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13 Oct 2004
www.medilexicon.com
Severe pain relief may be possible with a common anesthetic drug
A novel treatment using a common anesthetic drug has shown success in
reducing the severe pain caused by Complex Regional Pain Syndrome
(CRPS), according to a study published in the September 2004 issue of
Pain Medicine. CRPS, a disorder that can be associated with chronic pain
resistant to conventional therapies, affects between 1.5 and 7 million
people in the United States. CRPS is sometimes also known as Reflex
Sympathetic Dystrophy (RSD).
editor's note: Complex Regional Pain Syndrome is pain that may occur after an injury. In rare cases, the syndrome develops after surgery, a heart attack, a stroke or other medical problem. The pain is often described as a burning feeling and is much worse than expected for the injury or medical problem. Your doctor may also call this causalgia. The cause of the syndrome is not known.
"This pain disorder can be very difficult to treat. Currently-available
conventional therapies, at best, oftentimes only make the pain bearable
for many CRPS sufferers," said Ronald E. Harbut, MD, PhD, of Penn State
Milton S. Hershey Medical Center, corresponding author of the study. "In
our retrospective study, some patients who underwent a low-dose infusion
of ketamine experienced complete relief from their pain, suggesting that
this therapy may be an option for some patients with intolerable CRPS."
Thirty-three patients with unrelenting CRPS were treated using this
novel approach developed by Dr. Graeme E. Correll, BE, MBBS, in Mackay,
Queensland, Australia. Pain relief and the duration of this relief
appeared impressive. After only one treatment, there was complete relief
in 76% (25) of the group. 54% of the patients remained free of pain for
more than three months, 31% for more than six months. Although the
relief of pain did not last indefinitely, it was noted that following a
second treatment given to 12 of the patients, the outcome was improved.
In this retreated group 58% remained pain free for more than a year and
almost 33% experienced relief for over three years. The most frequent
side effect was a feeling of inebriation with less frequent effects
including hallucinations, dizziness, light-headedness and nausea.
"Ultimately, we want to find a way to improve the quality of life for
those who suffer with intolerable and endless CRPS -- that is our hope,"
said Harbut. Although optimistic about these early findings, "Certainly
more study is needed to further establish the safety and efficacy of
this novel approach." (A large clinical study is currently planned and
under development at Penn State Hershey Medical Center.)
Rollin M. Gallagher, MD, MPH, Editor-in-Chief of Pain Medicine, notes,
"How medical breakthroughs occur is usually a story of human ingenuity
and perseverance fueled by compassion and intellect. Dr. Correll's
promising innovation, forged by necessity in tiny resource-poor clinics
in the jungles of Papua-New Guinea and Northern Australia and carefully
shepherded to publication by his co-authors, may herald an effective
treatment for one of mankind's most enigmatic and agonizing diseases.
Prospective, controlled studies must follow to establish its safety and
efficacy."
Media wishing to receive a PDF of this article, please contact
medicalnews@bos.blackwellpublishing.net. Additional information about
CRPS can be found at www.rsdhope.org.
About the Authors
Graeme E. Correll, BE, MBBS, a Fellow of the Australian & New Zealand
College of Anaesthetists, has been an anesthesiologist for over 30
years. He originally worked as an anaesthetist (anesthesiologist) in
Papua-New Guinea (PNG) for 5 years in the remote jungle communities of
Lae and Rabaul. As anesthetic resources were limited in these isolated
areas, Correll relied heavily on the intravenous anesthetic ketamine.
Under these unique working conditions, Correll became exceptionally
experienced in the administration of this medication. Correll later
moved to Mackay, where he continued his profession for over 20 years as
the principal anaesthetist in what started out as a small sugar-cane
community in tropical northern Queensland. While in Mackay, he used his
anesthetic experience from PNG to eventually help him sort out and
develop a treatment method using low doses of ketamine that met the
analgesic needs of his chronic pain patients. He initiated this novel
approach to treating CRPS, while he was senior anaesthetist
(anesthesiologist) at Mackay Base Hospital.
Ronald E. Harbut, MD, PhD, Assistant Professor of Anesthesiology at Penn
State Hershey Medical Center, is Board Certified in Anesthesiology and
Pain Medicine and has a background in both Pharmacy and Pharmacology.
Harbut first met Correll while working in Australia in the late 1990s.
While in Australia, Harbut was impressed with Correll's findings and the
two began collaborative relationships that eventually led to the Mayo
Clinic Scottsdale. While at Mayo, Correll and Harbut's belief in a value
of this unique approach to treating neuropathic pain was furthered along
by colleague Jesse J. Muir, MD, who likewise shared a special interest
in the treatment of neuropathic pain. Working together, Correll's
technique was brought to the United States.
Other members of the research team include: Jahangir Maleki, MD, PhD,
Assistant Professor of Neurology, and Edward J. Gracely, PhD, Associate
Professor of Family, Community and Preventive Medicine and Public
Health. Both are from Drexel University College of Medicine in
Philadelphia. Maleki, who trained in psychiatry in Germany and in
neurology, neurophysiology, and pain medicine in the United States, was
instrumental with Harbut in writing this manuscript. Gracely provided
biostatistical analysis. Jesse J. Muir, MD, Assistant Professor of
Anesthesiology at Mayo Clinic Scottsdale, is Board Certified in
Anesthesiology and Pain Medicine. He has served as both Pain Clinic and
Pain Medicine Fellowship Director at Mayo Clinic Scottsdale.
Special recognition goes to Drs Maleki and Gracely for their analysis of
these data, to Drs Maleki and Muir for their help in developing this
manuscript, and to the Editorial Board of Pain Medicine for their
support and suggestions.
About Pain Medicine
Pain Medicine, the official journal of the American Academy of Pain
Medicine, is a multi-disciplinary journal dedicated to the pain
clinician, teacher and researcher. The journal reflects the rapid growth
in the area of pain research and management. Readers benefit from the
most up-to-date information available on the practice of pain medicine
as the journal promotes both visibility and credibility of pain medicine
as a medical specialty. For further information, please visit
www.blackwellpublishing.com/pme.
About the American Academy of Pain Medicine
Founded in 1983, the American Academy of Pain Medicine (AAPM) has
evolved as the primary organization for physicians practicing the
specialty of Pain Medicine in the United States. The organization is
devoted to the advancement of pain management, education and research.
AAPM is the only pain organization with representation in the American
Medical Association (AMA) House of Delegates. For membership information
and benefits - including your subscription to Pain Medicine - visit
www.painmed.org.
About The National Pain Foundation
If you are looking for additional resources and information on pain,
please visit www.painconnection.org. The National Pain Foundation, a
non-profit 501(c)(3) organization, was established in 1998 to advance
functional recovery of persons in pain through information, education
and support. The NPF is built on the belief that early intervention of
pain conditions can positively change the direction of a person's life.
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