Efficacy and safety of oral ketamine for the relief of intractable chronic pain: A retrospective 5-year study of 51 patients
Background This work summarizes the efficiency, failures and adverse effects of oral administration of ketamine at home for intractable pain. Methods This 5‐year retrospective study involved testing ketamine by intravenous in‐hospital administration, then a conversion to an oral route, or oral treat...
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| Published in: | European journal of pain Vol. 19; no. 7; pp. 984 - 993 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Blackwell Publishing Ltd
01-08-2015
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Background
This work summarizes the efficiency, failures and adverse effects of oral administration of ketamine at home for intractable pain.
Methods
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.
Results
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%; p < 0.02), with fewer adverse effects (33% vs. 68%; p < 0.01).
Conclusions
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. |
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| Bibliography: | ark:/67375/WNG-C5PGVC4G-N ArticleID:EJP624 Figure S1. Median oral ketamine dose (dot; whiskers: interquartile range 25-75%) for 55 cases.Figure S2. Median duration of oral ketamine treatment (dot; whiskers: interquartile range 25-75%). Extreme value corresponds to a 22-year-old patient with a genetic disease who received oral ketamine in a compassionate protocol.Table S1. Characteristics of treatment by ketamine: treatment response. Table S2. Effect of pain lowering with ketamine on working function. Table S3. Characteristics of patients with and without adverse effects with ketamine treatment. istex:D1939D13C7B71993E03B0218CA905D8BE218EDD9 Conflicts of interest Funding sources None. None declared. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 1090-3801 1532-2149 |
| DOI: | 10.1002/ejp.624 |