If you are reading this, you have likely already traveled a long and frustrating road. Most of our patients with Complex Regional Pain Syndrome (CRPS)—formerly known as RSD—have already climbed the standard "ladder" of care. You may have tried anti-inflammatories, Gabapentin, high-dose opioids, and invasive procedures like Spinal Cord Stimulators (SCS) with limited success.
When these treatments fail, it is rarely because you are "drug-seeking" or "imagining it." It is usually because standard treatments are trying to mask a signal that your brain has learned to amplify.
At Blue Sky Ketamine, we take a different approach. We don't just treat the symptom; we target the chemical "error" in the nervous system that keeps the pain loop active.
CRPS is a poorly understood neurological disorder involving the central and peripheral nervous systems. It typically creates intense burning pain, extreme sensitivity (allodynia), and temperature changes in a limb after an injury.
But why does the pain persist after the injury heals? The answer lies in a process called "Wind-Up."
Imagine a thermostat in your home. Under normal circumstances, it regulates the temperature perfectly. But if the sensor breaks, it might read "freezing" even when the house is on fire. The furnace kicks on, making the heat unbearable, but the sensor is stuck sending the wrong signal.
In your body, the "broken sensor" is caused by a neurotransmitter called Glutamate.
○ The Glutamate Flood: Nerve injury alters how your body handles glutamate. It causes spinal neurons to become hyperexcitable.
○ The Amplification: What should be a pain level of 1 or 2 is amplified by the nervous system into a pain level of 10.
○ The Result: Your brain creates persistent pain signals even in the absence of tissue damage.
We believe ketamine is uniquely suited to treat CRPS because it modulates two key receptors in the brain: NMDA and AMPA
1. Centrally: Stopping the "Wind-Up" In chronic pain conditions, your NMDA receptors remain stuck in the "open" position, allowing glutamate to flood the system. This tells your brain, "High danger! High pain!" constantly. Ketamine is an NMDA Antagonist. It effectively "sits" on the NMDA receptor and blocks it. By temporarily shutting down this constant flood of glutamate, ketamine allows over-excited nerves to "reset" or "reboot" to their normal baseline. This also engages AMPA, the receptor involved with neuroplasticity and repair.
2. Peripherally: Reducing Inflammation Ketamine also works at the site of the pain (the limb, joint, or nerve). Research indicates that ketamine can reduce specific pro-inflammatory chemicals (cytokines like IL-6 and TNF-alpha) that are often chronically elevated in CRPS patients. By blocking receptors on the peripheral nerves, it reduces the "noise" being sent up the spinal cord to the brain.
Many of our patients come to us after a failed SCS trial or explant. This can be demoralizing, but a failed SCS does not mean ketamine will fail. They work on entirely different principles.SCS (Hardware approach): Relies on the "Gate Control Theory." It uses electricity to "distract" the spinal cord so it can't feel the pain. If your central sensitization is too severe, the "gate" is broken, and electricity won't fix it.
Ketamine (Software approach): Works at the level of the neurotransmitter. It addresses the chemical imbalance—glutamate—that is keeping the gate broken.
Perhaps the most promising aspect of ketamine therapy is Neuroplasticity. Chronic pain physically alters the brain's structure (neural pathways). Ketamine triggers the production of BDNF (Brain-Derived Neurotrophic Factor), a protein that helps repair and regrow healthy neural connections. This provides a window of time where your brain can learn new, non-painful pathways.
Traditional ketamine infusions for pain can be prohibitively expensive and time-consuming, often requiring 20+ hours of intravenous ketamine.
Dr. Rosen has utilized ketamine for over a decade to successfully treat clients with CRPS. He has pioneered an evidence-based protocol that is:
○ More Efficient: Typically exposes clients to a total of 7 hours of intravenous ketamine, rather than the standard 20+ hours.
○ Cost-Effective: Significantly more affordable than high-volume clinic or hospital protocols.
○ Sustainable: Patients who achieve a noticeable reduction in their chronic daily pain are often transitioned to oral ketamine. This helps maintain the neuroplastic benefits of the infusion and promotes downstream pain relief without the need for constant clinic visits.
If you or someone you know suffers with CRPS, please reach out to Dr. Rosen for a free consultation at 505-336-0217.
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