Improving Outcomes of Therapy-Resistant Complex Regional Pain Syndrome Utilizing Ketamine Infusions and Comprehensive Rehabilitation Following Amputation: A Case Report

Abstract

BACKGROUND: Complex regional pain syndrome (CRPS) is a term describing signs and symptoms of a poorly understood neuropathic pain condition. Despite a number of treatment options, patients with CRPS often suffer from significant impairment and unsatisfactory pain relief. An option rarely considered in managing this condition is amputation due to concerns of pain recurrence or disease progression. CASE REPORT: A 50-year-old man with a history of refractory CRPS on high-dose opioids (over 400 morphine daily equivalents) presented with a request to consider amputation. After extensive interdisciplinary discussion, it was decided to proceed with amputation resulting in successful resolution of his CRPS symptoms with aggressive peri- and postoperative ketamine infusions and a comprehensive therapy program. The patient is now 6 years post amputation and denies phantom limb pain or the spread of CRPS to other limbs. He was subsequently tapered off all opioid medication and has only needed the occasional acetaminophen for pain. CONCLUSIONS: We demonstrate the potential for a selective treatment approach in a patient with treatment-resistant CRPS using IV ketamine infusions. KEY WORDS: Amputation, chronic pain, complex regional pain syndrome, ketamine