Pain is invisible, but it can be as disabling as any injury or disease. Often, the treatment for chronic pain depends on high-power opioid drugs such as oxycodone.
But, there may be a better, non-narcotic answer, according to Lacey physician Lucinda Grande.
Grande, who began her career as an anesthesiologist, is finding success with very low doses of ketamine, a drug used for anesthesia in surgery, but also known as a rave drug. It has eliminated, or greatly reduced, the need for opiates for some of Grande’s patients.
Grande said her patients have found themselves exercising, gardening, and enjoying daily activities that had not been possible when they were depressed with chronic pain.
“The challenge is, how do you get effective treatment into widespread use,” Grande said.
The use of ketamine for pain relief is documented in medical journals, but there is a need for a controlled double-blind study, Grande said. Such studies can be expensive, and are often funded by big pharmaceutical companies.
Grande is seeking subjects for a small study that she hopes will lay the groundwork for a larger study funded by the National Institutes of Health, which funds a large percentage of non-commercial medical and scientific research. Her study, sponsored by the University of Washington Family Medicine, seeks people who are currently using opioid pain medicine. Subjects would take ketamine or a placebo at home for two weeks. Neither the doctor nor the patient would know whether the patient was receiving ketamine or a placebo.
Ketamine works for Michael Brown. Brown, 68, of Olympia, developed multiple myeloma, a cancer of the blood, about 10 years ago. Last fall he was hospitalized at Providence St. Peter Hospital with a painful infection around the spine. The amount of opioids necessary to control the pain made him unstable on his feet and unsafe to go home.
Within 24 hours of starting ketamine, Grande said, Brown was almost off the opioids, walking and ready to go home. The infection that contributed to the acute episode was also cleared up.
He has continued to use ketamine along with occasional oxycodone, and is well enough to travel with his wife.
“It was excruciating,” Brown recalls of the pain, saying he would stare at the clock waiting for when he could take another oxycodone.
He also appreciates the non-narcotic aspect of ketamine.
“If I was at the end of my life,” he said, “I wanted to be very clear-headed and able to communicate with family and friends.”
Ketamine controls his pain subtly, Brown said. He said when he took oxycodone, he felt effects in 45 minutes and “felt really good for about three hours.” He doesn’t get the euphoria with ketamine, but is able to enjoy daily activities.
Dr. Gregory Terman is a professor in the anesthesiology and pain medicine department and the graduate program in neurobiology and behavior at the University of Washington. He said that ketamine has been widely used as an anesthetic and can be helpful because it does not depress areas of the brain that control breathing and blood pressure. But, in higher doses, it can cause hallucinations, dreams and a dissociated state.
“However, it was discovered several years ago that very small doses of ketamine could have pain relief effects without knocking them out or causing dysphoria,” he said in an email. Dysphoria is a feeling of discomfort or anxiety.
“Not too much is known from big placebo controlled studies of ketamine in treating chronic pain,” he said, thus the need for Dr. Grande’s study.
For now, Grande prescribes ketamine for a number of patients. Using the drug “off-label,” or for non-traditional ailments, is widely accepted, she said. “You can use drugs off label if they have good reason to believe they can be effective,” she said.
Because ketamine also has been used recreationally, it needs to be secured by medicinal users, Terman said. “Certainly there should be less risk than with opiates, and probably less than with sedatives, including sleeping pills,” Terman said.
Brown said he’s grateful for “any tool that has helped me manage pain and has helped me be more active.”