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Oral ketamine therapy in the treatment of postamputation stump pain
L Nikolajsen1, P O Hansen, T S Jensen
1Department of Neurology, Aarhus University Hospital, Denmark.
Background:
Hyperactivity of N-methyl-D-aspartate (NMDA) receptors may be one of the factors in the maintenance of postamputation stump pain.
Case Report:
Ketamine-a clinical available NMDA receptor antagonist-was administered intravenously to a patient with established stump pain in a double-blind saline-controlled fashion. Following infusion stump pain was alleviated for 31 hours. Ketamine reduced the allodynic area and wind-up-like pain and increased pressure-pain thresholds. Treatment was started with ketamine 50 mg x 4 per day dissolved in juice. No side effects or development of tolerance were observed during a 3-month treatment period.
Conclusion:
NMDA receptor antagonists may have a potential in the treatment of neuropathic pain, including stump pain.