Managing Chronic Pain: The Ketamine Option.

Area of Science:

• Anesthesiology
• Pain Medicine
• Pharmacology

Background:

• Ketamine, an anesthetic, is explored for chronic refractory pain despite off-label use and psychomimetic side effects.
• Current use is limited by a lack of comprehensive long-term data and defined clinical frameworks.

Purpose of the Study:

• To synthesize evidence on ketamine's efficacy and safety in chronic refractory pain.
• To identify knowledge gaps and propose a framework for rational, safe clinical application.

Main Methods:

• Narrative review of randomized and non-randomized clinical trials.
• Analysis of existing clinical guidelines and expert consensus statements.

Main Results:

• Ketamine offers significant short-term analgesia, particularly for neuropathic pain, and is generally well-tolerated in severe cases.
• Substantial data gaps exist regarding long-term efficacy, cognitive effects, addiction potential, and optimal dosing strategies.

Conclusions:

• Ketamine is not a first-line treatment; it requires specialist supervision within a structured care setting.
• Future research should focus on optimal administration routes, patient phenotyping, and long-term outcomes to ensure safe and effective use.