I am a younger person, still in my 20s. I was involved in a car accident nearly 10 years ago. At the time, I was healthy, a full time premed student who had been fast racked by my Liberal Arts school as they believed I had the potential to be their first Rhodes Scholar in nearly a decade. I also was just beginning a pro-career as a road cyclist, having been performing in local races as a cyclist specialist and overall triathlete. I have journal entries from this time that give me an account of my daily routine which was generally classes split into two sessions three days a week with weight training for an hour in the morning and an hour in the afternoon, along with 100 laps most days in the pool. I would generally cycle 5-6 days a week from 55-120 miles per day depending, along with usually 15 miles of trail hiking and 20+ miles of trail and track jogging per week. Somehow I managed this all with a full course load bringing in a consistent 4.0 while filling my time with reading in the park, long drives, writing music and so on.
One day just under ten years ago, I was out driving in the country to find some new cycling routes. I had my bike with me to try out a few hills and get a feel for the wind patterns. I had a couple friends -a married couple-who were following in a car behind me with their newborn to help out with traffic, wind and carrying supplies during the cycling points. We never got that far.
I asked if they would first like to go for a nature walk someone had built near a river in a canyon where I knew the caretaker, before we worked on the bike routes, to be followed up later by a tour of my college, some tennis and a picnic.
Just as I arrived and began to turn slowly off this downhill highway into the nature park, I looked in my rear view mirror to see my friends' car maybe 25 feet behind me but heading at full speed toward my vehicle-about 55mph. I was hit hard. I had enough time to throw my steering wheel to the left and hit the gas to try and avoid the wreck entirely or at least limit the damage to all of us. My car was thrown into a partial spin, while my right leg fully extended into the gas pedal was compressed as my hip was pushed forward by my car seat which torqued my lower back, tearing a disc and screwing up my SI joint fairly badly.
Anyways since then, I have had discograms, nerve ablation/rhizotomies,, epidurals, trigger point injections, physical therapy and everything you might expect. At this point I am told I only have the option of a two level fusion and discectomy. My insurance will not cover IDET as a last resort. My surgeon is not eager about allowing for a spine stimulator to possibly avoid an irreversible spine surgery that is likely to increase the rate of my back degeneration down the road. I cannot use corticosteroids due to an allergy to them. A pain med infusion pump also seems off the table as an option for the time being.
I know I can't continue like this. I find myself constantly compromising between the pain and the side effects from my medication regimen. I am always trying to find the best balance between the two.
As for the medications, my doses are extremely high after so many years of tolerance building up, almost embarrassingly so. I am not sedated ever, and no one I've known would ever guess I am on any medications at all. But there are subtle side effects such as a loss of passion in life like enjoying music, wanting to push myself harder toward goals like getting out and doing an uphill jog or finding myself feeling inspired at the sight of a beautiful sunset. If my pain levels are low and I don't take my meds for a day or more, I notice these things come back to me like writing music, inventing, getting out, etc. It's little things like that that have made the medications untenable as something to have to take for the rest of my life.
The surgical option, which has been virtually guaranteed to cause disc degeneration above and below the site of the procedure down the road, has been quoted to me as to likely offer a 25% chance of relief to some degree, great or small; a 25% chance of making my pain worse, and a 50% chance of no effect either way after I have healed.
I have assumed for some time I have been experiencing some kind of pain windup phenomena. My back may have deteriorated more and more over the years, but I think another reason for my worsening pain levels could be due to increased tolerance to opioids and pain windup at the central and local levels. I believe methadone may have had some of its superior properties in treating my pain especially when used in conjunction with a stronger, faster acting opiate because of some of its NMDA antagonist effects.
I began talking with my doctor about trying out a ketamine treatment using the "awake technique" a few years ago. He spoke with a number of area physicians and could find no one offering the treatment here. I was to go to California almost two years ago to have the treatment performed when my physician told me his office might be able to offer this service in the near future. Long story short it has been a waiting game. Every time I see my doctor, his office is getting closer to offering the treatment but it is always 6-8weeks away it seems and never gets any closer. I am reasonably sure I will begin the ketamine-based therapy quite soon.
I am curious, for those patients not strictly or formally diagnosed with CRPS as their primary pain condition, but who are sufferers of non-neuropathic chronic pain especially of the spine, has anyone had any success with this treatment??
Does anyone know of anyone else who has personally been helped significantly by this protocol?
I am personally hopeful, but not thrilled, with taking a medication that can cause severe nauseau and certain cognitive effects which I assume could be frightening to certain populations of people, especially when ketamine is administered in higher doses in an unfamiliar setting.
I have found a source for a similarly acting drug, legally aquired, so I could begin an at-home version of the ketamine protocol almost immediately if I were to choose that course but have not, nor do I wish to go that direction for reasons that I am sure are quite obvious.
I am set to have this treatment as soon as possible through my pain doctor's office by IV over the course of ten days with a four-hour infusion for each day of the treatment with the dosages slowly titrated up over these ten days to a level that is manageable. Nausea and any additional sedation required, including for anxiety that might be experienced, will likely be treated with midazolam which I have had during past surgeries on my spine and responded well to.
Things are coming to a head with my condition however and for the first time, I am more afraid of this continuing pain than anything else. With my pain having worsened by some good measure in the last eight months, while my ability to tolerate my medications' side effects having simulataneously gotten progressively worse, the idea of still living like this 12 months from now is not something I want to consider. I have decided I will finally go in for any major surgery on my back that's strongly suggested should this last ditch attempt at some sort of lasting relief fail via ketamine that my hope has been could allow me to titrate down from the opiates and off of them entirely preferably, so I might be able to have a normal, active life once again.
Having said that, what advice can others give?
Have the results been as good for standard chronic spine-related pain as opposed to just those suffering with CRPS or pain of neuropathic origin?
Was the treatment tolerable?
Lasting side effects?
Did you find other medications administerd simultaneously necessary for being able to tolerate the ketamine infusion?
What benefits were achieved?
Were you able to reduce your daily medication regimen?
How long did benefits last? Did quality of life improve?
For those who had a 2nd course of ketamine after the positive effects began to wear off, did you find the 2nd treatment worked better or lasted longer than the first?
Any advice, information, anything would be very much appreciated.
Just another person waiting for his old life to begin.