Affiliation:
1. Mountain View Headache and Spine Institute
Abstract
Introduction Fibromyalgia is a complex disorder characterized by distributed and persistent pain often associated with fatigue and depression. The underlying causal agents of this dysfunction are not clear. Ketamine has been used to treat chronic pain in a variety of pain syndromes, including fibromyalgia, but the dosing protocols used are neither standardized nor consistent across cases. The current case presents an opportunity to contribute to a progression towards a consensus on ketamine dosing for fibromyalgia. Case Presentation A 60-year-old female presented with indications of fibromyalgia and was administered a 9-session IV ketamine treatment for pain. The initial dosing was 50 mg, with a concentration of 1.0 mg/ml at an infusion rate of 0.8 mg/kg/hr. This was increased to 200 mg and eventually to 240 mg, maintaining a ketamine concentration 4.0–4.8 mg/ml at an infusion rate of 1.5 mg/kg/hr. Management and Outcomes Following the first 9-session therapy, the patient reported >50% pain relief from pre-infusion levels and was placed on a maintenance regimen in perpetuity. This regimen involves two monthly IV ketamine infusions, one day apart for two hours at a maintenance rate of 4.8 mg/kg/hr. Conclusion Ketamine by IV is an effective option for pain management in patients with fibromyalgia. Compared to previous case studies, it is recommended that increased total dose, frequent administration, and longer duration of infusions all may be necessary for ketamine to maximize its beneficial effects.
Reference19 articles.
1. Ketamine decreases postoperative pain scores in patients taking opioids for chronic pain: Results of a prospective, randomized, double-blind study;Antje M. Barreveld;Pain Medicine,2013
2. Outpatient intravenous ketamine for the treatment of Complex Regional Pain Syndrome: A double-blind placebo controlled study;Robert J. Schwartzman;Pain,2009
3. Chronic phantom limb pain: The effects of calcitonin, ketamine, and their combination on pain and sensory thresholds;Urs Eichenberger;Anesthesia & Analgesia,2008
4. Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients;Thomas Graven-Nielsen;Pain,2000
5. Ketamine infusion for pain control in elderly patients with multiple rib fractures: Results of a randomized controlled trial;Nathan W. Kugler;Journal of Trauma and Acute Care Surgery,2019