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Should Subanesthetic Ketamine be Considered When Managing Opioid Refractory Cancer Pain?
Peter Poon1, Rae Frances Bell2, Phillip Good3
1Monash University (P.P.), Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia; Supportive and Palliative Care Department (P.P.), Monash Health, Clayton, Victoria, Australia.
Journal of Pain and Symptom Management
|May 10, 2024
Summary
Subanesthetic ketamine use for opioid-refractory cancer pain is debated among clinicians. While some see potential, all agree more high-quality trials are needed to clarify its role and identify patient subgroups.
Area of Science:
- Palliative Care
- Pain Management
- Oncology
Background:
- Ketamine is used as a co-analgesic for opioid-refractory and neuropathic pain in cancer patients.
- The use of subanesthetic ketamine for opioid-refractory cancer pain remains a controversial topic in palliative care.
Purpose of the Study:
- To explore divergent clinical opinions on the utility of subanesthetic ketamine for managing opioid-refractory cancer pain.
- To present expert perspectives on the current evidence, clinical application, and future research directions.
Main Methods:
- Three independent clinicians reviewed key studies informing their approach.
- Each clinician provided practical advice and highlighted research opportunities.
- The study presents a divergence of opinion based on individual clinical experience and interpretation of existing literature.
Main Results:
- A divergence of opinion exists among clinicians regarding the effectiveness of subanesthetic ketamine for opioid-refractory cancer pain.
- All clinicians acknowledged a significant lack of high-quality clinical trials.
- There is consensus on the need for adequately powered trials and standardized methodologies.
Conclusions:
- Further research is essential to establish the role of subanesthetic ketamine in cancer pain management.
- There is a need for adequately powered trials with standardized methodology.
- Identifying specific patient sub-populations who may benefit from ketamine is a key area for future investigation.
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