man holding red and swollen wrist to indicate CRPS

Can Ketamine Provide Relief for Chronic Regional Pain Syndrome?

Complex Regional Pain Syndrome (CRPS) is a multi-faceted and often misunderstood chronic pain condition that can significantly impact the lives of those affected. Ketamine for CRPS is a newer form of treatment that can offer rapid relief without the side effects and abuse potential of traditional pharmaceuticals. Read our article to learn more about CRPS and how ketamine works to alleviate this painful condition. 

What is CRPS?

CRPS is characterized by intense pain, usually in one arm or leg, although it can spread to other extremities. It is often triggered by an injury, such as a fracture or deep cut. It has also been known to develop after a surgery or cardiac event. Pain persists after the original injury should have healed and manifests to a much greater degree than the original trauma.  

There are two subcategories of CRPS:

  • CRPS Type I was previously known as Reflex Sympathetic Dystrophy (RSD). This type presents without any indication of nerve damage and accounts for a majority of CRPS cases. 
  • CRPS Type II is also called “causalgia.” This is a much rarer form of CRPS that involves evident nerve damage in the injured limb. 

Symptoms of CRPS

The symptoms of CRPS are varied, but the most common include: 

Pain: pain is the number one symptom of CRPS. Patients report severe stabbing, burning, throbbing, grinding, and other unpleasant sensations in the affected limb or limbs.

Discoloration: the skin of the affected limbs may change color. It may appear bright red, patchy, or even purple. 

Swelling: acute swelling may be observed in the painful area. 

Temperature Changes: the painful limb may feel hot or cold in relation to the rest of the body. 

How is CRPS Usually Treated?

Because the pain felt by the patient is objectively out of proportion to what a doctor physically observes, CRPS was once thought to be largely psychological. Continued research has demonstrated that it is not, in fact, a mental health disorder (although chronic pain can certainly have mental health repercussions). Rather, CRPS manifests as a combination of physiological responses, including inflammation, hypersensitivity, circulatory issues, and poor brain response to pain signals. 

Treatment for CRPS depends on the type and severity of symptoms. It often involves several modalities to address the multi-faceted nature of the syndrome:

Medications

A wide range of pharmaceuticals may be used to treat CRPS. These are not limited to analgesics. For example, there is evidence to support the use of tricyclic antidepressants and certain blood pressure medications in the management of CRPS symptoms.  Anticonvulsants, like gabapentin, may also be helpful for nerve pain. 

Therapy

Various therapeutic techniques have been employed, some in an attempt to try to retrain the brain’s interpretation of pain signals. Mirror box therapy, for example, reflects the unaffected limb so it appears to the patient that they are moving the injured one without pain. Physical therapy may also be prescribed, with emphasis on mobility and weight bearing on the affected limb. 

Surgery

In extreme cases, surgery may be recommended to prevent physiological deterioration and improve quality of life. Spinal cord stimulators, for example, are implants that have been approved by the FDA for CRPS that has failed to respond to other therapies. 

A sympathectomy is another surgical procedure that may be employed, but only as a last resort. This involves removing the part of the sympathetic nervous system thought to be causing the amplified pain symptoms. One or more of the nerve cell bodies (ganglia) that run along the spinal cord is severed. This can also be done chemically or via radiofrequency (low-dose radiation). 

Evidence for Ketamine for CRPS

If you ask someone with CRPS, they will probably tell you they have tried just about everything, from heating pads to hypnosis. Traditional therapies are often inadequate or too extreme/dangerous (i.e. surgery or opioids). 

Ketamine continues to demonstrate efficacy in a wide array of both mental and physiological conditions, including CRPS. A 2021 study found that low dose ketamine significantly reduced CRPS patients’ pain scores, with effects lasting for up to four weeks in half of the test subjects. Systematic reviews of individual studies also continue to support the use of ketamine for treatment-resistant CRPS. 

Benefits of Ketamine for CRPS

Not only can ketamine treat symptoms of refractory CRPS,  it does so with potentially fewer risks and side effects than associated with some traditional therapies. Unlike opioids, for example, low dose ketamine has a lower addiction potential and patients do not experience the often-severe gastrointestinal side effects associated with drugs like oxycodone and hydrocodone. You also do not need to taper ketamine as you would with long-term use of opioids, antidepressants, neuropathic agents, and other medications traditionally used to treat CRPS. 

Furthermore, ketamine can have the added benefit of alleviating mental health concerns that have arisen as a result of living with chronic pain. It is not uncommon for CRPS patients to develop depression and, alarmingly, one study found that 49 percent have considered suicide. Thorough research and clinical evidence supports the use of ketamine for treatment resistant depression and acute suicidal ideation. 

Ketamine for CRPS in Florida

The Crane Center in Destin, Florida offers ketamine assisted psychotherapy as one of our many treatment modalities. We understand the frustration and despair that often accompany chronic pain and will work with you to find long term relief. If you have been suffering with CRPS or a treatment-resistant mental health disorder, please call our office or go online to schedule a consultation. 

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