In a phase II trial of terminally ill cancer patients with pain that did not respond to high-dose opioids, a 5-day continuous intravenous infusion of ketamine was gradually increased. Among 20 analyzed participants, 50% achieved a pain response: 40% had a complete response (fewer than three rescue opioids per day and pain at or below their personal goal) and 10% had a partial response (fewer than three rescue opioids). Most patients had mixed-type pain with a neuropathic component. The findings suggest that a slowly escalating ketamine infusion can be an effective option for refractory cancer pain when other treatments are limited.
Palliative care focuses on the holistic needs of patients and their families rather than on the pathology of a diagnosis, aiming to reduce the stress of illness. U.S. service members deployed to austere environments have significantly less access to such care than those in military treatment facilities in the U.S. Ketamine, widely used for analgesia and anesthesia in combat zones, preserves respiratory function, causes minimal hemodynamic changes, and yields lower pain scores compared to opioids. Its use for palliative care is a new clinical strategy to provide sedation and pain management for acute pain crises or comfort measures for the terminally ill, making it attractive for managing critically wounded patients during prolonged medical care when evacuation is impossible.