Health feature: Pains and gains of ketamine

Vomiting copious amounts of my own saliva into a plastic basin was never on my bucket list, but then again, neither was ketamine infusions for the treatment of chronic pain.

Many people have heard of ketamine as a drug used for treating horses, but also as a powerful “date rape” substance.

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But that bad rap should not obscure the fact that ketamine can be useful to treat pain and treatment-resistant depression. It worked for me.

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Ketamine facts

• Ketamine was first introduced in the ’50s as an anaesthetic that was highly effective for several reasons.

• Firstly, the drug attaches itself to receptors in a person’s brain and disrupts pain signalling.

• Secondly, ketamine is a dissociative medication that not only stops the pain, but creates a euphoric effect.

• Lastly, ketamine does not suppress a person’s cardiovascular or respiratory functions as many painkillers do. This means that it’s safer to use in a wider variety of patients.

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The research on ketamine indicates efficacy in the treatment of neuropathic and non-neuropathic pain; it is a rare medication that has any kind of an impact on fibromyalgia, a complex, little understood syndrome whose celebrity sufferer is Lady Gaga.

Clinical trials indicate a series of six infusions of a specific dosage over three weeks provides the best relief and one of the doctors who pioneered its use in Ireland has brought it to South Africa.

At the pre-treatment interview to determine my eligibility for the course, I was asked to indicate on a map of the body where it hurts. I answered that it was far easier to show where it did not hurt – the tip of my nose, my earlobes – those are the only bits I can honestly say do not hurt.

But anything with nerves and muscle fibres will emit pain at some time or another to a greater or lesser degree. So what does it mean to me on a daily basis?

I automatically cut off all sewn-in labels and any label I do not notice will announce its presence through provoking pain and a raised red welt where it is.

I cannot tolerate anything but soft clothes, will move mountains for seamless underwear and put socks on inside out.

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The princess in the tale who felt a single pea under 20 mattresses must have been a fibromyalgia sufferer, such is the acuity of touch.

Over the years, I learned to differentiate the pain, which is constant, from the experience of the pain, much as you have to tune out traffic noise if living in the centre of a busy city. Sometimes it is noisier and sometimes quieter, but it is always, always there.

The good news is that although it is chronic, it is not progressive and there is a lot you can do to manage it, but that basically means reconciling yourself to a life circumscribed by limits.

I have become so accomplished in this regard that to the external world I usually pass for normal. But all along, I have adhered to the advice from a laundry list of specialists.

I have learned not to rage against what I cannot fully control and accept that I am a high-energy personality with a body that simply cannot cope.

But for the longest time I have hidden the condition, fearing censure and honestly feeling like a hypochondriac as these “invisible ailments” are so little understood and the medical fraternity, unable to offer any adequate treatment, considered them “all in the head” and not in a good way.

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The key concept is that of central sensitisation, that my body has become acutely alert to any physical sensations and hyper-reacts to it.

My children understood that I could never watch them play team sports as sitting on a cold, hard concrete bench outdoors would trigger a fibro flare as my body seems to misidentify cold and the pressure of a hard surface for something life-threatening and initiates the pain sequences.

I have missed school events but have learned to carry a cushion as ordinary hard seats set the pain off. Some surgical units in South Africa offer a series of low dosages of ketamine titrated over time under properly regulated clinical conditions, including continuous ECG monitoring, and checking of blood pressure.

The ketamine can have severe side-effects and needs to be administered in a proper clinical environment. Nausea is a common side-effect and they pre-treat with calibrated doses of anti-nausea medication and ensuring you have not eaten or drunk three hours ahead of time.

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However, I proved to be among the rare subgroup of roughly one percent who hyper-salivate and so the final treatment had me throwing up all the saliva I had produced during the treatment.

As to the experience itself? Frankly, I am not a fan of the dissociative state it induced. As an adult child of an alcoholic, feeling anything less than 100% control is anxiety-provoking. I therefore fought initially against succumbing entirely, and would rub my fingers and thumbs together when feeling particularly overwhelmed.

I also took my own playlist and headphones that were not fully noise-cancelling, but the reality of other people in the environment gave me a sense of security.

The nurse did not entirely approve of my inability to relinquish control, but the point is, I wasn’t there for the trip but its impacts, which is just as well.

I found the visual hallucinations to be weird, but more to the point, as someone who loves art, I considered them aesthetically displeasing.

If I were there for the hallucinations alone, I’d want my money back. Time awareness receded as did memory – the experience is immersive and distorting.

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Recent imagery seemed to predominate, Christmas imagery was fully present the day after I put up the ornaments, but they were a real grab bag of people, places, animals and objects, with your perspective dronelike and above, but zooming in and out up and down telescoping at times.

The only reason to go back is for the sense of euphoria as pain is deadened to such an extent that the background noise of it is silent for once.

And therein lies the hope of ketamine treatment, that not only can it reset the “always on” button of hypervigilant pain response, but quieten the active chattering of the brain.

And that, given the neuroplasticity of the brain, this can be long-term and life-altering. In my case, it has not been a panacea for all ills, but weeks after finishing the six treatments the changes are subtle but profound and without a doubt worth the investment in myself.

If it requires repeating in the future, I’d be up for it. After all, we service our cars, so why not change our minds too?

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