Abstract
Ketamine, an N-methyl-D-aspartate receptor antagonist, is widely known as a dissociative anesthetic and phencyclidine derivative. Due to an undesirable adverse event profile when used as an anesthetic it had widely fallen out of human use in favor of more modern agents. However, it has recently been explored for several other indications such as treatment resistant depression and chronic pain. Several recent studies and case reports compiled here show that ketamine is an effective analgesic in chronic pain conditions including cancer-related neuropathic pain. Of special interest is ketamine’s opioid sparing ability by counteracting the central nervous system sensitization seen in opioid induced hyperalgesia. Furthermore, at the sub-anesthetic concentrations used for analgesia ketamine’s safety and adverse event profiles are much improved. In this article, we review both the basic science and clinical evidence regarding ketamine’s utility in chronic pain conditions as well as potential adverse events.
Highlights
Ketamine, a phencyclidine derivative, was first synthesized in the 1960s as a short-acting alternative to phencyclidine which demonstrated lower occurrence rates of emergence delirium (Domino, 2010)
No significant difference in and nonanalysis for 5 h analgesic benefit up to 2 weeks ketamine efficacy based on pain neuropathic after cessation of condition administration
We present ketamine as a therapy for cancer and chronic pain that is intractable to well-established therapeutics such as opioids
Summary
A phencyclidine derivative, was first synthesized in the 1960s as a short-acting alternative to phencyclidine which demonstrated lower occurrence rates of emergence delirium (Domino, 2010). The drug gained FDA approval for use as a sole or combine general anesthetic agent in 1970 with administration intravenously or intramuscular (Rosenbaum et al, 2020). While not currently FDA approved, there has been significant clinical evidence that suggests administration of ketamine at sub-anesthetic doses provides significant analgesic effects with limited side effects (Kronenberg, 2002). Intravenous ketamine infusions for chronic refractory pain are within the guidelines of the American Society of Anesthesiology (Cohen et al, 2018). Likewise, growing evidence supports alternative modes of delivery of ketamine in analgesia (Kronenberg, 2002). The purpose of this review is to highlight the current understanding of ketamine use in chronic pain management especially as it relates to cancer pain
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