Researcher may have found link between
CRPS/RSD and the
Inpatient ketamine insurance codes
Now you see it, now you don't: sensory–motor re-education in complex regional pain syndrome
Jennifer S Lewis *, Karen Coales *, Jane Hall * and Candida S McCabe *
* The Royal National Hospital for Rheumatic Diseases, Bath, UK; The Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
Correspondence: Professor Candy McCabe, Bath Centre for Pain Services, The Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BA1 1RL, UK. Email: email@example.com
The patient with complex regional pain syndrome (CRPS) commonly describes a lack of ownership of their painful limb, poor definition of that body part and difficulty with localization of the limb when performing daily activities. These descriptions suggest that sensory input from the limb may be reduced leading to neglect of the limb and poor motor control. However, the cardinal symptom of CRPS is pain, commonly severe, which demands a high level of attention. Patients are highly protective of the painful region and hypervigilant to any potential threats to their affected limb. These seemingly conflicting behavioural responses and sensory descriptions are confusing for the patient and health-care professional. In recent years our understanding has greatly advanced on how altered sensory perception of a CRPS affected limb relates to changes in the central representation of that body part, and how this may interact with motor planning and autonomic function. Excitingly, this increased knowledge has directly informed clinical practice via a new evaluation of sensory–motor re-education techniques and the development of novel interventions to enhance sensory discrimination. We review the common sensory problems seen in CRPS, the mechanisms that may be behind these clinical symptoms, and how sensory, motor and autonomic systems interact. Therapies designed to enhance sensory discrimination and motor planning are discussed, supported by the results of a small case series undergoing sensory re-education for CRPS. The clinical protocol and two case studies are available as additional online material to illustrate how all of this is applied in practice.
The 3-day ketamine treatment is reimbursed by insurance companies and government agencies.
Here are some suggestions / talking points regarding reimbursement from insurance carriers for treatment with intravenous (IV) ketamine.
Treatment of breakthrough pain due to RSD / CRPS is an accepted treatment by all insurance companies.
For over 30 years, treatment of breakthrough pain with IV ketamine at doses up to and including those doses required for general anesthesia has been approved by the Food & Drug Administration (FDA).
Ketamine is approved as a “general anesthetic". Anesthesiologists, therefore, are most qualified to use the drug. For more than three decades, anesthesiologists have used ketamine to treat breakthrough pain in numerous clinical situations because of its unique properties.
Breakthrough pain during dressing changes in burn victims (where intubation is not required because ketamine is a mild respiratory stimulant)
Breakthrough pain during procedures in children (where no IV required because ketamine can be given IM)
Breakthrough pain in asthmatics (where ketamine is a bronchodilator)
Breakthrough pain in wounded soldiers (where ketamine supports blood pressure)
Breakthrough pain in patients with RSD / CRPS (where ketamine uniquely inhibits the excitatory neuropeptide responsible neuropathic pain called glutamate and avoids the serious complications associated with the use of opioids - narcotics - to treat breakthrough pain)."