Ketamine for the Treatment of Intractable Pain Syndromes

Joshua P. Prager, MD, MS

Director, Center for Rehabilitation of Pain Syndromes
University of California, Los Angeles
Los Angeles, California

Ketamine, originally developed in the 1960s as an anesthetic agent, is thought to derive its analgesic effect mainly due to antagonism of the N-methyl-d-aspartic acid (NMDA) receptor. Despite its efficacy, the agent fell out of favor because of its dissociative and hallucinatory side effects. In recent years, however, ketamine has undergone resurgence in popularity, largely attributed to its demonstrated efficacy in patients with difficult-to-treat pain syndromes. Complex regional pain syndrome (CRPS), in particular, can be respond well to ketamine. Several methods have been utilized successfully to treat CRPS with ketamine. Short- or long-term infusions of ketamine may be used, either with or without the induction of coma. The agent has also found recent application in the management of combat-related trauma. Ketamine-based therapy requires tight and ongoing clinical management and should be administered only by physicians with experience in anesthesia and airway management. Within this clinical context, the evidence supports the use of ketamine as safe and effective treatment for intractable pain syndromes.

References

Schwartzman RJ, Alexander GM, Grothusen JR, et al. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study. Pain. 2009;147(1-3):107-115.
Correll GE, Maleki J, Gracely EJ, Muir JJ, Harbut RE. Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome. Pain Med. 2004 Sep;5(3):263-75.
Ben-Ari A, Lewis MC, Davidson E. Chronic administration of ketamine for analgesia. J Pain Palliat Care Pharmacother. 2007;21(1):7-14.
Berthelot JM. Current management of reflex sympathetic dystrophy syndrome (complex regional pain syndrome type I). Joint Bone Spine. 2006 Oct;73(5):495-9.

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