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CNS Drugs. 2019 Mar 2. doi: 10.1007/s40263-019-00618-2. [Epub ahead of print]

Expanding Role of NMDA Receptor Antagonists in the Management of Pain.

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Pain Management Program, St. Joseph's Hospital, St. Joseph's Health Care London, PO Box 5777, Stn. B., London, ON, N6A 4V2, Canada.
Department of Anesthesia and Perioperative Medicine, London Health Science Centre and Western University, 339 Windermere Road, London, ON, N6A 5A5, Canada.


Pain management is complex regardless of whether the pain is acute or chronic in nature or non-cancer or cancer related. In addition, relatively few pain pharmacotherapy options with adequate efficacy and safety data currently exist. Consequently, interest in the role of NMDA receptor antagonists as a pharmacological pain management strategy has surfaced. This narrative review provides an overview of the NMDA receptor and elaborates on the pharmacotherapeutic profile and pain management literature findings for the following NMDA receptor antagonists: ketamine, memantine, dextromethorphan, and magnesium. The literature on this topic is characterized by small studies, many of which exhibit methodological flaws. To date, ketamine is the most studied NMDA receptor antagonist for both acute and chronic pain management. Although further research about NMDA receptor antagonists for analgesia is needed and the optimal dosage/administration regimens for these drugs have yet to be determined, ketamine appears to hold the most promise and may be of particular value in the perioperative pain management realm.


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