Ketamine for the treatment of chronic non-cancer pain

Noppers, Ingeborg; Niesters, Marieke; Aarts, Leon; Smith, T.; Sarton, Elise; Dahan, Albert

doi:10.1517/14656566.2010.515978

Cited by 104 publications

(86 citation statements)

References 62 publications

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“…First introduced as an anesthetic in 1964, it has since evolved for use as a veterinary anesthetic, a recreational drug (Special K) sought out for its hallucinatory and dissociative effects, and an analgesic frequently used in the postoperative setting as well as in the management of pain syndromes (1)(2)(3)(4). Ketamine has also become a popular choice for mild sedation when airway reflexes and hemodynamic stability must be maintained.…”

Section: Introductionmentioning

confidence: 99%

Psychiatric side effects of ketamine in hospitalized medical patients administered subanesthetic doses for pain control

Rasmussen

2013

Acta Neuropsychiatr.

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Section: Introductionmentioning

confidence: 99%

Psychiatric side effects of ketamine in hospitalized medical patients administered subanesthetic doses for pain control

Rasmussen

2013

Acta Neuropsychiatr.

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“…Its chiral center on the C 2 atom of the ketamine cyclohexane ring gives rise to two enantiomers of ketamine (S(+)− and R(−)−). [56] It binds to the phencyclidinic site on postsynaptic channels and reduces the frequency and opening time of ion channels. [7] This blockade by ketamine at the NMDA receptors is dose-dependent in that the rate of onset and the recovery from blockade are increased by applying NMDA agonists.…”

Section: Pharmacological Propertiesmentioning

confidence: 99%

“…As a result, antagonists such as ketamine have been seen to stop afferent nociceptive transmission to the brain. [69] Ketamine also maintains blood pressure and preserves spontaneous breathing and laryngeal reflexes. [10] The S(+) isomer increases anesthetic potency two-fold over the racemic mixture while decreasing the psychotomimetic side effects.…”

Section: Pharmacological Propertiesmentioning

confidence: 99%

Role of ketamine for analgesia in adults and children

Vadivelu

Schermer

Kodumudi

et al. 2016

J Anaesthesiol Clin Pharmacol

100

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Ketamine an N-methyl-D-aspartate (NMDA) receptor blocking agent and a dissociative anesthetic with neurostimulatory side effects. In recent years, multiple research trials as well as systematic reviews and meta-analyses suggest the usefulness of ketamine as a strong analgesic used in subanesthetic intravenous doses, and also as a sedative. In addition, ketamine was noted to possess properties of anti-tolerance, anti-hyperalgesia and anti-allodynia most likely secondary to inhibition of the NMDA receptors. Tolerance, hyperalgesia and allodynia phenomena are the main components of opioid resistance, and pathological pain is often seen in the clinical conditions involving neuropathic pain, opioid-induced hyperalgesia, and central sensitization with allodynia or hyperalgesia. All these conditions are challenging to treat. In low doses, ketamine does not have major adverse dysphoric effects and also has the favorable effects of reduced incidence of opioid-induced nausea and vomiting. Therefore, ketamine can be a useful adjunct for pain control after surgery. Additional studies are required to determine the role of ketamine in the immediate postoperative period after surgical interventions known to produce severe pain and in the prevention and treatment of chronic pain.

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“…An important culprit in perpetuation of chronic pain is believed to be activation of the NMDA receptor. Drugs with NMDA receptor blocking activity include ketamine, dextromethorphan, amantadine, memantine and methadone [Noppers et al 2010;Shah and Diwan, 2010;Kleinbohl et al 2006]. An ideal pain modulator for chronic pain would be a molecule with the ability to block this receptor, but to date there have been no studies testing any of these agents in patients with rheumatic pain.…”

Section: Nontraditional Analgesic Agentsmentioning

confidence: 99%

Management of Chronic Pain in the Rheumatic Diseases with Insights for the Clinician

Fitzcharles¹,

Shir

2011

Therapeutic Advances in Musculoskeletal

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Pain that accompanies musculoskeletal conditions should be regarded as an illness entity in its own right and deserves treatment in parallel with the management of the underlying condition. Recent understanding of the pathophysiology of rheumatic pain invokes interplay of the nociceptive mechanisms driven by local tissue factors and the neurogenic responses that sustain chronic pain. In line with other pain conditions, ideal treatment of rheumatic pain should be through a multimodal approach, integrating nonpharmacologic as well as pharmacologic treatments. In the light of this new concept of pain mechanisms, future pharmacologic treatment options may encompass a wider scope than the use of traditional analgesics and nonsteroidal anti-inflammatory drugs. There is currently limited experience for use of pharmacologic treatments that act primarily on neurogenic mechanisms in rheumatic conditions. Drug combination studies are lacking, but this strategy seems clinically reasonable to allow for an approach to treating pain from different mechanistic perspectives. An added advantage would be the opportunity to use lower doses of individual drugs and thereby reduce the side effect profile. Ideal pain management must also include attention to the important coassociates of pain such as effects on sleep, mood and energy, which all have an impact on the global burden of suffering. Although complete relief of pain is still an unrealistic objective, reasonable outcome goals for symptom relief should be accompanied with an improvement in function.

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Ketamine for the treatment of chronic non-cancer pain

Abstract: There is now evidence form a limited number of studies that pain relief lasting for months is observed after long-term intravenous ketamine infusion, suggesting a modulatory effect of ketamine in the process of chronic pain, possibly via blockade of upregulated NMDAR.

Cited by 104 publications

References 62 publications

Psychiatric side effects of ketamine in hospitalized medical patients administered subanesthetic doses for pain control

Psychiatric side effects of ketamine in hospitalized medical patients administered subanesthetic doses for pain control

Role of ketamine for analgesia in adults and children

Management of Chronic Pain in the Rheumatic Diseases with Insights for the Clinician

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