"Burst" ketamine for refractory cancer pain: An open-label audit of 39 patients

Citation
K. Jackson et al., "Burst" ketamine for refractory cancer pain: An open-label audit of 39 patients, J PAIN SYMP, 22(4), 2001, pp. 834-842
Citations number
26
Categorie Soggetti
General & Internal Medicine","Neurosciences & Behavoir
Journal title
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN journal
08853924 → ACNP
Volume
22
Issue
4
Year of publication
2001
Pages
834 - 842
Database
ISI
SICI code
0885-3924(200110)22:4<834:"KFRCP>2.0.ZU;2-4
Abstract
The results of a novel approach to the use of ketamine in refractory cancer pain are reported. In this prospective, multicenter, unblinded, open-label audit, 39 patients (with a total of 43 Pains) received a short duration (3 to 5 days) ketamine infusion. The initial (lose of 100 mg/24 hr was escala ted if required to 300 mg/24 hr and then to a maximum dose of 500 mg/24hr T he overall response rate was 29/43 (67%). Analysis of results according to pain mechanisms showed that 15/17 somatic and 14/23 neuropathic pains respo nded. In 5 patients who appeared to respond, it is possible that another co ncurrent intervention may have contributed in whole or part for the pain re lief observed. After cessation of ketamine, 24/29 maintained good pain cont rol, with a maximum documented duration of eight weeks. However, 5 of the i nitial 29 responders experienced a recurrence of pain within 24 hours, and ketamine was recommenced. Of these, 2 underwent another intervention for Pa in control while 3 continued on ketamine until their deaths between two and four weeks late): Twelve patients reported adverse psychomimetic effects, with the incidence rising with increasing dose. Four of these were non-resp onders and the ketamine was stopped. Eight were responders, and in 3 the ad verse effects were rendered acceptable with dose reduction; the other 5 rej ected a dose reduction. The results reported suggest the need for further i nvestigation of the place of ketamine in cancer pain management (C) US. Can cer Pain Relief Committee, 2001.