Ketamine in chronic pain: A Delphi survey

Area of Science:

• Pain Medicine
• Pharmacology
• Neurology

Background:

• European guidelines lack recommendations for ketamine in chronic pain management.
• Practice heterogeneity necessitates expert consensus for consistent ketamine use.
• A Delphi survey was initiated to establish national consensus on ketamine for chronic pain.

Purpose of the Study:

• To achieve national consensus among pain specialists on ketamine's role in treating chronic pain.
• To address the lack of European recommendations and practice variations in ketamine use.
• To provide evidence-based guidance for ketamine administration in pain clinics.

Main Methods:

• A four-round internet-based Delphi questionnaire was employed.
• The survey included 96 items derived from a literature search on ketamine for chronic pain.
• Twenty-eight pain experts participated, completing all survey rounds.

Main Results:

• Consensus was reached on 81.3% of survey items.
• Neuropathic pain is the primary indication for ketamine, with moderate utility for other conditions.
• Intravenous infusion (0.5-0.9 mg/kg/d for 4 days) in a hospital setting, administered quarterly, is preferred. Adverse events were rare.
• Effectiveness is assessed one month post-infusion, with a recommendation for combining ketamine with non-pharmacological treatments.

Conclusions:

• A consensus was established for using ketamine in refractory chronic pain patients.
• The findings provide a foundation for future comparative trials on ketamine therapy.
• Key agreements include prioritizing neuropathic pain, preferred IV infusion protocols, and combination therapy.