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Successful use of ketamine for intractable cancer pain
Dominique A Lossignol1, Myriam Obiols-Portis, Jean-Jacques Body
1Institut Jules Bordet, Clinique des Soins Supportifs et des Soins Palliatifs, Service de médecine interne, Université Libre de Bruxelles, 1 Rue Héger Bordet, 1000, Brussels, Belgium. dominique.lossignol@bordet.be
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GOALS AND WORK: Despite medical awareness, intractable pain is a serious problem in cancer and occurs in up to 2% of advanced cancer patients. However, few data are available concerning the optimal treatment of such patients. The emergence of intractable pain may notably be due to the activation of N-methyl-D-aspartate (NMDA) receptors located in the central nervous system. NMDA antagonists might thus be an interesting approach in such pain syndromes.
Patients And Methods:
Twelve patients with intractable cancer pain received a test dose of 5-10 mg of ketamine, a strong NMDA antagonist, in order to determine their response and tolerance to the drug. Continuous intravenous infusions of ketamine associated with morphine were then administered.
Main Results:
The acute test dose was successful in all cases (VAS <3/10 after 5 min). The prolonged use of ketamine allowed us to reduce the total daily dose of morphine required (range: 200-1,200 mg) by 50% and allowed eight patients to go home with a portable pump with morphine and ketamine during a relatively long period of time (range: 7-350 days, median: 58 days). Side effects were moderate (dizziness) and they were limited to the test phase.
Conclusion:
Our data suggest the importance of NMDA receptors in the genesis of chronic cancer pain and indicate that NMDA antagonists should be further studied for the management of cancer pain and, in particular, intractable pain.
Insights
Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, effectively managed intractable cancer pain by reducing morphine needs. This study highlights NMDA receptor importance in chronic pain and suggests further research into NMDA antagonists for cancer pain management.
Area of Science:
- Oncology
- Pain Management
- Neuroscience
Background:
- Intractable cancer pain affects up to 2% of advanced cancer patients.
- Optimal treatment strategies for intractable cancer pain remain limited.
- N-methyl-D-aspartate (NMDA) receptor activation in the central nervous system is implicated in intractable pain.
Purpose of the Study:
- To evaluate the efficacy and safety of ketamine, an NMDA antagonist, in managing intractable cancer pain.
- To determine the potential of NMDA antagonists as a therapeutic approach for cancer pain syndromes.
Main Methods:
- Twelve patients with intractable cancer pain received an initial test dose of ketamine (5-10 mg).
- Following successful tolerance, patients received continuous intravenous ketamine infusions combined with morphine.
- Patient response and side effects were monitored throughout the treatment period.
Main Results:
- The acute ketamine test dose was effective in all patients, significantly reducing pain scores (VAS <3/10 within 5 minutes).
- Prolonged ketamine administration reduced daily morphine requirements by 50%.
- Eight patients were discharged with portable pumps for home administration of ketamine and morphine, with treatment durations ranging from 7 to 350 days (median 58 days).
- Observed side effects, primarily dizziness, were moderate and confined to the initial test phase.
Conclusions:
- The study suggests a significant role for NMDA receptors in the development of chronic cancer pain.
- NMDA antagonists, such as ketamine, show promise for managing intractable cancer pain.
- Further investigation into NMDA antagonists is warranted for effective cancer pain management.
