title: Ketamine for pain in adults and children with cancer: a systematic review and synthesis of the literature.
abstract: OBJECTIVE
  Chronic cancer pain is often refractory and difficult to treat. Ketamine is a medication with evidence of efficacy in the treatment of chronic pain.
  
  
  METHODS
  This article presents a synthesis of the data on ketamine for refractory cancer pain in adults and children.
  
  
  RESULTS
  There are five randomized, double-blind, controlled trials of ketamine use in cancer pain that demonstrate improvement in pain for some patients. There are six prospective, uncontrolled trials in cancer pain that also demonstrate improvement in pain scores for some patients. There are no randomized, controlled trials in children with cancer pain, although there are a few studies reflecting improved pain control with ketamine for children with cancer pain. Adverse events for adults on ketamine are most commonly somnolence, feelings of insobriety, nausea/vomiting, hallucinations, depersonalization/derealization, and drowsiness. However, when ketamine is combined with benzodiazepines, feelings of insobriety, hallucinations, and depersonalization/derealization are not reported. Children on ketamine have had few reported adverse effects, which include sedation, anorexia, urinary retention, and myoclonic movements. Recommended ketamine infusion dosages are from 0.05 to 0.5 mg/kg/h (intravenous or subcutaneous). Recommended oral dosages of ketamine are 0.2-0.5 mg/kg/dose two to three times daily with a maximum of 50 mg/dose three times daily.
  
  
  CONCLUSIONS
  Despite limitations in the breadth and depth of data available, there is evidence that ketamine may be a viable option for treatment-refractory cancer pain.
authors.affiliation: Departments of Pediatrics and Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Amy Lee
authors.initials: AL
authors.lastname: Bredlau
authors.forename: Rajbala
authors.initials: R
authors.lastname: Thakur
authors.forename: David Nathan
authors.initials: DN
authors.lastname: Korones
authors.forename: Robert H
authors.initials: RH
authors.lastname: Dworkin
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D002986:Clinical Trials as Topic; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications*; D059408:Pain Management / Q000379:methods*; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000700:Analgesics; D007649:Ketamine
keywords: Adverse Events; Cancer Pain; Children; Chronic Pain; Ketamine; Pediatric