ketamine in chronic pain

Re: ketamine in chronic pain

Rajat — Fri, 12 Oct 2012 14:14:49 GMT

[quote user="Claire Fisher"]The anesthetists at Liverpool run a pain clinic so I believe they see quite a few both dogs referred straight to the pain clinic and dogs seen by other services in the hospital.[/quote]

ahh I see- makes sense. Thank you claire.

Re: ketamine in chronic pain

Claire Fisher — Tue, 09 Oct 2012 23:25:50 GMT

[quote user="Rajat"]

Hi Mark

Thanks- I too am talking about chronic OA- only I didn't quite catch onto what you meant by intermittent IM dosing. I think I now get it that youre using it on an outpatient basis.

My current understanding for chronic dorsal horn stimulation is that a single shot may not be as good as a lengthier time of action for an antagonist.Could be very wrong so am genuinely interested to see Liverpool folks info if they have any. PS how many chronic OA dogs do the anesthetists treat?

[/quote]

The anesthetists at Liverpool run a pain clinic so I believe they see quite a few both dogs referred straight to the pain clinic and dogs seen by other services in the hospital.

Re: ketamine in chronic pain

Rajat — Tue, 09 Oct 2012 20:56:08 GMT

[quote user="robloxley"]

Do you have any experience of amantadine - I ask as it's something I've read of but not tried

[/quote]

Hi Rob

Yes I use it fairly often, often when there's breakthrough pain on a NSAID (or the first chosen painkiller) I will add amantadine for 14 days at 5mg/kg SID as a pulse therapy while adding in additional analgesics for longer term use. Or in some cases, by itself. It does seem to give benefits, and sometimes the second analgesic (or the one with more s/e) can be withdrawn or dose reduced.

Re: ketamine in chronic pain

Mark Holmes — Tue, 09 Oct 2012 19:38:15 GMT

I think it is what Wolverine was made of

Re: ketamine in chronic pain

Mark Holmes — Tue, 09 Oct 2012 19:38:00 GMT

I think it is what Wolverine was made of

Re: ketamine in chronic pain

Rob Loxley — Tue, 09 Oct 2012 19:30:38 GMT

Do you have any experience of amantadine - I ask as it's something I've read of but not tried

Re: ketamine in chronic pain

Rajat — Tue, 09 Oct 2012 13:14:04 GMT

Hi Mark

Thanks- I too am talking about chronic OA- only I didn't quite catch onto what you meant by intermittent IM dosing. I think I now get it that youre using it on an outpatient basis.

I do us ketamine CRI in older OA dogs. I keep them in for a day or two rather than sending them home on it (duhh)!!They seem to do well with them.

Alternatively, Amantadine does the same orally. I have to confess an occasional ketamine jab IM is not attractive to me as a means of controlling windup and and upregulated NMDA receptors etc, but hey if it works for you who am I to argue.

PS Because ketamine IM stings, there is some work in people and infants (and I think I read about it in dogs as well) about intranasal sprays, in people they were using micro doses about 1mg total, and finding some decent results, will see if I can find the study.

Cheers

Raj

Re: ketamine in chronic pain

Mark Holmes — Tue, 09 Oct 2012 09:53:39 GMT

[quote user="Rajat"]

Mark thanks, if they publish something worthwhile I hope to catch it, I would question them though that if I am getting a good response to CRIs so don't see why we need subject the animal to repeated IM injections, and ups and downs in plasma concs? I start low- 3-5ug/kg/min = approx 200-300ug/kg/hour- and find good responses often at these rates alone unless an animal comes in with severe pre existing pain... If you have a buddy there maybe you could ask why they use it over CRIs ? Also the as needed bit confounds me, are they judging it on sedation and pain scores? I use it a lot periop when I cannot use it as needed coz the animal is out for the count..

[/quote]

I think we are talking about different uses. The title of the thread is chronic pain, ie that experienced due to chronic arthritic and therefore single intermittant ketamine im is suggested. I use CRI peri and post operatively and it is brilliant. The purpose in chronic pain is to adjuct the use of other modes of analgeisa. I don't know where you live but around here people find walking a dog on a ketamine infusion a bit impractical. It must be the wet weather we get.

Re: ketamine in chronic pain

James Laidlaw — Tue, 09 Oct 2012 08:52:10 GMT

How often do you need to give CRI's? Just to play devils advocate a short sharp stingy injection is no worse than placing an IV or hospitalising for CRI, surely?

Re: ketamine in chronic pain

Rajat — Tue, 09 Oct 2012 08:43:31 GMT

Re: ketamine in chronic pain

james herriot lied — Mon, 08 Oct 2012 20:02:18 GMT

Well, my little old lady is happy with the response from Saturday. Unfortunately, she's asking for more tramadol which - by my reckoning - she shouldn't need for another six days. Seems one problem might be being replaced by another..........

Re: ketamine in chronic pain

Mark Holmes — Mon, 08 Oct 2012 19:59:46 GMT

Raj You get a good response to intermittent 0.5-1mg/kg im given as needed. Speak to the anaesthetists at Liverpool.

Re: ketamine in chronic pain

Rajat — Mon, 08 Oct 2012 19:16:39 GMT

Hi Andrew

Ketamine is useful to 'reset' the NMDA receptor as you said, hence helping with some chronic pain states, but it won't take it back to day 1 with no pain. If you believe the dog has allodynia or hyperalgesia (sounds like it might) then ketamine is worth a try

Remembering tho that it needs to be given as a CRI. Dose rates vary.- starting from 2 ug/kg/min to 20ug/kg/minute. You need to give a loading dose of 0.25-0.5mg/kg I.

Obviously not useful for at home use- a drug that has been reported as beneficial in dogs with chronic OA with a very similar mode of action that can be used at home is Amantadine. It is dosed daily at 5mg/kg- I usually use it in pulses of 14 days on then stop until signs of pain become apparent again

The study into Amantadine: http://www.ncbi.nlm.nih.gov/pubmed/18289289

Other things you can do are add in Gabapentin (presuming some degree neuropathic pain if localized to LS spine) try acupuncture ( I have found this to give v good results esp for back pain) try shaving the skin and applying lidocaine patches (available commercially as versatis patches).. but not forgetting radiographs MRI etc to see if there is a surgical or otherwise treatable problem..

An excellent resource for veterinary analgesia and anaesthesia related stuff is VASG.org

Best of luck!

Raj

Re: ketamine in chronic pain

james herriot lied — Sat, 06 Oct 2012 16:18:21 GMT

I get the feeling that the penultimate post on this thread was deleted, after Mark responded. Otherwise, you need to take some water with it at 8.30 on a Friday evening, Mark - weekend drinking is a marathon, not a sprint.

Just tried the ketamine thing on a toy poodle: ongoing neck pain which seems to be largely intractable, although I'm not completely convinced by the objectivity of owner, or the degree of confinement at home (little hints, like 'ooh, he was tearing around like a mad thing earlier in the evening - then he started screaming later'). Started at 0.5mg/kg i/m, explained the intended effect to the owner, so we'll see what transipres.

Re: ketamine in chronic pain

Mark Holmes — Fri, 05 Oct 2012 20:28:04 GMT

Actually she is head of department at Liverpool. So probably taught Claire

Re: ketamine in chronic pain

Claire Fisher — Fri, 05 Oct 2012 18:19:32 GMT

I went to a CPD evening at Liverpool University recently and they advised using ketamine at 1mg/kg for chronic pain. Could be repeated as needed - speaker though for most dogs would last 2 - 3 months.

Re: ketamine in chronic pain

Andrew Mellor — Fri, 05 Oct 2012 18:01:26 GMT

[quote user="Nicola Lawlor"]

This may be the thread you need http://www.vetsurgeon.org/forums/t/11503.aspx?PageIndex=1

[/quote]General Anaesthetic - Spay.

Thank you so much for that , doesn't time fly I was looking back through things thinking it was about 4-6 weeks ago. Must be getting old

If Mark sees this, is there any chance you could tell us if your anaesthetist friend has any more info on it's use.

If it is that good then may have to start all the old dears on it !

Re: ketamine in chronic pain

patrick murphy — Fri, 05 Oct 2012 17:56:32 GMT

just saw in the Independent today that it is a breakthrough anti-depressive drug in humans. how about FUS cats with a bit of arthrits

Re: ketamine in chronic pain

Nicola Lawlor — Fri, 05 Oct 2012 17:20:57 GMT

This may be the thread you need http://www.vetsurgeon.org/forums/t/11503.aspx?PageIndex=1

Re: ketamine in chronic pain

Michael Woodhouse — Fri, 05 Oct 2012 14:51:03 GMT

*Think* it was Mark Holmes and *think* the dose was very small 0.5-1mg/kg. *Think* he said makes them wobbly for 20 mins.

Don't quote me.

Re: ketamine in chronic pain

Laurence Webb — Fri, 05 Oct 2012 14:25:24 GMT

You're not imagining it, although I can't remember what the thread was. I tried it once following the thread in an elderly very arthritic labrador. Didn't seem to make any difference in that case although I'd be keen to try it again if I found a suitable case.