Ketamine for the Treatment of Chronic Pain: A Comprehensive Review

Overview

Journal Health Psychol Res

Date 2021 Nov 8

PMID 34746491

Citations 13

Authors

Jacob E Israel

Samantha St Pierre

Emily Ellis

Josephine S Hanukaai

Nazir Noor

Giustino Varrassi

Markus Wells

Alan D Kaye

Affiliations

Soon will be listed here.

Abstract

Background: Chronic pain significantly worsens the quality of life. Unlike neuropathic, musculoskeletal, postoperative pain, and cancer pain, chronic primary pain cannot be explained by an underlying disease or condition, making its treatment arduous.

Objectives: This manuscript intends to provide a comprehensive review of the use of ketamine as a treatment option for specific chronic pain conditions.

Study Design: A review article.

Setting: A review of the literature.

Methods: A search was done on PubMed for relevant articles.

Results: A comprehensive review of the current understanding of chronic pain and the treatment of specific chronic pain conditions with ketamine.

Limitations: Literature is scarce regarding the use of ketamine for the treatment of chronic pain.

Conclusion: First-line treatment for many chronic pain conditions includes NSAIDs, antidepressants, anticonvulsants, and opioids. However, these treatment methods are unsuccessful in a subset of patients. Ketamine has been explored in randomized controlled trials (RCTs) as an alternative treatment option, and it has been demonstrated to improve pain symptoms, patient satisfaction, and quality of life. Conditions highlighted in this review include neuropathic pain, fibromyalgia, complex regional pain syndrome (CRPS), phantom limb pain (PLP), cancer pain, and post-thoracotomy pain syndrome. This review will discuss conditions, such as neuropathic pain, fibromyalgia, complex regional pain syndrome, and more and ketamine's efficacy and its supplementary benefits in the chronic pain patient population. As the opioid crisis in the United States continues to persist, this review aims to understand better multimodal analgesia, which can improve how chronic pain is managed.

Citing Articles

Arketamine: a scoping review of its use in humans.

Leal G, Lima-Araujo I, Roiter D, Caliman-Fontes A, Mello R, Kapczinski F Eur Arch Psychiatry Clin Neurosci. 2024; .

PMID: 39680139 DOI: 10.1007/s00406-024-01945-2.

Effects of a synergic interaction between magnesium sulphate and ketamine on the perioperative nociception in dogs undergoing tibial plateau leveling osteotomy: a pilot study.

Galosi M, Pennasilico L, Piccionello A, Serino F, Tosi F, Sassaroli S Front Vet Sci. 2024; 11:1453673.

PMID: 39539316 PMC: 11557496. DOI: 10.3389/fvets.2024.1453673.

A narrative review of the complex panorama regarding chronic neuropathic pain mainly for the psychological issues.

Martins J, Marson F Heliyon. 2024; 10(19):e38282.

PMID: 39403499 PMC: 11472089. DOI: 10.1016/j.heliyon.2024.e38282.

Lumbar Sympathetic Block to Treat CRPS in an 18-Month-Old Girl: A Breaking Barriers Case Report and Review of Literature.

Ayad A, Agiza N, Elrifay A, Mortada A, Girgis M, Varrassi G Pain Ther. 2024; 13(6):1325-1334.

PMID: 39235698 PMC: 11544111. DOI: 10.1007/s40122-024-00650-1.

Ketamine in Chronic Pain: A Review.

Faisco A, Dinis R, Seixas T, Lopes L Cureus. 2024; 16(2):e53365.

PMID: 38435232 PMC: 10908414. DOI: 10.7759/cureus.53365.

References

Salas S, Frasca M, Planchet-Barraud B, Burucoa B, Pascal M, Lapiana J . Ketamine analgesic effect by continuous intravenous infusion in refractory cancer pain: considerations about the clinical research in palliative care. J Palliat Med. 2012; 15(3):287-93. DOI: 10.1089/jpm.2011.0353. View

Juni A, Klein G, Kest B . Morphine hyperalgesia in mice is unrelated to opioid activity, analgesia, or tolerance: evidence for multiple diverse hyperalgesic systems. Brain Res. 2006; 1070(1):35-44. DOI: 10.1016/j.brainres.2005.11.054. View

Mills S, Nicolson K, Smith B . Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019; 123(2):e273-e283. PMC: 6676152. DOI: 10.1016/j.bja.2019.03.023. View

Petrenko A, Yamakura T, Baba H, Shimoji K . The role of N-methyl-D-aspartate (NMDA) receptors in pain: a review. Anesth Analg. 2003; 97(4):1108-1116. DOI: 10.1213/01.ANE.0000081061.12235.55. View

Hirota K, Lambert D . Ketamine: its mechanism(s) of action and unusual clinical uses. Br J Anaesth. 1996; 77(4):441-4. DOI: 10.1093/bja/77.4.441. View

Rigo F, Trevisan G, Godoy M, Rossato M, Dalmolin G, Silva M . Management of Neuropathic Chronic Pain with Methadone Combined with Ketamine: A Randomized, Double Blind, Active-Controlled Clinical Trial. Pain Physician. 2017; 20(3):207-215. View

Jabbour H, Jabbour K, Abi Lutfallah A, Zeid H, Nasser-Ayoub E, Abou Haidar M . Magnesium and Ketamine Reduce Early Morphine Consumption After Open Bariatric Surgery: a Prospective Randomized Double-Blind Study. Obes Surg. 2019; 30(4):1452-1458. DOI: 10.1007/s11695-019-04317-1. View

Schwartzman R, Alexander G, Grothusen J, Paylor T, Reichenberger E, Perreault M . Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study. Pain. 2009; 147(1-3):107-15. DOI: 10.1016/j.pain.2009.08.015. View

Gaunitz C, Schuttler A, Gillen C, Allgaier C . Formalin-induced changes of NMDA receptor subunit expression in the spinal cord of the rat. Amino Acids. 2002; 23(1-3):177-82. DOI: 10.1007/s00726-001-0125-3. View

10.

Bruehl S . Complex regional pain syndrome. BMJ. 2015; 351:h2730. DOI: 10.1136/bmj.h2730. View

11.

Ossipov M, Dussor G, Porreca F . Central modulation of pain. J Clin Invest. 2010; 120(11):3779-87. PMC: 2964993. DOI: 10.1172/JCI43766. View

12.

Jensen T, Madsen C, Finnerup N . Pharmacology and treatment of neuropathic pains. Curr Opin Neurol. 2009; 22(5):467-74. DOI: 10.1097/WCO.0b013e3283311e13. View

13.

Lee J, Choi S, Park K, Choi Y, Jung H, Lee D . Comparison of complex regional pain syndrome and fibromyalgia: Differences in beta and gamma bands on quantitative electroencephalography. Medicine (Baltimore). 2019; 98(7):e14452. PMC: 6407989. DOI: 10.1097/MD.0000000000014452. View

14.

Zorina-Lichtenwalter K, Meloto C, Khoury S, Diatchenko L . Genetic predictors of human chronic pain conditions. Neuroscience. 2016; 338:36-62. DOI: 10.1016/j.neuroscience.2016.04.041. View

15.

Jaeger H, Maier C . Calcitonin in phantom limb pain: a double-blind study. Pain. 1992; 48(1):21-27. DOI: 10.1016/0304-3959(92)90127-W. View

16.

Wiesenfeld-Hallin Z . Sex differences in pain perception. Gend Med. 2005; 2(3):137-45. DOI: 10.1016/s1550-8579(05)80042-7. View

17.

Moyse D, Kaye A, Diaz J, Qadri M, Lindsay D, Pyati S . Perioperative Ketamine Administration for Thoracotomy Pain. Pain Physician. 2017; 20(3):173-184. View

18.

Zarate Jr C, Singh J, Carlson P, Brutsche N, Ameli R, Luckenbaugh D . A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry. 2006; 63(8):856-64. DOI: 10.1001/archpsyc.63.8.856. View

19.

Wiech K, Kiefer R, Topfner S, Preissl H, Braun C, Unertl K . A placebo-controlled randomized crossover trial of the N-methyl-D-aspartic acid receptor antagonist, memantine, in patients with chronic phantom limb pain. Anesth Analg. 2004; 98(2):408-413. DOI: 10.1213/01.ANE.0000096002.53818.BD. View

20.

Treede R, Rief W, Barke A, Aziz Q, Bennett M, Benoliel R . A classification of chronic pain for ICD-11. Pain. 2015; 156(6):1003-1007. PMC: 4450869. DOI: 10.1097/j.pain.0000000000000160. View