RADICAL RELIEF

For some people who suffer chronic pain, a drug that is known on the street
as "Special K" may be the answer.

At his worst, Brett Lovell, 32, of Lebanon, Pa., experienced such searing
pain that he couldn't straighten his arm, and the fingers of his left hand
curled up like a claw. The pain had him downing 25 pills a day.

Then he undertook an experimental treatment - a seven-day coma in which he
was pumped full of a drug called ketamine, which doctors use as an
anesthetic and street dealers refer to as the recreational drug "Special K."

The experimental procedure gave him fleeting hallucinations, but it helped.
"I can enjoy life better today," said Lovell, who is down to just one pill
a day and can maneuver a computer mouse.

Ketamine is now being touted as a revolutionary treatment for a severe pain
disorder.

In the treatment, ketamine is infused intravenously and continuously while
patients are supported by a ventilator - and are virtually dead - for days.

Robert Schwartzman, chairman of neurology at Drexel University College of
Medicine, is the U.S. pioneer of the experimental treatment, which resets
the link between the pain sensory neurons and the brain.

He equates the brain to a computer. "For five days we turn your computer
off so you're not having any pain," he said. When the brain is turned back
on, the pain system is "rebooted."

Considered a safe anesthetic, ketamine - known in street parlance as K or
Special K - is chemically similar to PCP and causes inebriation,
hallucinations and dissociation, a sensation that patients are not in their
bodies. These side effects have led to its popularity at raves and reports
of its use as a date-rape drug.

That history was not lost on Sandra Lovell, who watched her son Brett in
his coma. "All I can describe it as is seeing your child laying there
dead," she said. "The worst part was when he was coming out of it. It's
like coming off one of the worst trips from LSD."

One of his hallucinations was of his brother, a police officer, trying to
shoot him, a vision that greatly distressed his parents.

Yet for Lovell, the trip - which cost about $30,000 - was worth it.

The extreme nature of treatment speaks to the desperation of those with
chronic regional pain syndrome or reflex sympathetic dystrophy, a condition
that affects 1.5 million Americans, according to the Reflex Sympathetic
Dystrophy Syndrome Association.

The syndrome produces intense, burning pain, and causes normally
non-painful sensations - touch, movement and temperature - to be agonizing.

"It makes you feel like you've been doused in gasoline and set on fire,"
said Cynthia Toussaint, 44, a sufferer in Valley Village, Calif., who runs
a nonprofit organization to help women in pain.

The condition can result from any type of injury, such as a turned ankle or
carpal tunnel syndrome. It develops in 1 to 2 percent of fractures and 2 to
5 percent of peripheral nerve injuries.

The body's pain system, which is necessary to telling us something is
wrong, goes awry in these cases.

When pain fibers from the injury site activate, they trigger a chain
reaction that changes the structure of the pain neurons. These changes
provoke the neurons to fire even more - like a car engine revving out of
control - which creates more pain, said Daniel Carr, chief executive
officer of IDDS, a New York City-based company that is testing a ketamine
nasal spray.

The syndrome often goes misdiagnosed and mistreated, said Schwartzman. Most
of his patients have already seen 10 other doctors by the time they find him.

And, many, especially children, face skepticism from their doctors, who
think the patients are just trying to get attention.

"I got such horrible looks from doctors, like I had two heads," said Megan
Vanatta, 21, of Washingtonville, N.Y., who has had the disorder since she
was 7. "Doctors would ask, 'Are your parents fighting? Do your parents
abuse you?' "

The earlier the condition is treated, the more effective it seems to be -
but there is no cure and no one treatment works universally, experts say.
The ketamine coma is only for the most serious cases.

A number of U.S. doctors use ketamine in small doses to treat pain while
patients are awake, but Schwartzman and two German colleagues, Ralph-Thomas
Kiefer and Peter Rohr, are the first to infuse it in comatose patients for
up to seven days.

So far, the trio has treated 26 American patients in Germany. All patients
received significant temporary pain relief, and nine remain completely
pain-free from nine months to three years after the infusion.

Ketamine is FDA-approved in the United States for two-day use when the
patient is awake, but Schwartzman holds out little hope that the coma
procedure will ever be allowed here.

At Hahnemann University Hospital in Philadelphia, Schwartzman studies
ketamine use for less severe patients and as boosters for those who have
returned from Germany.

He just finished a study of 50 patients who were awake during five days of
ketamine use - also not enough, he said - and plans to go back to the FDA
in a couple of months for approval to try 10-day outpatient infusions.

It may seem strange for a mind-altering substance to be used medically, but
the history of ketamine is like many other drugs - if it works for one
thing, scientists say, let's see if it works for another.

"The problem unfortunately is that we have so many horrible diseases
related to the brain and so few drugs," said Bita Moghaddam, neuroscience
professor at the University of Pittsburgh who uses ketamine in rats to
mimic schizophrenic symptoms. "If you have a drug you think is relatively
safe, you have to use what you have."

Ketamine has also been used to study alcoholism and dementia, and explored
as a treatment for sleep apnea and addictions and an aid in psychotherapy.

While many severe pain sufferers are enthusiastic about the ketamine coma,
researchers are more cautious.

"Initial observations are exciting," said Srinivasa Raja, director of pain
medicine at Johns Hopkins University School of Medicine. "But it has to be
tempered with the fact that they are not blinded observations. They have to
be followed through over time."

Timothy Lubenow, a pain specialist at Rush University Medical Center in
Chicago, had a patient who went to Germany and "had great pain relief up
until the plane ride back," he said. "She bumped her knee, which was the
affected part, and the pain came back."

Schwartzman hopes that continuing research on treatments for severe pain
will yield alternatives to the ketamine coma and that in the future "we
won't need the ketamine sleep."

But, "right now, for dreadful patients, the only thing I've seen work is to
have them go to sleep," he said.

ONLINE EXTRA

For more information about ketamine and reflex sympathy dystrophy, go to
(http://go.philly)http://go.philly. com/ketamine