“Intravenous lidocaine infusion is used to assess the potential benefits of lidocaine & related medications on managing your pain. Depending on the specific cause of your pain, some patients report immediate & long continued relief associated with the intravenous administration of lidocaine” [1]
Ketamine Infusions for relieving pain are becoming increasing popular these days, but what exactly is Ketamine? Well, the answer is that it started off as an anaesthetic agent when it “was first synthesized in the 1960s as a safer dissociative analgesic” [2], and is now being used extensively (in much smaller doses) in order to treat neuropathic pain. It is different from conventional pain killers, so if other drugs have failed, then it can be beneficial [2,3].
So What Does the Research Say?
“In the chronic pain arena, Ketamine Infusion use continues to evolve. There is strong evidence to support its short-term use for neuropathic & nociceptive pain… Its potential ability to prevent ‘windup’ & possibly, ‘reboot’ aberrant neurologic pathways in neuropathic & central pain states, has generated intense interest” [3]
Neuropathic pain describes feeling a burning sensation, with affected areas sensitive to touch. Further symptoms could also include feeling agonizing pain, numbness, having trouble sensing temperatures, and pins and needles. Nociceptive pain is the most common form of pain. It is generated by potentially harmful stimuli which are sensed by our body’s nerve endings (nociceptors). The latter describes the nerve endings which are prevalent in the skin, bones, joints, muscles and organs, located within our body’s three central cavities – the abdomen, pelvis and chest. The job of these receptors, is to make us aware of damaged tissue, and alert us to potential damage. Further, they react indirectly to the chemicals released from damaged tissue.
Putting the Spotlight on Specific Pain Conditions
“Evidence suggests that IV ketamine provides significant short-term analgesic benefit in patients with refractory chronic pain, with some evidence of a dose-response relationship” [4]
Complex Regional Pain Syndrome (CPRS)
This refers to a chronic (long-term) pain condition which can impact any area of the body, although it frequently affects an arm or leg. With regards to research, reports discussing 6 different studies that solely focused on using Ketamine Infusions to treat CRPS, indicated that: “The majority report pain relief of several weeks after an infusion in an inpatient setting over 4 to 5 days. However, outpatient infusion protocols requiring multiple serial infusions also reported pain relief lasting several months in some cases” [2]. This is excellent news, and booking outpatient appointments at the London Pain Clinic gives patients the flexibility to come in at a time of day which fits into their work schedule and family commitments.
Traumatic Spinal Cord Injury
Studies indicate that according to the dose of ketamine that the patient receives, relief can last for two weeks” [2]
CEBM level 2 evidence for Intravenous Ketamine Infusion treatment, indicates that longer-duration infusions offer patients suffering from chronic neuropathic pain, longer lasting relief from their pain [2]. And whilst the rate of infusion does not appear to be associated to either the time period, or the degree of pain relief provided by various ketamine infusion protocols, the result of increases in the total dose of ketamine administered: culminate in a higher degree of pain relief, and possibly a longer time period without pain. The later observation could possibly be attributed to either the extended duration of infusions, or the higher doses of ketamine being delivered [2].
Would Could Exclude Me From Treatment?
Your specialist pain consultant will conduct a comprehensive review of your medical history, and give you a full examination. If this form of treatment is not suitable for you, then they will inform you, and discuss other options. Patients with certain medical issues and conditions would not be suitable candidates. These include: being pregnant, or intending to become pregnant; epilepsy; unstable/untreated thyroid function; unstable mental health issues (e.g. schizophrenia/psychoses), note: depression is not normally a barrier to treatment); uncontrolled bronchitis/asthma; a chest infection; arrhythmic heart beat, angina; unstable heart disease; or uncontrolled/untreated high blood pressure [5].
Can I Drive After My Ketamine Infusion?
No, you must not drive either after, or whilst recovering from treatment [5].
References
[1]. Stanford Health Care (2020). “Intravenous Lidocaine Infusion.”
https://stanfordhealthcare.org/medical-treatments/i/intravenous-lidocaine-infusion.html#:~:text=The%20intravenous%20lidocaine%20infusion%20is,the%20intravenous%20administration%20of%20lidocaine
[2]. Maher, D. “Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization.” Anesthesia & Analgesia: February 2017 – Volume 124 – Issue 2 – p 661-674.
https://journals.lww.com/anesthesia-analgesia/fulltext/2017/02000/Intravenous_Ketamine_Infusions_for_Neuropathic.41.aspx
[3]. Allen CA, Ivester JR Jr. Ketamine for Pain Management-Side Effects & Potential Adverse Events. Pain Manag Nurs. 2017 Dec;18(6):372-377. Epub 2017 Jul 23. PMID: 28743507.
https://pubmed.ncbi.nlm.nih.gov/28743507/
[4]. Orhurhu et al. “Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” Anesthesia & Analgesia. 2019 Jul;129(1):241-254.
https://pubmed.ncbi.nlm.nih.gov/31082965/
[5]. NHS UK (2020). “Ketamine Infusion.”
https://www.iow.nhs.uk/Downloads/Chronic%20Pain/Ketamine%20Infusion%20Leaflet.pdf
