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New CH.com Forum › Cluster Headache Help and Support › Medications, Treatments, Therapies › Ketamine coma for chronic pain?

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Ketamine coma for chronic pain? (Read 2563 times)

MattyAA CH.com Veteran Offline I Love CH.com! Posts: 242 Poland, EU Gender:	Ketamine coma for chronic pain? Jun 27^th, 2009 at 10:45am I wondered if this was discussed with any of you guys? I recently found an article on such experiments being conducted for chronic pain patients. Multimedia File Viewing and Clickable Links are available for Registered Members only!! You need to or
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Bob Johnson CH.com Alumnus Offline "Only the educated are free." -Epictetus Posts: 5965 Kennett Square, PA (USA) Gender:	Re: Ketamine coma for chronic pain? Reply #1 - Jun 27^th, 2009 at 1:22pm Multimedia File Viewing and Clickable Links are available for Registered Members only!! You need to or is another source but I have not explored it and so can not make a recommendation.
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MattyAA

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Re: Ketamine coma for chronic pain?
Reply #2 - Jun 27^th, 2009 at 1:44pm

Aye, true, neither have I tried much but I just red recently a lot on all possible pain alterations, I also pondered phanton pain, to the centre where I am going for acupuncture since I tried giving it a go, even if it fails I am meeting with pretty elder male who lost his leg and feels the pain in the lost leg not having it, It got me intrigued that maybe the brain records pain... and how they treat such pains? Bions for stimuling nerves is one option, DBS is another, ergotamines and hallucinogens is yet another, bio feed backs is one more, Ketamine belongs to hallucinogen therapies I believe?

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cluster

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Re: Ketamine coma for chronic pain?
Reply #3 - Jun 27^th, 2009 at 3:21pm

There was a brief case report about:

Quote:

[P02.168] IV Ketamine in the Clinic To Treat Cluster Headache

John Claude Krusz, Dallas, TX

OBJECTIVE: To investigate the utility of IV ketamine in treating cluster headache in an outpatient clinic. Cluster headaches are difficult to treat and additional treatment strategies are most desirable for this disabling disorder. BACKGROUND: Ketamine, in subanesthetic doses, has been shown to be useful in treating neuropathic pain syndromes and, in small open-label studies, refractory migraine headaches. Ketamine, at the doses employed, is an antagonist of NMDA-type glutamate receptors. DESIGN/METHODS: 4 cluster headache sufferers, all male, were treated with IV ketamine in a headache clinic during an active cluster period. The average age was 42.3 years of age. An antecubital line was placed and pulse oximetry monitoring was used in all cases. 0.4mg/kg of ketamine was infused over 90-120 minutes. In 3 cases, a second 90 minute infusion was also given. RESULTS: IV ketamine abolished the ongoing cluster headache episodes in all 4 cases treated. The average length of time that cluster headache episodes ceased was 3.4 days (range = 1.5-12 days). No patient fell asleep during treatment with ketamine. 3 patients reported transient lightheadedness during the IV infusion, lastging an average of 18 minutes. No hallucinations or dysphoria were reported by any patient. CONCLUSIONS/RELEVANCE: This results of this open-label study suggest that ketamine may have a utility in treating ongoing cluster headaches. It further suggests that NMDA glutamate receptors may play a role in the cluster headache process, possibly in the maintenance of aberrant neuropathic pain signaling. IV ketamine, in subanesthetic doses, is well tolerated and efficacious in treating disabling cluster headaches. Ketamine should be studied in a double-blind manner in this this condition.
Category - Headache - Therapeutics

Tuesday, April 28, 2009 11:30 AM

Poster Session II: Headache I (11:30 AM-2:30 PM)

Source: 61st Annual Meeting of the American Academy of Neurology 2009 - Abstracts Category Headache -

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- German CH Site

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monty

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Re: Ketamine coma for chronic pain?
Reply #4 - Jun 27^th, 2009 at 6:10pm

MattyAA wrote on Jun 27^th, 2009 at 1:44pm:

Ketamine belongs to hallucinogen therapies I believe?

Not necessarily. Ketamine blocks glutamate/NMDA receptors at lower doses, and at higher doses, it also affects the mu and sigma opiate receptors (perhaps like salvia divinorum). At large doses, it will knock a person out and cause hallucinations, but at smaller doses, it blocks pain without any hallucinations.

The study that cluster quoted was interesting - but the interruption of the headaches (average 3.4 days) is too short to make that particular therapy likely to catch on ... IVs are involved procedures and ketamine has potential for abuse/dependency. If a larger dose of ketamine did 'reset' the system like clusterbusters, it might be something that catches on ... but my feeling is that twice a week IVs won't get traction in the system.

There are other glutamate blockers to consider ... one person on this forum did mention their doctor putting them on a medicine used for alzheimers (memantine) that is a glutamate blocker - that didn't do much good, but might work in other patients, and there are other glutamate blockers worth trying.

Magnesium is one simple, cheap and rather safe way to reduce glutamate transmission of pain, and most clusterheads have a pronounced magnesium deficiency. It may not be enough to shut the cycles off, but it can reduce pain and is a good thing to include in the arsenal.

Taurine is another compound that blocks some glutamate activity without interfering with normal cognitive functions.

« Last Edit: Jun 27^th, 2009 at 7:39pm by monty »

The outer boundary of what we currently believe is feasible is far short of what we actually must do.

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