Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that has been increasingly used in the management of treatment-resistant chronic pain conditions, particularly representing neuropathic involvement or central sensitization. Complex regional pain syndrome (CRPS) is a prototypical condition often treated with ketamine infusions. Although the analgesic benefits of ketamine as an opioid-sparing adjunct in the preoperative period have been well studied, the use of ketamine to mitigate chronic pain conditions remains largely anecdotal, composed largely of case reports and uncontrolled small studies. The limited evidence and published reports support the use of ketamine infusions as one aspect of a comprehensive, multimodal approach for CRPS. Although ketamine infusions are relatively safe when titrated appropriately, with minimal respiratory depression, side effects include sympathetic activation, unpleasant psychomimetic effects, lower urinary tract symptoms, and hepatic dysfunction.
Clozapine as an Effective Antipsychotic in Treatment Resistant Mania: Two Case Reports
