Reduction of central neuropathic pain with ketamine infusion in a patient with Ehlers-Danlos syndrome: a case report.
OBJECTIVE
Ehlers-Danlos syndrome frequently causes acute and chronic pain because of joint subluxations and dislocations secondary to hypermobility. Current treatments for pain related to Ehlers-Danlos syndrome and central pain syndrome are inadequate. This case report discusses the therapeutic use of ketamine intravenous infusion as an alternative.


METHODS
A 27-year-old Caucasian female with a history of Ehlers-Danlos syndrome and spinal cord ischemic myelopathy resulting in central pain syndrome, presented with severe generalized body pain refractory to multiple pharmacological interventions. After a 7-day course of ketamine intravenous infusion under controlled generalized sedation in the intensive care unit, the patient reported a dramatic reduction in pain levels from 7-8 out of 10 to 0-3 out of 10 on a numeric rating scale and had a significant functional improvement. The patient tolerated a reduction in her pain medication regimen, which originally included opioids, gabapentin, pregabalin, tricyclic antidepressants, and nonsteroidal anti-inflammatory drugs.


CONCLUSIONS
Ketamine infusion treatment has been used in various pain syndromes, including central neuropathic pain, ischemic pain, and regional pain syndrome. Reports have suggested that ketamine modulates pain by the regression of N-methyl-D-aspartate receptor to a resting state. As such, propagation of nociceptive signal to brain is interrupted allowing for the restoration of physiological balance between pain inhibition and facilitation. The present report shows that this treatment option can be used in patients with refractory central pain syndrome in the setting of spinal cord myelopathy secondary to Ehlers-Danlos syndrome. In addition, as seen in this case, this protocol can potentially decrease the chronic use of pain medication, such as opioids.
Department of Physical Medicine and Rehabilitation, University of California Irvine, Orange, CA.
Tony Chung Tung
TC
Lo
Department of Immunology, University of Connecticut School of Medicine, Farmington, CT.
Stephen Tung
ST
Yeung
Department of Physical Medicine and Rehabilitation, University of California Irvine, Orange, CA.
Sujin
S
Lee
Department of Palliative Medicine, University of California San Diego, La Jolla.
Kira
K
Skavinski
Department of Palliative Medicine, University of California Irvine, Orange, CA, USA.
Solomon
S
Liao
analgesia; central neuropathic pain; central pain syndrome; connective tissue disorders
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