Ketamine
What is ketamine?
Ketamine is a dissociative anesthetic, or an anesthetic that blocks signals to the conscious mind from other parts of
the brain. It can cause a dreamlike state of mind or hallucinations. Because it does not suppress breathing as much as
other anesthetics, it is often used for minor surgery and for animals. Scientists in the US and Europe are currently
studying ketamine as a drug for pain therapy and the treatments of alcoholism, depression, and heroin addiction.
How can ketamine help people with RSD/CRPS?
What ketamine does is block neurons in the brain that release pain signals, which means that the patient feels decreased
or no pain when under its influence. It also allows damaged nerve cells to heal. There are currently three kinds of
ketamine treatments: the awake technique (continuous low dosage for 4-5 days), outpatient low-dose infusion (4-5 hours
a day for two weeks, then gradually lower doses), and the coma technique (continuous high dosage for about a week).
Alessa's RSD is so severe that she requires the coma technique, which is the most radical treatment.
What happens during the coma treatment?
The patient is put into a ketamine-induced coma (with additional drugs to combat the drug's hallucinogenic effects) and
monitored for several days. The dose given here is extremely high; while low-dose ketamine infusions typically run
between 25 and 90 milligrams, this treatment gives the patient between 600 and 900 milligrams. The coma calms the
nervous system and "reboots" the patient, much like a computer. There are risks with this treatment, since the patient
is in a coma: he or she could have a stroke or suffer other complications, though Dr. Schwartzman, Alessa's doctor at
the Drexel University College of Medicine, has never had major problems with temporarily comatose patients. Thirteen of
Dr. Schwartzman's patients have been completely cured; they no longer see him because their RSD is in complete
remission. All of the patients who receive this treatment have had at least some decrease in their pain levels, and some
have little to no pain at all. The goal is for the patient to wake up from the coma pain-free. In order to ensure the
maximum benefits for RSD patients after ketamine treatment, they must have physical therapy after the procedure, as
going back to one's normal routine immediately can set off the RSD again. Patients may also need occasional boosters
of ketamine, though these are typically in small doses and are legal in the United States, whereas the coma treatment
is done only in Germany. Some treatments are currently taking place in Monterrey, Mexico, but the vast majority are
done in Tubingen, Germany.
Why does Alessa have to go to Germany for her treatment?
Ketamine is considered a schedule 3 drug in America because of its abuse as a hallucinogen, especially in the rave
scene. Therefore, only a small amount of ketamine is legally allowed for medical treatment according to federal law.
RSD patients can get therapeutic boosters of ketamine in the United States, but the high doses required for the five-day
coma are only legally available overseas. Because of travel expenses, the length of the hospital stay, and other
factors, this procedure can cost anywhere from $50,000 to $150,000, and another $100,000 if the patient requires an air
ambulance.
An article from the January 2008 issue of Anesthesiology News regarding the ketamine coma can be found here.