In countries like Sweden and Germany they are inducing a Ketamine Coma for the treatment of RSD. A few years ago there was a lot of hubub on the US and UK I beleive about the toxin SNX111 being used and developed for oral form. Are we seeing any of these or other treatments like these coming to Canada to treat long term severe RSD? There is an entire community of us looking for any new breakthroughs in this area. In Canada most studies or research seems to focus on Chronic pain as a whole, and there is little to be found for investigational therapies for RSD. Any new info?
Not that I am aware of. As you probably know, the current term for the condition is CRPS one and two, depending on whether or not there is injury to a major nerve. Many of the symptoms of the condition are poorly understood. I remember a lecture years ago at the annual meeting of the American Society of Anesthesiologists in New Orleans-- the lecturer presented evidence that many of the changes that occur in bone mineralization, hair and nail growth, skin color, blood flow, etc were the consequence of immobilization of the extremity, rather than consequences of the pain disorder itself. He went on to give his opinion that RSD was nothing more than the natural consequence of poor physical therapy after injury. This was a brave statement, in front of a large group of people who made good livings from doing sympathetic nerve blocks every day! Many of the people in the room stood and walked out, some of them whistling as they left.
I used to do sympathetic blocks as a routine part of my practice, and I enjoyed them very much. The patients had temporary relief from their pain, and my wallet was temporarily filled with money. The patients were then supposed to go to aggressive physical therapy, and learn to use the limb as much as possible. It was clear that the curative part of the process was the physical therapy, NOT the blocks. And yet the blocks paid me several hundred dollars and took about 15 minutes to perform, while the physical therapy took hours and the therapist was paid a fraction of my salary. I'm not sure where I am going here... just musing a bit. I'll try to pull things together in the next paragraph...
It bothers me that doctors would rather walk out of a lecture to avoid hearing something that might cut into their income, than stick around and consider a new point of view. The American health care system-- and probably the systems in other countries as well-- are biased to reward procedures. Perhaps in part because of that bias, we often hear about 'techniques' or 'procedures' to fix things. Plus, as a society, we often would rather find a quick fix rather than change our lifestyles... just look at the popularity of bariatric surgery. Knowing what I know about how the mind works and how pain is processed, I doubt there will ever be the breakthrough you are hoping for. The one 'breakthrough', if you call it that, that I have predicted for some time will be the ability to prevent tolerance to opiate medications. I don't really know if in the big picture this will be a good thing, or whether it will end up having devastating effects on society.
The use of ketamine coma reminds me of the coma induced on the world's only survivor of rabies infection-- a young lady who happens to live in my town of Fond du Lac, who went to school with my son. She was placed in a ketamine coma (other meds were used as well, but the ketamine was thought to offer anti-viral properties that significantly contributed to her miraculous survival). Since that time several years ago the technique has been repeated a number of times around the world, but unfortunately all patients have died from their rabies infections. To tie it back to RSD... there are always trials going on, and in the early stages they always have their cheerleaders. But those early reports, that sometimes make the CBS Nightly News, are a far, far cry from replicated techniques that work in a majority, or even a fraction, of people with similar conditions.
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