Note from Dr. Katinka van der Merwe: Please note that my opinion of any treatment is often based upon my own research only. It is not my intent to encourage nor discourage you from seeking a specific treatment. My only intent is to supply information in a fair and balanced manner. As with any treatment, you are responsible for researching any possible treatment that you may consider, including its pros and cons.
Ketamine does not address the original cause of CRPS, but rather changes the Nervous System
Ketamine, initially developed as an anesthetic, is now used to manage CRPS pain through its ability to block NMDA receptors in the nervous system. These receptors are linked to central sensitization, a hallmark of CRPS. Ketamine treatments are administered in three ways: low-dose infusions, the “coma technique,” or outpatient procedures. The low-dose infusion is the most common and costs between $10,000 and $50,000, often requiring multiple sessions. The controversial “coma technique,” banned in the U.S., involves placing the patient in a five-day coma, costing over $60,000, with significant risks, including neurological injury or death.
Side Effects of Ketamine Infusions for CRPS
Ketamine is known as one of the most effective treatments for CRPS today. However, all that means is that it is more effective than most other treatments for longer periods of time. Although ketamine has been known to cause remission in some lucky patients, most patients seem to have to go back repeatedly for expensive booster treatments. In addition, Ketamine may have quite severe side effects, even permanent neurologic injury or death in the case of the coma treatment. It has been shown that ketamine has negative stimulatory effects on cardiac function and is related to the systemic release of catecholamines (their release by sympathetic nerve endings increases the rate and force of muscular constriction of the heart), inhibition of the vagal nerve (the very thing that contributes to CRPS to begin with), and inhibition of norepinephrine re-uptake at peripheral nerves and non-neuronal tissues such as the myocardium. Heart muscle depression has been observed after high-dose ketamine infusions or during repeated dosing.
TL;DR
While Ketamine can provide substantial pain relief, its long-term effects remain understudied. Patients often need recurring booster treatments, and side effects may include cardiac dysfunction, neurological changes, and vagus nerve inhibition. Ketamine alters the nervous system but doesn’t address the underlying cause of CRPS, making it a short-term solution rather than a comprehensive treatment.
Dr.Katinka’s hypothesis is that Ketamine changes the Nervous System for often long periods of time, if not permanently. No study that she could find has ever been performed to study the long-term changes of Ketamine in the human body. In her experience with treating CRPS patients who have previously undergone Ketamine treatments, Ketamine represents somewhat of a ‘wild card’ effect, in that it will sometimes make the patient not respond to treatment as well as other CRPS patients, especially if the Ketamine treatments have been recent.
Neridronate, a bisphosphonate drug, gained attention following a very small Italian study showing significant pain relief in early-stage CRPS patients. It works by reducing bone loss, a common issue in CRPS, but it does not promote new bone growth. While the drug shows potential, its effects are limited to CRPS cases within the first four months of onset.
Side Effects of Neridronate CRPS Treatment
Side effects of Neridronate include joint pain, cardiac arrhythmias, and jaw necrosis—a severe condition where the jawbone dies, often triggered by dental surgery. Jaw necrosis affects up to 20% of IV-administered bisphosphonate users. Although the drug is being studied in the U.S., its long-term safety and insurance coverage remain uncertain, urging caution for potential users.
Epidural Steroid Injections (ESIs) involve a doctor injecting a steroid into the epidural space of the spine to reduce inflammation and irritation. Sympathetic nerve blocks involve injecting anesthetics into sympathetic nerves that are affected by CRPS. A Lumbar sympathetic nerve block is injected near the lower spine (lumbar region), while a Stellate ganglion block is used to treat pain in the arm, shoulder, and face. Both target sympathetic nerves, but a lumbar block targets the lumbar sympathetic ganglion, while a stellate ganglion block targets the stellate ganglion located in the neck. Patients who have received significant pain relief from sympathetic nerve blocks are often recommended a Sympathectomy, which is performed to interrupt the portion of the patient’s sympathetic nervous system (SNS) that is affected by CRPS. During sympathectomy, the sympathetic ganglia that cause CRPS pain are cut surgically, or chemically destroyed. It may also be destroyed with radiofrequency. Surgical sympathectomies are irreversible procedures causing nerve signals to be irreparably disrupted. Sympathectomies are extremely controversial, as there is little evidence to fully support the efficacy of the procedure.
The Side Effects of Sympathectomies for Treating CRPS Pain
In addition to the irreversible nature of Sympathectomies, potential side effects include distorted bodily functions, disrupted vascular responses, reduced physiological responses to strong emotions, immune dysfunction, and exacerbated pain through sympathetic sprouting.
Given the high risk of complications, sympathectomies are typically “last resort” procedures for patients who face edema, tissue loss, and recurrent infection.
Many doctors (including myself) deem this procedure risky due to the irreversible damage to sympathetic nerves.
“Managing CRPS symptoms without addressing the root cause is like putting a wet towel over a fire alarm while the house is burning down. Not only is this approach not helpful, it is actually harmful. In order to tackle this problem logically, you must heal the central nervous system (CNS).”
— Dr. Katinka van der Merwe
Creator of the World’s Leading Neurologic Rehabilitation Program
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