Ketamine: an introduction for the pain and palliative medicine physician

Pain Physician. 2007 May;10(3):493-500.

Abstract

A history of an escalating chronic intractable pain in a patient with cryoglobulinemia, vasculitis, and severe cutaneous ulcerations is presented. A strategy of progressive, multi-agent, N-methyl-D-aspartate-receptor (NMDA-R) blockade that resulted in adequate pain control and a three-fold reduction in opioid consumption is described. Diagnostic process of neuropathic pain and the role of NMDA-R in the development of hyperalgesia are briefly reviewed. Thereafter, existing clinical literature describing the use of Ketamine, a major NMDA-R antagonist for management of malignant pain, is reviewed. Lastly, evidence-based original protocol for intravenous adjuvant Ketamine analgesia for severe cancer pain is presented.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Amines / therapeutic use
  • Analgesics / administration & dosage*
  • Analgesics, Opioid / therapeutic use
  • Central Nervous System / drug effects*
  • Central Nervous System / physiopathology
  • Cryoglobulinemia / complications
  • Cyclohexanecarboxylic Acids / therapeutic use
  • Drug Therapy, Combination
  • Excitatory Amino Acid Antagonists / administration & dosage*
  • Female
  • Gabapentin
  • Hepatitis C / complications
  • Hepatitis C / surgery
  • Humans
  • Ketamine / administration & dosage*
  • Methadone / therapeutic use
  • Methylphenidate / therapeutic use
  • Oxycodone / therapeutic use
  • Pain, Intractable / drug therapy*
  • Pain, Intractable / etiology
  • Pain, Intractable / physiopathology
  • Receptors, N-Methyl-D-Aspartate / antagonists & inhibitors*
  • Receptors, N-Methyl-D-Aspartate / metabolism
  • Treatment Outcome
  • Ulcer / complications
  • Vasculitis / complications
  • gamma-Aminobutyric Acid / therapeutic use

Substances

  • Amines
  • Analgesics
  • Analgesics, Opioid
  • Cyclohexanecarboxylic Acids
  • Excitatory Amino Acid Antagonists
  • Receptors, N-Methyl-D-Aspartate
  • Methylphenidate
  • gamma-Aminobutyric Acid
  • Ketamine
  • Gabapentin
  • Oxycodone
  • Methadone