The neurocognitive effects of 5 day anesthetic ketamine for the treatment of refractory complex regional pain syndrome.
BACKGROUND
Complex regional pain syndrome I (CRPS) is characterized by severe neuropathic pain that exceeds the severity of an injury and is refractory to traditional treatments. Recent experimental interventions include ketamine infusion therapy.


OBJECTIVE
We sought to evaluate the physical, neurocognitive, and emotional effects of extended treatment with anesthetic doses of ketamine in refractory CRPS I patients.


METHODS
Nine patients (eight females) received a neuropsychological evaluation pre- and 6 weeks post-treatment that evaluated intellectual and academic abilities, executive functioning/processing speed, attention, learning and memory, and motor functioning. Mood/affect and personality were also evaluated and patients completed an extensive pain questionnaire.


RESULTS
There was a marked reduction in the report of both acute and overall pain after treatment. Brief attention and processing speed improved significantly post-treatment, whereas all other cognitive domains remained stable, with the exception of a mild decline in motor strength.


CONCLUSIONS
Findings suggest that, at least at a 6-week follow up: (1) deep ketamine therapy is effective for relief of pain CRPS I and (2) there were no adverse cognitive effects of extended treatment with deep ketamine infusion. No definitive conclusions could be drawn about the relationship between mood and personality factors and the presence of CRPS I.
Koffler
Sandra P
SP
Department of Psychiatry, College of Medicine, Drexel University, 245 North 15th Street, Philadelphia, PA 19102, USA. Sandra.Koffler@drexelmed.edu
Hampstead
Benjamin M
BM
Irani
Farzin
F
Tinker
Jennifer
J
Kiefer
Ralph-Thomas
RT
Rohr
Peter
P
Schwartzman
Robert J
RJ
D000328:Adult; D000777:Anesthetics / Q000494:pharmacology* / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007649:Ketamine / Q000494:pharmacology* / Q000627:therapeutic use*; D007858:Learning / Q000187:drug effects; D008950:MMPI; D008297:Male; D009483:Neuropsychological Tests; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy*; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology; D012720:Severity of Illness Index
D000777:Anesthetics; D007649:Ketamine