Best practices -- ketamine, pain relief, "K pains"
August 5, 2016 12:49 PM   Subscribe

Someone close to me uses ketamine, and is having agonizing, 10/10, "I would consider killing myself" abdominal pains. They've had ER visits, one in-patient stay, various tests (MRI, CT, endoscopy, blood work). Results of tests include: anemia, high magnesium, low calcium. Pain may be (is likely?) caused by ketamine use causing inflamed bile ducts.

Now the issue is how to manage the excruciating pain without using more ketamine (assuming the ketamine is the cause of the inflammation/pain). The doctors have prescribed relatively high doses of Advil (800) and Tylenol (650); the Advil has now triggered gastritis with bleeding, which is complicating things.

Any best practices or lived experiences for how to manage this pain / kick ketamine? Person did quit ketamine for a few weeks but keeps resorting back to it because of the agonizing pain.

Some internet links suggest Prevacid.

Person is in the New York City area.
posted by ClaudiaCenter to Health & Fitness (16 answers total) 2 users marked this as a favorite
High levels/ongoing use of ketamine is also associated with major bladder issues -- and bladder pain is fucking horrible. Is that a thing that's come up?

What exactly are you asking? Med recommendations?
posted by fiercecupcake at 1:02 PM on August 5, 2016

I'm stunned that this person was prescribed NSAIDs for a situation like this. Did steroid anti-inflammatory therapies come up with the physician?
posted by late afternoon dreaming hotel at 1:03 PM on August 5, 2016 [4 favorites]

One of the links you gave suggests a warm bath. I would add a good quality salt to the bath. Ideally, it should be Celtic sea salt, which you can Google and order online. But, for today, get kosher salt or canning and pickling salt or sea salt with no additives from a local store.

I have a history of serious gut issues and serious pain. Good quality salt is enormously helpful in addressing gut issues.

One of the links also suggests going easy on fats. I will suggest specifically going easy on long chain triglycerides as these need to be broken down (ie digested). Medium chain triglycerides help heal the gut and can be absorbed directly without digestion, even when used topically. A good source of MCTs is coconut oil. Medium chain triglycerides have a long history of being medically prescribed for very serious gut problems, such as Cystic Fibrosis or stomach cancer.

Try to limit the fats in the diet to organic butter, coconut oil, palm oil and ghee (clarified butter) until this is better.

Aloe Vera can also do good things to the gut.

All three of these are known to promote diarrhea. Start with one and only one. Give it a few days to see how it is impacting them. Then add a second to the mix. Again, give it a few days. Start slow, with small amounts. Otherwise, you are likely to see serious intestinal drama.

I would start with the salt water baths first. That has resolved abdominal agony for me in the past.
posted by Michele in California at 1:06 PM on August 5, 2016 [2 favorites]

Do any of the doctors know about the ketamine use? With pain that bad it might be a better idea to start getting second opinions.
posted by Aleyn at 1:13 PM on August 5, 2016 [9 favorites]

I will add that you need to get their calcium levels up. Calcium is necessary to start the clotting process. Getting their calcium levels up may reduce their bleeding and may also help reduce inflammation. Calcium and iron should not be taken together.
posted by Michele in California at 1:17 PM on August 5, 2016 [1 favorite]

A non-medication remedy that I use for the gut-wrenching pain I experience every once in a while is to put a heating pad on my belly. I don't know what it does, exactly, but it really helps me get through days where I want to carve my organs out with a dull spoon.
posted by xingcat at 1:28 PM on August 5, 2016 [1 favorite]

Just an FYI: Heat treatments increase blood flow. This can make bleeding worse. You might consider ice packs until the bleeding is resolved. Both hot and cold treatments are effective non drug means to address local pain. Cold treatments are an effective means to stop bleeds. Cold treatments are used often in the CF community to treat lung bleeds at home in hopes of avoiding a trip to the ER.

Consuming small amounts of sugar can also take the edge off. It won't stop the pain, but it can make it more bearable. My sons sometimes gave me a single sugar cookie when I had extreme pain and suffering while withdrawing cold turkey from medication (and curled up in a ball on the floor in the darkest corner of our apartment the entire weekend).
posted by Michele in California at 1:48 PM on August 5, 2016

Hypocalcemia (low calcium levels) can be caused by kidney disease, which could be caused by ketamine use. I wonder if their pain is kidney-related.
posted by thegreatfleecircus at 1:48 PM on August 5, 2016 [2 favorites]

Unless your friend's medical team know about the ketamine, they'll likely stick with prescribing the high doses of NSAIDs. This won't help with the gastritis, which was very probably caused by the ketamine in the first place.
posted by scruss at 2:01 PM on August 5, 2016 [3 favorites]

Response by poster: They know about the ketamine – sorry I wasn't clear about that
posted by ClaudiaCenter at 2:12 PM on August 5, 2016 [1 favorite]

Is inpatient drug treatment or asking your friend's medical team for advice on that an option?
posted by a lungful of dragon at 2:18 PM on August 5, 2016 [1 favorite]

This sounds severe enough that your friend should seriously consider doing a full detox at an in-patient rehab clinic to cut ketamine usage completely. You're a good friend; I hope they find relief from their pain soon.
posted by Hermione Granger at 2:35 PM on August 5, 2016 [2 favorites]

The pain may have been caused by gastritis in the first place, which is a common problem even among non-ketamine users. Use of NSAIDs like ibuprofen can make these problems worse.

The advice on the second link you sent is good advice for people suffering from symptoms of reflux, gastritis, or pain associated with the biliary tract. I'd honestly have them focus on those types of commonsense measures and close follow up with a gastroenterologist if they haven't already.

As for kicking ketamine use, I would strongly encourage them to see an addiction counselor or whatever addiction treatment services they might have access to. Knowing the local area might help refer them to relevant resources. Assuming that the pain is simply related to gastritis or ketamine, this actually could be a great opportunity for them to make a change in their lives and get off drug use, but it's extremely important to try to help advocate for the closest follow up and most intensive addiction treatment services possible because this type of situation is also a setup for someone to potentially be tempted into a new addiction like narcotics.

I am also sending you MeMail.
posted by treehorn+bunny at 9:42 PM on August 5, 2016 [3 favorites]

We can't deal with this here. This situation is so acute and so complex and we have so little information (not your fault) that any specific advice we can give other than "go back to the hospital" or "get into an inpatient care program of some kind" is frankly irresponsible. Your friend has 10/10 pain, drug withdrawal/dependency, gastric bleeding, and who knows what else. Your friend needs to be getting cared for 24/7 by actual doctors who know their history, have access to their tests, and are trained/equipped to deal with things like this. This is not something to be fucking around with internet stranger advice over, snd I'm kinda shocked at how blithely some of the folks above are taking this.

Get your friend back to a doctor and try to find a way to keep them there. That would be the best thing to do, if you want your friend to survive this life-threatening on multiple fronts situation.
posted by Anticipation Of A New Lover's Arrival, The at 4:01 AM on August 6, 2016 [9 favorites]

Response by poster: Thanks everyone. Person is in regular contact with treating medical professionals / doctors (which I have encouraged). Agree that person should seek drug treatment, which I have also encouraged.
posted by ClaudiaCenter at 10:39 AM on August 6, 2016 [1 favorite]

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