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Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science

Advisor

Dr. Nancy Reid, MHA, DHSc, PA-C

Abstract

There have been significant efforts to reduce opioid prescribing and find alternate means for managing chronic severe pain. In 2016, the Centers for Disease Control issued guidance that “nonopioid pharmacologic therapy was preferred for chronic pain.” The Food and Drug Administration restricts opioids for “the management of pain severe enough to require an opioid and for which alternative treatments are inadequate.” In October 2017 the federal government declared that the opioid crisis had reached the level of a national emergency. Complex Regional Pain Syndrome (CRPS) is a chronic pain condition associated with severe pain and functional limitations. Opioids have been used for the management of severe pain associated with CRPS. Ketamine is a medication approved by the FDA for general anesthesia but has been provided in subanesthetic dosing for analgesia. Emerging evidence, and recently published guidelines, support intravenous ketamine as a therapeutic option for CRPS related pain. This review will compare and contrast the relative efficacy and safety of opioid therapy versus intravenous ketamine infusions for the management of pain from CRPS. Specific consideration will be given to determining if intravenous ketamine should be offered prior to opioid therapy, rather than as a salvage therapy only for opioid refractory patients.

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