Ketamine: an introduction for the pain and palliative medicine physician.
A history of an escalating chronic intractable pain in a patient with cryoglobulinemia, vasculitis, and severe cutaneous ulcerations is presented. A strategy of progressive, multi-agent, N-methyl-D-aspartate-receptor (NMDA-R) blockade that resulted in adequate pain control and a three-fold reduction in opioid consumption is described. Diagnostic process of neuropathic pain and the role of NMDA-R in the development of hyperalgesia are briefly reviewed. Thereafter, existing clinical literature describing the use of Ketamine, a major NMDA-R antagonist for management of malignant pain, is reviewed. Lastly, evidence-based original protocol for intravenous adjuvant Ketamine analgesia for severe cancer pain is presented.
Okon
Tomasz
T
Department of Palliative Medicine, Marshfield Clinic, Marshfield, WI 54449, USA. okon.tomasz@marshfieldclinic.org
D000328:Adult; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002490:Central Nervous System / Q000187:drug effects* / Q000503:physiopathology; D003449:Cryoglobulinemia / Q000150:complications; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage*; D005260:Female; D000077206:Gabapentin; D006526:Hepatitis C / Q000150:complications / Q000601:surgery; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D008691:Methadone / Q000627:therapeutic use; D008774:Methylphenidate / Q000627:therapeutic use; D010098:Oxycodone / Q000627:therapeutic use; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors* / Q000378:metabolism; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications; D014657:Vasculitis / Q000150:complications; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D003509:Cyclohexanecarboxylic Acids; D018691:Excitatory Amino Acid Antagonists; D016194:Receptors, N-Methyl-D-Aspartate; D008774:Methylphenidate; D005680:gamma-Aminobutyric Acid; D007649:Ketamine; D000077206:Gabapentin; D010098:Oxycodone; D008691:Methadone