Ketamine Infusions (case study)

Ketamine infusion for refractory pain in Dercum’s Disease (Adiposis dolorosa): a novel treatment approach.

Dercum’s disease (Adiposis dolorosa) is a rare disorder characterized by multiple, tender subcutaneous nodules on the trunk and extremities. There is a higher incidence in obese, postmenopausal women. The exact mechanism is unknown, but it is hypothesized to be due to abnormal blood flow or circulatory dysfunction. Treatment is extremely challenging and is often times resistant to numerous modalities. We present the case of a 47 year-old female with a 2-year history of Dercum’s disease. The patient had seen numerous physicians and tried multiple treatment modalities, all with little success. After initial consultation, the decision was made to proceed with 2 four-hour trials of IV Ketamine infusions in the ICU. Patient reported approximately 60% relief of her pain immediately after her infusions and states that the relief lasted through her follow up four weeks later. Dercum’s disease remains a devastating diagnosis for many patients. It is extremely challenging to treat and has a significant adverse effect on patients’ quality of life. Ketamine infusions should be considered after conservative methods of treatment have failed and prior to proceeding to invasive treatment solutions such as liposuction.

*Case reports are generally considered a type of anecdotal evidence. Given their intrinsic methodological limitations, including lack of statistical sampling, case reports are placed at the foot of the hierarchy of clinical evidence, together with case series.

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