamine infusion regimen, but this provided only temporary relief. Her RSD was so severe that she required the coma technique, which is the most radical treatment. Only the most serious cases of RSD are referred to Germany for the coma treatment.

What happens during the coma treatment?
The patient is put into a ketamine-induced coma (with additional drugs to combat the drug's hallucinogenic effects), supported on a ventilator, and monitored in the Intensive Care Unit (ICU) for five to seven days. The dose of ketamine given here is extremely high; while low-dose ketamine infusions typically run between 25 and 90 milligrams, this treatment gives the patient between 600 and 900 milligrams. The coma calms the nervous system and "reboots" the patient, much like a computer. At the appropriate time, the ketamine is tapered and the patient is brought out of the coma gradually, and once off the ketamine remains in the ICU for several days before being moved to a regular hospital room for about a week. The patient then has to stay in a hotel near the hospital for a week or more to make sure there are no complications.

There are significant risks with this treatment, since the patient is in a coma. He or she could have a stroke, blood clot, pneumonia, or suffer other complications, though there have never been any “catastrophic” complications. All patients suffer some hallucinations, and many have night terrors. The results are worth the risk, however – the RSD is in complete remission in approximately half of the patients who have undergone the ketamine coma treatment. All of the patients who receive this treatment have had at least some decrease in their pain levels, and some have little to no pain at all. Brandy developed pneumonia during the treatment, but it was treated right away and was gone quickly.

The goal is for the patient to wake up from the coma pain-free, as Brandy did. In order to ensure the maximum benefits for RSD patients after ketamine coma treatment, many must have physical therapy after the procedure. Patients will also need boosters of ketamine following the ketamine treatment. These boosters are done in Philadelphia, whereas the coma treatment is done in Saarbrucken, Germany. Some treatments are currently taking place in Monterrey, Mexico, but the majority have been done in Germany.

Why did Brandy have to go to Germany for her treatment?
The U.S. Food and Drug Administration will not allow ketamine to be used to induce a coma in RSD patients. RSD patients can get therapeutic boosters of ketamine in the United States, but the high doses required for the five-day coma are only legally available in other countries. Brandy’s specialist, Dr. Robert J. Schwartzman of Drexel University College of Medicine in Philadelphia, is one of the few RSD specialists in the nation. He has partnered with Dr. Peter Rohr, Head of Anesthesiology at Klinikum Saarbrücken in Germany to do the ketamine coma treatments at the Klinikum Saarbrücken.

How much does the ketamine coma treatment cost?
Travel expenses, the length of the hospital stay, and other factors (such as the value of the dollar against the Euro) add up. This procedure can cost from $50,000 to $150,000, plus another $100,000 if the patient requires an air ambulance. Because the ketamine coma treatment isn’t approved in the U.S., health and medical insurance companies won’t cover the cost of the treatment or the travel. The follow-up physical therapy and booster treatments may or may not be covered by insurance; in Brandy’s case, the physical therapy will be, but the boosters and associated travel will not.