Should Subanesthetic Ketamine be Considered When Managing Opioid Refractory Cancer Pain?
Journal of pain and symptom management – August 01, 2024
Source: PubMed
Summary
When traditional pain medications fail, ketamine offers hope for cancer patients experiencing severe, treatment-resistant pain. Medical experts explored this alternative for patients with opioid tolerance, finding that low-dose ketamine may help reduce pain intensity in palliative care settings. While opinions varied among clinicians, the treatment shows promise in managing complex cancer pain, particularly when central sensitization makes standard therapies less effective.
Abstract
In the cancer pain setting, ketamine has been typically employed as a co-analgesic for opioid refractory and neuropathic pain. One controversial topic is whether subanesthetic ketamine be considered when managing opioid refractory cancer pain. In this "Controversies in Palliative Care" article, three clinicians independently answer this question. Specifically, each clinician provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. Three independent clinicians reported a divergence of opinion regarding the usefulness of subanesthetic ketamine for managing opioid refractory cancer pain. All investigators acknowledged the lack of high-quality trials. All agreed on the need for adequately powered trials, the development of standardized methodology, and the exploration of any patient sub-populations that may benefit from ketamine for cancer related pain.