title: CNS Measures of Pain Responses Pre- and Post-Anesthetic Ketamine in a Patient with Complex Regional Pain Syndrome.
abstract: BACKGROUND
  Previous reports have indicated that ketamine anesthesia may produce significant improvement if not complete recovery of patients with complex regional pain syndrome (CRPS).
  
  
  OBJECTIVE
  Here we report on a patient who had CRPS affecting mainly the right side of her body who underwent functional magnetic resonance imaging (fMRI) scans prior to and in the months following apparent successful treatment with anesthetic doses of ketamine.
  
  
  METHODS
  The patient underwent two imaging sessions: one during her pain state (CRPS+) and 1 month after her ketamine treatment in her pain-free state (CRPS-). Both spontaneous and evoked (brush, cold, and heat) pain scores decreased from 7–9/10 on a visual analog scale prior to the treatment to 0–1 immediately following and for months after the treatment. For each imaging session, the identical mechanical (brush) and thermal (cold and heat) stimuli were applied to the same location (the skin of the dorsum of the right hand).
  
  
  RESULTS
  Comparison of CRPS+ vs CRPS- for the three stimuli showed significant changes throughout the cerebral cortex (frontal, parietal, temporal, cingulate, and hippocampus), in subcortical regions such as caudate nucleus, and in the cerebellum. In addition, resting state network analysis showed a reversal of brain network state, and the recovered state paralleled specific default networks in healthy volunteers.
  
  
  CONCLUSIONS
  The observed changes in brain response to evoked stimuli provide a readout for the subjective response.
  
  
  CONCLUSIONS
  Future studies of brain function in these patients may provide novel insight into brain plasticity in response to this treatment for chronic pain.
authors.affiliation: Pain/Analgesia Imaging Neuroscience (PAIN) Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
authors.forename: L
authors.initials: L
authors.lastname: Becerra
authors.affiliation: Drexel University College of Medicine, Department of Neurology, Philadelphia, Pennsylvania, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Schwartzman
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University, Tuebingen, Germany.
authors.forename: R T
authors.initials: RT
authors.lastname: Kiefer
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University, Tuebingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Rohr
authors.affiliation: Pain/Analgesia Imaging Neuroscience (PAIN) Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
authors.forename: E A
authors.initials: EA
authors.lastname: Moulton
authors.affiliation: Pain/Analgesia Imaging Neuroscience (PAIN) Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
authors.forename: D
authors.initials: D
authors.lastname: Wallin
authors.affiliation: Pain/Analgesia Imaging Neuroscience (PAIN) Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
authors.forename: G
authors.initials: G
authors.lastname: Pendse
authors.affiliation: Pain/Analgesia Imaging Neuroscience (PAIN) Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
authors.forename: S
authors.initials: S
authors.lastname: Morris
authors.affiliation: Pain/Analgesia Imaging Neuroscience (PAIN) Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Borsook
mesh_terms: D000328:Adult; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods*; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging / Q000379:methods; D016896:Treatment Outcome
chemical_list: D007649:Ketamine