RSD In DE: "Yes Sir, That's My Baby"–70 Year Old Specialist Is Touted And Ketamine Treatment Upheld

Okay, after all the ballyhoo this week about Utilization Review, fines, missed deadlines, and lawyers now practicing under the fear of God [well, some of us do that anyway], I am ready to write about something gentle, upbeat, uplifting, or at least non-controversial.....  So I came across this decision involving a DACD Petition seeking approval for Ketamine injections for a diagnosis of reflex sympathetic dystrophy, the objective of which was ostensibly pain relief and improved function.   There's a positive note.  So I offer to you Ellen Fister v. DuPont Merck Pharmaceuticals, IAB # 1139427 (7/7/10).

Testifying for the claimant was Dr. Frank Falco, a local physician with expertise in physical medicine and rehabilitation, having referred the claimant for treatment with Dr. Robert Schwartzmann of Philadelphia.  Dr. Schwartzmann, Professor and Chair of the Dept. of Neurology at Drexel University College of Medicine, has been involved in Ketamine trials to effectively eliminate neuropathic pain, in preference over Lidocaine, Methadone, and Dextromethorphan, for example.  The most current medical literature would suggest that Ketamine is statistically more effective than placebo in reducing pain and restoring functionality.  Dr. Falco testified that his patients on referral to Dr. Schwartzmann have in large number been able to eliminate narcotic use in the Ketamine protocol.  Similar programs have only been available in Mexico or Germany and have required that patients be coma-induced; the U.S. protocol for this treatment does not require FDA approval because there is no coma involved.  Moreover, the pain relief can extend nine to eighteen months in duration.  Dr. Falco acknowledged that Dr. Schwartzmann is in his early 70s and has focused his medical career on treatment and evaluation of RSD, and his reputation in the area of CRPS and RSD is internationally renowned.

Defense medical evidence was submitted on behalf of DuPont in the form of two reports prepared by Dr. Adam Sackstein.  Dr. Sackstein did not endorse a diagnosis of complex regional pain syndrome (another name for RSD) and characterized claimant's condition as neuropathic right upper extremity pain.  Dr. Sackstein deemed treatment to date to be reasonable and necessary and would allow for an increase in Neurontin and Zanaflex, with a focus on medication management and if that did not produce optimal results, consideration for a spinal cord stimulator.  Dr. Sackstein commented that Ketamine therapy is experimental in nature and palliative at best, with no evidence to suggest it would improve function.

The Hearing Officer who considered this narrowly-defined issue, Lydia Anderson, awarded the treatment.  She authored a credible, concise opinion outlining why the Ketamine protocol is not experimental (Medicare pays for it) and how the treatment operates to block neuropathic sympathetically mediated pain.  There is consideration of other treatment modalities which have already been attempted with this claimant to no avail.  And of course, there is an appropriate amount of deference to Dr. Schwartzmann, who did not testify, but had Dr. Falco as his mouthpiece.  Dr. Schwartzmann is 70.  He is one of the deans of RSD evaluation and treatment, and apparently the Ketamine protocol is "his baby".

Lessons learned?

•     Ketamine is not experimental

•     Ketamine is not a placebo

•     Dr. Schwartzmann is a force to be reckoned with if the issue is RSD or CRPS

•     Dr. Falco does one heck of a commercial for the docs he refers to

•     Ketamine is Dr. Schwatzmann's "baby"

That said, at 70 ....shouldn't it be his "grandbaby"?

Stay cool, stay poolside and have a great weekend!