Targeting Affective Mood Disorders With Ketamine to Prevent Chronic Postsurgical Pain.

Ketamine, an anesthetic added to the World Health Organization's essential medicines lists, is effective for acute pain at sub-anesthetic doses and may relieve some chronic pain. In 2019, its S-enantiomer was approved for treatment-resistant major depressive disorder. Pre-existing anxiety or depression and severe postoperative pain are risk factors for chronic postsurgical pain. This review examines ketamine's effects on biological and psychological processes underlying pain and mood disorders, focusing on non-NMDA receptor mechanisms and human trial results, to assess whether short-term ketamine can prevent acute postsurgical pain from becoming chronic.

Study at a glance

Abstract

The phencyclidine-derivative ketamine [2-(2-chlorophenyl)-2-(methylamino)cyclohexan-1-one] was added to the World Health Organization's Model List of Essential Medicines in 1985 and is also on the Model List of Essential Medicines for Children due to its efficacy and safety as an intravenous anesthetic. In sub-anesthetic doses, ketamine is an effective analgesic for the treatment of acute pain (such as may occur in the perioperative setting). Additionally, ketamine may have efficacy in relieving some forms of chronic pain. In 2019, Janssen Pharmaceuticals received regulatory-approval in both the United States and Europe for use of the S-enantiomer of ketamine in adults living with treatment-resistant major depressive disorder. Pre-existing anxiety/depression and the severity of postoperative pain are risk factors for development of chronic postsurgical pain. An important question is whether short-term administration of ketamine can prevent the conversion of acute postsurgical pain to chronic postsurgical pain. Here, we have reviewed ketamine's effects on the biopsychological processes underlying pain perception and affective mood disorders, focusing on non-NMDA receptor-mediated effects, with an emphasis on results from human trials where available.