Chapters Transcript Video Educational Session: Clinical | 339 - Oral Ketamine for Complex Facial Pain Elevates Cortisol Levels in Cushing's Disease Wednesday, February 22, 2023 5:00 - 6:30 p.m. PST Stephanie Van, MD Educational Session: Clinical | 339 - Oral Ketamine for Complex Facial Pain Elevates Cortisol Levels in Cushing's Disease Hi I'm dr Stephanie van, I'm an assistant professor at johns Hopkins School of Medicine. I am a Vietnamese woman with long black hair wearing a dark blazer and blouse sitting in front of a colorful bookshelf that also features a t shirt that's black with white font that says the future is accessible. I'm excited to present a poster at a p 2023. It features a case study of complex chronic facial pain after multiple pituitary tumor receptions for cushing's disease. Uh This patient had a lot of residual sinus and headache pain that was really refractory to a lot of 1st and 2nd line medicines and procedures. So we decided to go out of the box and try compounded oral ketamine capsules which are third line for complex chronic pain as well as PTSD ketamine is an old medication that's been used for many, many decades. I use it as a third line pain management strategy. It's an M. D. A receptor antagonist so it helps improve plasticity and relearning neural pathways in the brain and it can help people dissociate from past traumatic experiences or complex chronic pain. Um So with oral ketamine, this patient's pain actually significantly improved her mood improved her quality of life overall improved, which was really encouraging. But because of her history of cushing's she was getting her cortisol levels monitored and ketamine was associated with an increase in her serum cortisol levels. Now this hasn't really been shown in human studies. Most of the studies we know that this does happen is in animal models. Um So it's nice to present this in a human case who was already getting her cortisol levels checked um thankfully when she stopped the Royal Academy, the cortisol levels normalized. So this confirmed she didn't have a recurrence of her cushing's and this was all attributable to the ketamine. The concepts in this paper are really important to present because even though it's one case, it's a unique example of a third line out of the box compounded medicine, it's not FDA approved but it's a well known drug in the field of pain medicine and psychiatry. Um And it's a case where someone's cortisol levels were already being monitored. Um So it's a nice human example of ketamine influence on cortisol levels. Um potentially the hypothalamic pituitary access which also mediates our experiences of pain, stress and trauma. Um All of this nicely fits into uh us learning more about how pain and trauma and hormones are connected Created by
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