Subtyping patients with chronic pain can guide effective & safe ketamine treatment

For the most part, therapeutic management of chronic neuropathic pain and conditions like CRPS, fibromyalgia and phantom limb pain has focused on antidepressants, opioids and anti-epileptic cocktails. Yet, more than 60% of patients respond poorly or not at all to these combinations. Studies show that NMDAR blockade with agents like ketamine at sub-anaesthetic doses is a promising alternative, yet data from observational follow-up beyond three-months has not yet been readily available.

A prospective, observational study enrolling patients who received low-dose ketamine from 30-pain clinics in France was published in PAIN earlier this year. Patients with refractory, chronic pain were followed up over a full year. Overall, even a single ketamine treatment demonstrated an initial diminution of pain, maintained to some extent for up to a year. However, distinct pain-trajectories linked to demographics and clinical variables were identified. The authors conclude that subtyping these patients prior to ketamine administration and using higher doses of ketamine will optimize management of refractory chronic pain with the drug.

Link to the article

OUR NEW BRANDING - Why have we done this?

“Health is all in the MIND”

Kēta [noun] the state of being vexed; troubled

In the Kannada dialect of Southern India,
Kēta-MIND literally translates as ‘troubled mind’.

The MIND encompasses the faculties of consciousness and thought, and enables us to feel and reason.

What a perfect target for the beneficial effects of ketamine infusion therapy (KIT), whether for mood disorders or chronic neuropathic pain.

By changing one letter (an 'e' for a 'd') we no longer limit KCSA clinics to ketamine treatments, but open the door to other therapeutic interventions targeting 'troubled minds' as well.

KCSA currently offers outpatient ketamine infusions at the following locations:

BEDFORDVIEW (GP)

CAPE TOWN (WC)
Re-opening soon!

UMHLANGA (KZN)

HILTON (KZN)

Contact a KCSA branch

Professor Christopher Szabo is Honorary Professor in the Department of Psychiatry, University of the Witwatersrand, and Emeritus Professor in the Faculty of Health Sciences. He is Editor in Chief of South African Psychiatry.

Professor Bonga Chiliza is head of the Dept of Psychiatry at UKZN and immediate past president of SASOP. He is deputy editor of the South African Journal of Psychiatry.

Professors Szabo and Chiliza discuss depression and ketamine infusion therapy with KCSA Founder Dr Alan Howard

As glutamate neurotransmission evolves as the new target in the management of Treatment Resistant Depression and suicidality, the spotlight swings towards ketamine therapy.

'Beyond Madness', the outstanding podcast series with the provocative title, hosted by Prof. Christopher Szabo, turns its focus towards ketamine for the second time. (Link to the the first podcast here).

The clinical context and consequences of resistant depression are discussed, and Dr Howard elaborates on the emergence of ketamine as an innovative treatment option.

Link to the latest podcast here

35-year-old Chloe describes her treatment at KCSA-Umhlanga as "the most profound experience of my life..."

Chloe had 'done it all.'

She battled resistant depression for 10-years, working her way through the formulary of available antidepressants and mood stabilizers. Psychotherapy didn't help either.

Chloe lived with excruciating pain from nerve impingement in her neck, requiring facet injections, rhizotomy and finally, successful fusion surgery. But still she described herself as 'lost as a person - without a spark or joy in my heart.' She describes admission to a psychiatric facility as 'beyond harrowing.'

After outpatient ketamine treatment, Chloe describes herself as: 'finally feeling like myself again - and even better!'

Read Chloe's colourful description of her ketamine journey.

Read Chloe's testimonial

Thalamic blood flow is linked to improvement in depression after ketamine infusion, research finds.

Using Arterial Spin Labelling (ASL) to measure thalamic cerebral blood flow (CBF), researchers in Germany have linked their findings to improvement in depressive symptoms after ketamine.

The fact that changes in CBF are
present 24h after ketamine treatment, suggests that these effects are a consequence of neurofunctional
plasticity. CBF might potentially be used to inform treatment decisions for depression.

Read the article

In the next newsletter..

'Happy mice' help us understand how ketamine works...

Ketamine activates adult-born immature granule neurons (ABINs) to rapidly alleviate depression-like behaviours in mice

We are not planning on opening any 'Keta-MICE' clinics (yet!) but fascinating research out of the Dept. Neurology at NW University, Chicago published in Nature Communications identifies a specific cell population in the hippocampus that mediates the antidepressant action of ketamine.

How did KCSA start in South Africa?

KetaMIND Clinics of South Africa (KCSA) was founded by Dr Alan Howard, a Consultant in Emergency Medicine who returned home permanently to his native South Africa from Ireland in 2019.

To read more about Dr Howard and KCSA's flagship clinic in the Natal Midlands in two informative articles published in South African Psychiatry click on the link below.

Read about the start of KCSA

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