Healing Chronic Pain Syndromes with Ketamine

This is a story about a nurse anesthetist and how she healed with ketamine.

I was put in touch with Beth, a person with an exciting story about being healed through ketamine. She’s a mutual friend of a special person who’s an expert at aligning people for the greater good.

Beth is an active woman, a nurse anesthetist, who suffered with years of foot pain that eventually prevented her from enjoying her favorite activity, nature hikes. She consulted with a podiatrist, and he recommended a double bunion osteotomy to correct the second toe deformity. Shortly after, she had the surgery, and the procedure went as planned, without apparent complications. Some days later, Beth removed the bandages and her foot appeared dark and mottled to everyone’s surprise. The bruising and dark skin represents a probable lack of blood flow and inadequate healing. Her foot and especially the toes were painful. She presented her painful, dark foot to her surgeon, who initially dismissed her pain and offered reassurance that it would heal with time.

Left With Pain

The wounds from the foot surgery were healed, but she was left with pain. Not just any type of pain, constant pain. In life, pain is as real as it gets. People can deny many things, but no one can deny pain, no matter who you are. Accurately describing pain involves several dimensions:

Location – The pains started from the toes and would travel to her ankle.

Duration – The pain was constant, as if someone was continuously hitting her foot with a hammer.

Intensity and timing – The pain was sometimes less and sometimes stronger, but it was always there; sometimes dull, about a 4/10 on the pain scale, to quickly 10/10.

Quality - The pain was knife-like, shooting, stabbing and excruciating when the sheets touched her toes. She found sleep nearly impossible, and nothing could be touching her foot.

Impact on function – Physical activity was impossible because of the pain. Hiking was certainly out of the question.

The pain was constant, never going away. The pain was knife-like, stabbing, and quickly became intolerable.

Pain Dismissal

Again, she presented her pain to the podiatrist, and again, he blew Beth’s pain as if she was dreaming it up. Though the scars from the foot surgery healed, she was left incapacitated, unable to walk normally, unable to work as a nurse anesthetist, and certainly unable to enjoy those nature hikes she was dreaming about.

Beth was referred to a pain management doctor who is an anesthesiologist. She was diagnosed with Complex Regional Pain Syndrome or CPRS, which is defined as abnormal pain after a trauma or injury. Here’s a rundown of CRPS.

Complex Regional Pain Syndrome is a chronic pain condition that usually affects one limb, often after an injury. It’s believed to be caused by damage to or malfunction of the peripheral and central nervous systems. CPRS affects many systems including the nervous, immune, vascular, energy, and ultimately the cells. The condition is characterized by prolonged or excessive pain and changes in skin color, temperature, and swelling in the affected area.

Common signs and symptoms of CRPS:

Continuous, intense pain: This pain is described as a burning, "pins and needles," or as if the limb is being squeezed. It may be out of proportion to the severity of the initial injury.

Sensitivity to touch or cold: Even mild or normal touch can be perceived as painful (allodynia).

Swelling in the affected area: This can be persistent and might increase over time.

Changes in skin temperature: The skin on one extremity feels warmer or cooler than the opposite.

Skin discoloration: Skin may become discolored, turning red, purple, pale, or blotchy.

Changes in skin texture: Skin may appear shiny and thin.

Abnormal hair and nail growth: Hair may grow faster or slower than usual. Nails can grow faster or slower and become brittle or grooved.

Joint stiffness and damage: Movement can be restricted, and the joints may become stiff. In severe cases, cartilage damage ensues.

Muscle spasms, weakness, or atrophy: Reduced muscle coordination and strength, leading to tremors or an unsteady gait.

Decreased ability to move the affected limb: Motor disability, with decreased range of motion.

Abnormal sweating pattern in the affected area: Either increased sweating (hyperhidrosis) or reduced sweating (anhidrosis).

How CPRS Happens

Surgery inherently involves the disruption of anatomical structures, which includes severing skin, nerves, and blood vessels to some extent. The primary goal is to address a specific medical issue, which sometimes necessitates cutting through these tissues. Surgeons employ techniques to minimize damage and facilitate healing. However, despite meticulous surgical techniques, the manipulation of tissues can lead to complications such as pain, delayed healing, or, in cases like Beth's, more complex conditions such as CRPS.

When CPRS develops, the skin is dark, mottled in color, and abnormally sensitive to touch. For example, most CPRS patients experience allodynia, which is a medical term for abnormal pain response from a normal sensory stimulus, such as the sheet touching her foot in this case.

The pain management doctor first treated Beth “nerve-numbing” medications called gabapentin, and anti-inflammatory medications such as ibuprofen with limited relief. He then performed specialized lumbar sympathetic nerve blocks using local anesthetics. The hope was to calm her nerves causing the pain, both peripheral and in her brain. The block also calms down the autonomic nervous system and the pain fibers supplying the foot. Beth underwent several of these blocks, again with partial relief. The blocks worked at first and then would wear off, and she found herself back at square one. Additionally, the costs of the blocks were becoming a financial burden, adding to her distress in addition to her inability to work.

A Dead-End

Months had passed since the surgery and Beth could hardly sleep. Even the lightest touch from sheets escalated her pain to 10 out of 10 on the VAS pain scale. The pain was becoming intractable, meaning nothing would help it. She found herself at the end of the road; in French this is called “cul-de-sac.” Beth was becoming isolated, hopeless, and felt like a burden to those around her. Such feelings are the essential ingredients for suicide as I’ve explained in the Revolutionary Ketamine. She began to have suicidal ideations. Her husband wanted to take her to a concert, instead Beth was wondering how she could end her life in a hundred different ways.

A friend sent her a Netflix documentary about a young girl with CRPS who was treated with prolonged ketamine infusions. As a nurse anesthetist, Beth is familiar with ketamine as she’s given to many patients. Initially, she was skeptical about trying ketamine, thinking there’s no way it would work. Some months later, she repeated the blocks, and the same thing happened: the relief wore off. Now she was on narcotic pain medicines and life as she knew it had changed. Again, she thought to herself if this is how her life was going to be, it wasn’t worth living.

Her friends urged her to consider ketamine. They pushed her to go a little farther. Beth went to the pain management doctor inquiring about using ketamine to treat her CPRS pain. He hesitated to treat her with it and told her he would research the drug and get back to her.

New Hope with Ketamine

In desperation, Beth went to a nurse anesthetist colleague who ran a ketamine clinic. Beth was given the typical low-dose ketamine protocol used for CPRS, a prolonged infusion of ketamine over several hours. She rapidly felt a difference after the first treatment. The pain had reduced in intensity. She experienced a moment without pain for the first time since the surgery. Beth had a total of seven treatments. During that time, the color returned to her foot, the pain subsided, and was able to get restorative sleep for the first time in months.

The treatments were cash-pay since insurance doesn’t cover the use of ketamine for chronic pain syndromes like CPRS. For now, only Spravato intranasal ketamine is covered by insurance. But she found a way to pay for the treatments because it literally saved her life. She was on the brink of suicide. Beth also attributes her result to her belief in God and having good friends, which helped her push further.

CRPS is a complex condition that can evolve, potentially spreading to other body parts or worsening symptoms. Early diagnosis and treatment are essential to manage the symptoms effectively. If you suspect CRPS, it's crucial to consult with a healthcare professional for a proper evaluation and appropriate management.

Since Beth recovered from CPRS, more patients have reached out with CPRS. But the rate limiting factor is that ketamine is out of reach financially, and most understand the importance of using ketamine, but they're not doing it because they feel like they can't afford it and it's just frustrating.

There’s many more stories like this in my book The Revolutionary Ketamine.