Chronic Pain Chronicles with Dr Karmy
Join Dr. Grigory Karmy M.D., a distinguished chronic pain management physician with over 20 years of experience, on a captivating journey through the world of pain relief in his podcast series. Delving into the latest regenerative medical treatments like PRP, stem cell injections, and prolozone therapy, alongside educational discussions on pain transmission and various medical options, Dr. Karmy shares invaluable insights and real-life stories, empowering listeners to find relief and regain control over their chronic pain.
Chronic Pain Chronicles with Dr Karmy
Episode 2: Infusions in Chronic Pain Management: Psychedelics, Lidocaine, Vitamins - Which Infusion is Right for You?
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Dr. Grigory Karmy offers a comprehensive analysis of the therapeutic potential of ketamine and lidocaine infusions in managing various medical conditions, from chronic pain to treatment-resistant depression. He elucidates how these infusions work, their mechanisms of action, and the scientific evidence supporting their use.
Tune in to learn about ketamine and lidocaine infusions in chronic pain management, exploring their potential to transform lives while navigating the controversies that accompany their rise.
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They're used for neuropathic pains. They're used for widespread pains such as fibromyalgia. They're also used for migraine headaches.
Raveena:Hello and welcome to Chronic Pain Chronicles with Dr. Karmy. Your go to podcast for all things related to managing chronic pain. I'm your host Raveena Aujla and today we're diving into a fascinating topic that's been revolutionizing chronic pain treatment, ketamine and lidocaine infusions. We'll be delving into how these infusions have provided much needed relief for individuals grappling with widespread pain. As we uncover the potential of ketamine and lidocaine infusions in our quest to conquer chronic pain, we're joined by Dr. Grigory Karmy, an expert in pain management with over 20 years of medical experience.
Dr Karmy:This is Dr. Karmy, and today I wanted to discuss infusions in chronic pain management. Infusions is a relatively new approach to pain management, and for the first time it came to Ontario about 10 years ago, initially only lidocaine infusions. were used, and then, a bit later, ketamine infusions started being used as well. These infusions have its, their own advantages and disadvantages compared to other types of procedures. And, I don't know. I don't know. Relatively new, and so the evidence to support their use is weak. And of course, like everything else in pain management, there's a lot of controversy. First of all, let's look at pros and cons of infusions. In general, the advantage of infusions is that the medicine goes throughout the whole body. It's not limited to a single muscle or a single joint, and it's also able to reach potentially some hard to reach areas. the brain. The disadvantages are basically the same as advantages. The more widespread the medication goes, the more side effects it's likely to have. So we're going to talk Generally speaking, injections are safer than infusions, everything else being equal. what sort of, conditions are infusions being used for? They're used for neuropathic pains, they're used for widespread pains such as fibromyalgia. They're also used for migraine headaches. Some patients respond better to ketamine infusions and some people respond better to lidocaine infusions. In some cases both medications are mixed together in the same infusion. Lidocaine? Of course, is the same medication that's used in nerve blocks, but because it is used as an infusion where the medicine goes into a vein, it's able to reach more areas and it's able to reach harder to reach areas. The risks with Lidocaine infusions include heart rhythm abnormalities, which is why, the monitoring is more extensive than with nerve blocks. Also seizures, again, compared to nerve blocks, Lidocaine infusions are a little, has more side effects. the reason to use them is mostly because. Not everybody responds to nerve blocks, or sometimes it's not practical to try to inject every millimeter of the body if the pain is very widespread. Ketamine infusions are a little different. Ketamine is a psychedelic. And there's a lot of buzz right now around psychedelics, and they're used not just for pain, they're used for PTSD, for depression, and a growing list of other applications. Generally speaking, ketamine is less likely to cause seizures compared to lidocaine, but what it can do is cause hallucinations. flushing, hallucinations, changes again in heart rhythm, but typically at a higher doses. Both lidocaine and ketamine can also cause nausea and vomiting. And then there's an issue of addiction. Psychedelics, including ketamine, can be addictive when used in pill form and given to take home, which is something that's not done frequently in Ontario, the risk of addiction is likely to be higher. When one is using ketamine as an infusion in controlled setting, the risk of addiction becomes lower. There's a lot of controversy about best dose of these medications as well as best frequency. There is some coverage by OHIP for lidocaine infusion, but only for certain conditions such as post stroke pain and mass MS pain, and only every two months. In terms of research, there is a little bit of indication, at least for ketamine, that it's trying to offer infusions more frequently at the beginning, say twice a week or once a week. May lead to better long term outcome where after a series of initial treatments one may be able to space out or stop the infusions. and the benefit continues. typically the benefit does not continue indefinitely, of course, so after a period of time infusions would have to be repeated. the range of responses varies from days to weeks to perhaps months if you do a series of injections at the beginning close together. Coverage for these injections is a bit of an issue. Often the coverage that's available is not, through the government, is not sufficient to be able to control the pain with infusions. However, often it will allow patients to at least try the infusions to see whether or This is the kind of treatment that would work for them. Typically, initially, the doses of infusions are lower, and if there's no response, the doses can be gradually raised. There's also variability in terms of duration of infusions. For depression, ketamine infusion, for instance, only requires a 45 minute time period, while Most of the infusion done for chronic pain require a longer time period, anywhere from two to four hours. In terms of the role of infusions, I think it is still too early to tell. I think there will be some patients who will respond to infusions, but not to other treatments. However, what percent of patients will do it. do that I'm still not sure. For majority of the patients my sense is from talking to other people that the response is typically weeks and one has to keep doing the procedure. an ongoing basis in order to maintain the benefit, a little bit like oral tablets for pain. There's also other types of infusions that are not necessarily used for pain and are not or hip covered. that are making their way into Ontario. These include ozone infusions, NADH infusions, vitamin infusions. Some people use them for energy level and for general sense of well being. I do not believe that there has been much research in terms of using them for chronic pain.
Raveena:As we come to the end of today's episode, I want to extend a heartfelt thank you to our host Dr. Karmy for generously sharing his expertise and shedding light on the current stance of infusions and pain management, particularly here in Ontario. Your comprehensive understanding of how these infusion therapies compare to traditional nerve block treatments has provided us with invaluable insights. Remember, when it comes to your health, it's Always consult with your own physician or healthcare provider for personalized advice and guidance. In future episodes, we plan to explore widespread painful conditions relevant to patients with chronic pain more thoroughly, including fibromyalgia. Additionally, Dr. Karmy's interest in regenerative medicine opens up avenues for discussions on approaches such as prolozone, platelet rich plasma injections, and stem cell injections. So stay tuned for more insightful conversations and expert perspectives on chronic pain management and treatment options. Until next time, this is Raveena Aujla from Chronic Pain Chronicles with Dr. Karmy.
