Journal article
CNS Measures of Pain Responses Pre- and Post-Anesthetic Ketamine in a Patient with Complex Regional Pain Syndrome
Pain medicine (Malden, Mass.), v 16(12), pp 2368-2385
Dec 2015
PMID: 26745152
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Previous reports have indicated that ketamine anesthesia may produce significant improvement if not complete recovery of patients with complex regional pain syndrome (CRPS).
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.
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).
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.
The observed changes in brain response to evoked stimuli provide a readout for the subjective response.
Future studies of brain function in these patients may provide novel insight into brain plasticity in response to this treatment for chronic pain.
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Details
- Title
- CNS Measures of Pain Responses Pre- and Post-Anesthetic Ketamine in a Patient with Complex Regional Pain Syndrome
- Creators
- L Becerra - McLean HospitalR J Schwartzman - Drexel UniversityR T Kiefer - University of TübingenP Rohr - University of TübingenE A Moulton - McLean HospitalD Wallin - McLean HospitalG Pendse - McLean HospitalS Morris - McLean HospitalDavid Borsook - McLean Hospital
- Publication Details
- Pain medicine (Malden, Mass.), v 16(12), pp 2368-2385
- Publisher
- Wiley
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:000368297000019
- Scopus ID
- 2-s2.0-84956947249
- Other Identifier
- 991019167624304721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Anesthesiology