Comments for Pain Management Specialist in San Diego & La Jolla

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Nancy Sajben MD

Nancy Sajben MD — Thu, 16 Feb 2012 07:38:41 +0000

I do not know of other doctors who prescribe ketamine with one exception, anesthesiologists who give it IV. Even there, I know of only a small number in the USA. I do treat patients, but before they come long distance, it is important that they find local doctors who will continue to prescribe for them.

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Sue

Sue — Wed, 15 Feb 2012 20:58:01 +0000

Dr. Sajben,
Thank you for your discussion of Ketamine. I have suffered with treatment resistant depressiion for many years and with anxiety for the last few years. I have read about Ketamine for some time now and have been so frustrated that more doctors are not willing to use it. I live in the New Orleans area. Do you know of any doctors in this area who use ketamine or could you tell me how I might be able to find one? Do you treat patients for depression? I would really appreciate any help. Thank you,
Sue

Comment on Carry On —> Inspiration by Nancy Sajben MD

Nancy Sajben MD — Wed, 15 Feb 2012 18:16:15 +0000

Yes, I have patients whose depression responds rapidly to ketamine, either intranasal or under the tongue. It takes a great deal of time of post their case reports, not easy with my busy schedule.

Comment on Depression PTSD – Ketamine Rapid Relief by Nancy Sajben MD

Nancy Sajben MD — Wed, 15 Feb 2012 18:14:13 +0000

I do not know of other doctors who prescribe ketamine with one exception, anesthesiologists who give it IV. Even there, I know of only a small number in the USA.

Comment on Ketamine Intranasal for Rapid Relief of Pain and Depression by Nancy Sajben MD

Nancy Sajben MD — Wed, 15 Feb 2012 18:13:55 +0000

I do not know of other doctors who prescribe ketamine with one exception, anesthesiologists who give it IV. Even there, I know of only a small number in the USA.

Comment on Depression PTSD – Ketamine Rapid Relief by ianpvr

ianpvr — Wed, 15 Feb 2012 17:07:28 +0000

Do you know of any doctors in Mexico who are working with oral, sublingual or intranasal administration of ketamine for depression or PTSD?

Comment on Carry On —> Inspiration by Lisa

Lisa — Mon, 13 Feb 2012 23:31:24 +0000

I know there is a lot of ‘hype’ in the news right now about ketamine and its relief for depression. Do you currently have patients who are treated with ketamine and what have their results been? I am currently working with a phsyciatrist and CBT therapist to relieve major depression with very little results. I’ve read a lot about the ketamine treatment and am seriously thinking about finding someone who uses this therapy. Any information on your experiences with this would be greatly appreciated.

Comment on Ketamine Intranasal for Rapid Relief of Pain and Depression by bryan

bryan — Sat, 04 Feb 2012 00:35:19 +0000

Hi Nancy, do you know of any Michigan psychiatrist that will prescribe nasal Ketamine?, other scripts have not helped with ptsd and damage from stress, I believe this drug could help, perhaps i could come see you

Comment on Case Reports – Fibromyalgia, Spinal Stenosis, Disc Disease, CRPS, Transverse Myelitis, Central Pain by Kay Stewart

Kay Stewart — Tue, 31 Jan 2012 03:52:22 +0000

Thank you for sharing in this way. I will keep this link as a reminder of your skill and knowledge, should the need arise for self, family, or friends.

Comment on Case Reports – Fibromyalgia, Spinal Stenosis, Disc Disease, CRPS, Transverse Myelitis, Central Pain by Janis Van Wyck

Janis Van Wyck — Mon, 30 Jan 2012 04:13:30 +0000

Tremendous work!

Comment on Ketamine Intranasal for Rapid Relief of Pain and Depression by Nancy Sajben MD

Nancy Sajben MD — Mon, 30 Jan 2012 02:37:25 +0000

I am sorry. It is not lawful for an MD to give patients medical advice without an examination.
I would be happy to speak with your physician if you wish to call me about doing that.

Comment on Ketamine Intranasal for Rapid Relief of Pain and Depression by Nancy Sajben MD

Nancy Sajben MD — Mon, 30 Jan 2012 02:35:45 +0000

I am so sorry. It is not lawful for me to give medical advice without an examination.I would be happy to speak with your doctor if you contact me to make arrangements.

Comment on Ketamine Intranasal for Rapid Relief of Pain and Depression by Linda

Linda — Mon, 30 Jan 2012 02:01:02 +0000

Interested in the pain flares between ketamine infusions. What dosage do you use of the ketamine nasal spray? Where would my doctor send the script?

Thank you!

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Nancy Sajben MD

Nancy Sajben MD — Sun, 29 Jan 2012 02:47:20 +0000

Dear Lori,

It is not legal for an MD to give patients medical advice without an examination in the office. I am sorry.
I would be happy to speak with your daughter’s physician if you wish to call me and find out details about doing that.
I have posted a link to a study on my newest page “Case Reports” [top left below photo, 1/28/12] showing pain reduction after detoxing from high dose opioids.
Most doctors are not aware that opioids create pain. That may be especially important in the setting of chronic pain.

That said, it is a patient’s decision to taper off opioids and try mediations that may have failed while they were on them.
Best of luck to you and your daughter.

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Nancy Sajben MD

Nancy Sajben MD — Sun, 29 Jan 2012 02:40:00 +0000

Thank you. I have no patient experience with this as yet but will trial it.

Comment on Case Reports – Fibromyalgia, Spinal Stenosis, Disc Disease, CRPS, Transverse Myelitis, Central Pain by Jude

Jude — Sat, 28 Jan 2012 23:26:11 +0000

It’s so good to see your new posts after so many months. Thank you for your genuine interest in relieving the suffering of others and for providing information that is difficult for a lay person to come by easily.

Comment on Ketamine Intranasal for Rapid Relief of Pain and Depression by Gerard Skibba

Gerard Skibba — Fri, 27 Jan 2012 12:44:30 +0000

Hello Dr Sajben, Your survey-review of low dose intranasal ketamine is spot-on. The depression relief is one of the best parts of the benefits provided by rational use of this medication. I feel that the low grade depression that is engendered by chronic pain is the major contributing cause of the malaise that inevitably develops with time.
If the suffering is stopped early, many of the longer time-frame disabilities will not occur but if they have, they should be reversible. My own previous experiance with intranasal ketamie (50mg/ml) is that it first relieved the myocloni that seem to be a part of opioid pain control problem that I had.
Please feel free to repost any parts of my previous emails to you.
Thank You,
Best Regards
Gerard

Comment on RSD – CRPS – Complex Regional Pain Syndrome – Long Distance Patients by Nancy Sajben MD

Nancy Sajben MD — Wed, 25 Jan 2012 00:43:05 +0000

Again, specifically, if tethered to the spinal cord, or some other complication, they cannot be removed.

Comment on RSD – CRPS – Complex Regional Pain Syndrome – Long Distance Patients by Nancy Sajben MD

Nancy Sajben MD — Wed, 25 Jan 2012 00:41:53 +0000

I believe they can be removed, but they may become tethered to the spinal cord itself. I presume that may occur when they have been in for some time. I do not implant these, but one of the foremost anesthesiology pain specialist in the country, Harvard trained in pain management, will not put these in and will not refer patients for them.

Comment on RSD – CRPS – Complex Regional Pain Syndrome – Long Distance Patients by Maureen

Maureen — Sun, 22 Jan 2012 13:57:08 +0000

I just had the scs implanted two weeks ago. I am getting that sharp pain and burning near the battery site. It happens with the scs on or off. I really am wishing I never got it. I feel that the small relief that I am getting is not worth it. Are you telling me that the leads can never come out and no MRI ever? I do believe they can be removed.

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Lorri Cockrell

Lorri Cockrell — Fri, 13 Jan 2012 00:33:43 +0000

Hello:

I am a mother to a daughter with full body RSD after foot surgery, I too have taken my daughter to all the possible treatments in the US….We are trying the LDN. Normally she takes demerol and nasal ketamine. The reason I am writing is to ask about how hard was it to go from the opiate med to LDN and if you experienced jittery and like your body didn’t want to stop and what you did for yourself to get through till the LDN started working. May I ask how long it took for the LDN to start working for you. I only wish for my daughter to get through the rough part to just maybe it will give her relief as her life has been hell. Any help surely will be appreciated.

Thank you……Lorri

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by scott f

scott f — Thu, 05 Jan 2012 21:24:03 +0000

Dr. Sajban,

I Wanted to make you aware of this —
http://www.neuropathie.nu/gliopathic-pain/glia-as-target-for-new-analgesics-and-palmitoylethanol.html

Normast is quite expensive – but, it looks like the science is sound.
I am a patient with neuropathic pain – and, have tried both the tablets and the granules. I notice an immediate improvement with granules.

Sincerely
Scott

Comment on RSD – Complex Regional Pain Syndrome – A Case Report by Jill Holmes

Jill Holmes — Wed, 28 Dec 2011 18:20:37 +0000

My daughter was diagnosed with Complex Regional Pain Syndrome (CRPS)/RSD in February 2011. The second day after starting swim practice, she was in level 9 pain. She had injured her left foot previously and this is where the pain started. Pain continued to spread up the leg through her hip. She was diagnosed right away and received physical therapy. We were told most cases resolve within a year. She was prescribed gabapentin which did not resolve the pain and left her incapacitated with side effects. Then Lyrica, which resulted in an allergic reaction. She continued with physical therapy, and in addition to her strong will, she was able to get off crutches and used a cane intermittently. Still, she was always in pain coupled with the other symptoms that come with this disorder. Simple physical activities such as walking were limited.
I spent countless hours searching the internet trying to gain a better understanding of CRPS and to somehow find something that might work. Last September, my daughter’s condition took a drastic turn for the worst. She was wheelchair bound, level 10 pain, and unable to attend school. Again, more medications were tried that were not successful and once again came with a host of debilitating side effects. Weeks passed.
Then everything changed. I found a posting on low dose naltrexone and after more searching, I found Dr. Nancy Sajben’s website. I am so impressed with Dr. Sajben. She is a kind, compassionate physician who truly cares about her patients. She listened to our plight. She spent time with us explaining everything and answered all of our questions. She explained that each patient is unique and their pain management varies in the types of medications that may prove to be effective. We left with several prescriptions, including LDN, and for the first time in a long time – hope. The effect of the LDN was almost immediate and with no side effects. The doctor worked closely with her dose until the pain disappeared entirely!!! With 3mg of LDN a day, she is back in high school and looking forward to college.
I don’t know how to put it into words, just how deeply thankful we are to you (Dr. Sajben). Dr. Sajben, your approach to pain management has changed our lives forever. I am so thankful for the hours you spent to create a website that made it possible for us to learn about effective approaches to pain management and to find you. Without access to the information on this site, and an appointment with you, I shudder to think about what the future held for my daughter. Thank you so much!

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Nancy Sajben MD

Nancy Sajben MD — Mon, 14 Nov 2011 05:53:11 +0000

I am unable to predict effects of any medication, not even morphine is able to reduce chronic pain in everyone. But I do stress the need for polypharmacy especially for severe chronic pain.

I have never seen low dose naltrexone cause any liver problems. My addictionologist colleagues report liver problems only on 400 mg, not lower doses.

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Nancy Sajben MD

Nancy Sajben MD — Mon, 14 Nov 2011 05:47:31 +0000

I have been very pleased with the results of my patients on nasal ketamine so far. It is much better than the oral ketamine I have prescribed for ten years.

I have one of the best compounding pharmacies nearby, and they do ship:

PJ’s Prescription Shoppe in San Diego, 619-223-5404

Best of luck.

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Kay Hill

Kay Hill — Thu, 10 Nov 2011 19:59:05 +0000

Dr. Sajban,

Thank you for your website. My husband suffers central cord pain (dysesthesia and allodynia) from bruising his spinal cord (C5/6 area) in a fall and is suffering other fallout from the injury. He just started taking 4.5 mg. LDN hoping that it might help the pain. It has disturbed his sleep so he will be taking it in the mornings. He also takes 20 mg. of zocor daily and is concerned that there might be complications with the liver. Do you think there is a possibility of the LDN helping the type of pain he has and do you have any qualms about his taking it while he takes zocor?

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by margaret Wateron

margaret Wateron — Sat, 29 Oct 2011 12:50:53 +0000

I am trying to find a Compounding Pharmacy to prvide the Intra nasal Ketamine.
Where did Gerard Skibba get his?
My PM physician is willing to prescribe this.
It seems that some of the reluctance stems from the abuse of this drug socially.

Help please.

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Gerard Skibba

Gerard Skibba — Tue, 06 Sep 2011 04:15:39 +0000

Dr. Sajben: for information about Intaranasal Ketatmine
Backup/Details: Intranasal Ketamine
Background: Product profile
• Optimal dose is 3 to 5 sprays (30 – 50 mg)
• Absolute bioavailability PMI-100 = 35.5%
Therapeutic Index
• 15 X difference between analgesic and anesthetic dose
• Analgesic Dose of 50mg PMI-100 (50mg*35.5%) = 18 mg
• Anesthetic Dose of IV Ketamine (Ketalar® ) = 280 mg
Intranasal Ketamine Review
Pharmacokinetics, Dose Proportionality and Absolute Bioavailability of PMI-100 (Intranasal
Ketamine) in Healthy Volunteers, 2 period, cross-over, IV vs. PMI-100 (10, 30, 50 mg)
• t1/2 (h) = 5.8
• Tmax(h) = 0.42
• Bioavailability 35.3% [90% CI 22.3-55.8]
From: http://intranasal.net/Hospice/IN%20ketamine%20in%20military%20combat%20pain%20situations.pdf
I received a trial of intranasal ketamine for Osteoarthritis and Opioid Induced Hyperalgesia. I achieved good relief using 50-70 mg every 3-6hrs. The best thing that happened was that all the spastic muscle issues and cramping from the hyperalgesia stopped immediately. I was able to restart physical therapy exercises and even noted that I was able to recruit muscles that I had not been able to work on before. My current MD gave me just one trial but is reluctant to keep prescribing for off-label use. I will have to have a talk with him again and if he won’t relent I will need to seek another local MD. I have Medicare as well as VA and the time for changing MD’s and/or insurance is just around the corner. I have been on Vicodin for the last 15 years or so and have been using ultra low dose naltrexone 10 nanograms oral with my Opioid doses to prevent the development of tolerance and also to preclude addiction.

Comment on Welcome to my Weblog on Pain Management! Thanks for stopping by. by Nancy Sajben MD

Nancy Sajben MD — Sun, 26 Jun 2011 08:42:59 +0000

Dear Margaret,

I am so sorry. It is against the law for an MD to give medical advice without a history and examination.

Comment on LDN World Database – Low Dose Naltrexone by Nancy Sajben MD

Nancy Sajben MD — Sun, 29 May 2011 10:44:58 +0000

Naltrexone is valuable for different conditions in different dosage ranges. If you are on opioid analgesics, then the ultra low dose of 1 microgram to 40 micrograms may be helpful to many, depending upon the dose of opioid you are taking. But a dose of 1 to 4.5 mg would cause you to go into opioid withdrawal. There is data that shows people who taper off opioids have less pain. Opioids cause pain. They activate glia that produce cytokines that cause pain. I discussed the mechanism here. .