Efficacy and safety of ketamine in patients with complex regional pain syndrome: a systematic review.

Despite being a recognized clinical entity for over 140 years, complex regional pain syndrome (CRPS) remains a difficult-to-treat condition. While there have been multiple therapies explored in the treatment of CRPS, NMDA antagonists such as ketamine continue to hold significant interest because of their potential ability to alter the central sensitization noted in chronic pain states. The objective of this review is to identify published literature for evidence of the efficacy and safety of ketamine in the treatment of CRPS. PubMed and the Cochrane Controlled Trials Register were searched (final search 26 May 2011) using the MeSH terms 'ketamine', 'complex regional pain syndrome', 'analgesia' and 'pain' in the English literature. The manuscript bibliographies were then reviewed to identify additional relevant papers. Observational trials were evaluated using the Agency for Healthcare Research and Quality criteria; randomized trials were evaluated using the methodological assessment of randomized clinical trials. The search methodology yielded three randomized, placebo-controlled trials, seven observational studies and nine case studies/reports. In aggregate, the data available reveal ketamine as a promising treatment for CRPS. The optimum dose, route and timing of administration remain to be determined. Randomized controlled trials are needed to establish the efficacy and safety of ketamine and to determine its long-term benefit in CRPS.

Pathophysiology of the spreading of complex regional pain syndrome revisited: a case report.

OBJECTIVE: To determine if there is a relationship in our patient developing complex regional pain syndrome from a jellyfish and its subsequent spread to the contralateral side. METHODS: Data bases were searched using PubMed and Ovid. Keywords searched include "complex regional pain syndrome,""jelly fish," and "pathophysiology." RESULTS: This patient was successfully treated with a spinal cord stimulator implantation with bilateral lead placement at thoracic spine (T9) stimulating her lower extremities in addition to the leads that had already been placed in her cervical spine for her upper extremities. CONCLUSION: Definite knowledge of the pathophysiology of complex regional pain syndrome would allow better identification of risk factors for the development of this condition after trauma. This patient is at higher risk of developing complex regional pain syndrome and should avoid surgeries (such as knee and wrist surgeries) and high risk physical activities.

Complications of cervical transforaminal epidural steroid injections.

Although cervical transforaminal epidural steroid injections are used in the treatment of radicular pain, there are a number of major and minor complications reported in the medical literature. These complications are limited to retrospective studies, retrospective survey studies, case reports, and data obtained from studies evaluating the benefit of cervical transforaminal steroid injections. Thus, the data are limited in value with regard to identifying evidence-based recommendations for future research. We aim to review and critically evaluate literature focusing on the incidence and clinical presentations of major complications associated with cervical transforaminal steroid injections. The goal of this review is to identify pertinent journal information that aids in the improvement in clinical care and guides future research by increasing the awareness of the potential major complications associated with this procedure and their presentations.