Expert: Dr Ian Jackson - please note UK based - 3/5/2010

Question
I have RSD/CRPS, 9 (long) years now. I had an umbilical hernia repair, in January this year.The following day i noticed I was in remission from the chronic pain and othe rsymptoms which lasted about 6 weeks. Symptoms are now back. Now I have my notes from the surgery and Fentanyl and Propafol were used as anaesthesia. With consideration to the 'chemistry', I suppose, could it be possible that they had a similar reaction the out-patient ketamine infusion therapies given to RSD patients. I may have stumbled on a new treatment! I know Fentanyl patches are used in RSD and fentanyl infusions are used in long term cancer patients but those are continuous. Any thoughts? Thank you.

Answer
Hi Kelly
I would chat about this with your chronic pain specialist as this is outside my area of expertise. The chemistry or rather pharmacology of how the ketamine works is via various receptors (known as GABA receptors) that exert some control on pain pathways. Fentanyl doesn't work on these but there is definite evidence that propofol has some effect on them - so perhaps this is a new use for propofol!
Kind regards
Dr Ian Jackson