Summer 2010 - The British Pain Society

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PAIN SHORTCUTS (CONTINUED) for more than 28 days before entry into the study and remained on the same medications and doses throughout the study. Subjects had not had ketamine before. Appropriate exclusion criteria were applied and the subjects randomised to either the ketamine or the placebo group. The subjects received a full neurological examination and pain evaluation at the start of the study. The subjects were asked to complete a short form McGill questionnaire, quality of life questionnaire and a seven question pain questionnaire weekly until the start of the infusions. The subjects all wore an activity watch for at least 2 weeks prior to treatment and 2 weeks following treatment. The subjects underwent sensory and motor tests 2 weeks prior to treatment and at 1 and 3 months post treatment. On all 10 infusion days the subjects were monitored for cardiac rhythm, blood pressure, pulse and oxygen saturation. Subjects were given Clonidine 0.1mg orally and midazolam 2mg IV prior to the infusion and 2mg IV following the 4 hour infusion. All subjects were infused with 100ml normal saline with or without ketamine for 4 hours daily for 10 days ( 5 days on, 2 days off, 5 days on)The maximum ketamine infusion rate was 0.35mg/kg/h, not to exceed 25mg/hr. On the first day the IV ketamine infusion was set to 50% of the max rate, 75% max rate on the second day and maximum rate on the third day and maintained at maximum rate for the duration on the study. Following the last infusion the subjects were reviewed at 2 weeks and then monthly for 3 months. They were asked to wear the activity watch from the last infusion until the 2 week post infusion visit and were asked to complete the short form McGill, quality of life and pain questionnaires weekly until the end of the study 3 months after the last infusion. The study was stopped at the halfway point because an interim analysis was conducted which showed there was little placebo effect .This meant that statistical significance could be reached in many of the study parameters with a smaller number of study subjects than was originally anticipated. Also further experience with outpatient ketamine infusions showed that 50mg/hr provided much greater pain relief for a greater period of time. 10 subjects were in the placebo group and 9 subjects in the ketamine group. The study showed a significant reduction in pain (p
R E S E A R C H & D E V E L O P M E N T COST EFFECTIVE MINIMALLY INVASIVE PERIPHERAL NERVE STIMULATION THE FIRST GENERATION OF OFFICE BASED NEUROSTIMULATION THERAPIES PENS THERAPY Frequency dependant electrical current delivered directly to a peripheral nerve, or to the most peripheral branches of a peripheral nerve, to inhibit pain signals. PENS is used to identify patients who are likely to benefit from a permanently implanted peripheral neurostimulator, thereby reducing the incidence of late failure. PENS also offers patients the potential for intermediate relief and management of chronic peripheral neuropathic pain. For more information on PENS therapy: Tel: +44 (0)1293 763 070 or visit www.algotec.com
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Summer 2010 - The British Pain Society

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