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