Efficacy and safety of oral ketamine for the relief of intractable chronic pain: A retrospective 5‐year study of 51 patients. (10th November 2014)

• Record Type: Journal Article
• Authors: Marchetti, F.; Coutaux, A.; Bellanger, A.; Magneux, C.; Bourgeois, P.; Mion, G.
• Is Part Of: European journal of pain. Volume 19:Number 7(2015)
• Page Start: 984
• Page End: 993
• Publication Date: 2014-11-10
• Subjects: Pain -- Periodicals; Pain -- Treatment -- Periodicals; Pain -- Physiological aspects -- Periodicals; 616.0472
• DOI: 10.1002/ejp.624
• Languages: English
• ISSNs: 1090-3801

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="ejp624-sec-0001" sec-type="section"> <title>Background</title> <p>This work summarizes the efficiency, failures and adverse effects of oral administration of ketamine at home for intractable pain.</p> </sec> <sec id="ejp624-sec-0002" sec-type="section"> <title>Methods</title> <p>This 5‐year retrospective study involved testing ketamine by intravenous in‐hospital administration, then a conversion to an oral route, or oral treatment directly administered at home. The daily intravenous dose was increased by steps of 0.5 mg/kg to attain an effective daily dose of 1.5–3.0 mg/kg. Pain was evaluated on a numeric scale from 0 to 10, and evidence of adverse effects was collected every day. The effective daily dose was delivered orally (three to four intakes). If effective, ketamine was continued for 3 months. Short infusions or direct oral treatment began with a 0.5‐mg/kg dose, then the daily ketamine dose was increased in 15‐ to 20‐mg increments.</p> </sec> <sec id="ejp624-sec-0003" sec-type="section"> <title>Results</title> <p>Among 55 cases (51 patients, neuropathic pain 60%), the mean effective oral dose was 2 mg/kg. Ketamine was effective in 24 patients (44%, mean pain reduction 67 ± 17%), partially effective in 20% (mean pain reduction 30 ± 11%), with a mean opioid sparing of 63 ± 32%, and failure in 22%. Half of the patients experienced adverse effects, but only eight had to stop treatment. For patients with opioid therapy, failure of ketamine was less frequent (7% vs. 36%; <italic>p</italic> < 0.02), with fewer adverse effects (33% vs. 68%; <italic>p</italic> < 0.01).</p> </sec> <sec id="ejp624-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Pain was reduced or abolished in two‐thirds of patients under ketamine therapy; ketamine was effective for patients taking opioids and resulted in few adverse effects.</p> </sec> </abstract>