Ketamine Infusion: The Wild Wild West (and East)

Le résumé fourni par la source

Ketamine (RS-2-[2-chlorophenyl]-2-[methylamino] cyclohexanone) was developed first by Parke-Davis in 1962 and has been used primarily for general anesthesia in human and veterinary medicine. It is a noncompetitive antagonist of the N-methyl-d-aspartate (NMDA) receptor, but has several other actions such as the modulation of monoamine, muscarinic, µ and κ opioid receptors, and voltage-gated calcium channels. It has a range of effects in humans including acute analgesia, “dissociative” anesthesia, hallucinations, elevated blood pressure, and bronchodilation. It is commonly employed in the initiation and maintenance of general anesthesia but also increasingly used in mitigating pain and anxiety with various procedures and has more recently been used in battlefield medicine and in the treatment of certain psychiatric conditions. It was used in psychiatric research in the 1970s and now is an established agent in refractory depression [1]. Ketamine in pain management was first reported in 1989. The first retrospective study of the longitudinal effects of intravenous ketamine in patients treated with complex regional pain syndrome (CRPS) was published in Pain Medicine in 2004 [2]. Low-dose ketamine produces analgesia and reportedly modulates central sensitization and hyperalgesia of various etiologies. There is weak to moderate evidence suggesting that ketamine may prove useful for certain chronic neuropathic pain conditions, particularly complex regional pain syndrome (CRPS) [3]. In the context of the opioid “crisis” and, unfortunately, in the absence of good evidence, ketamine is being used increasingly in infusion clinics to manage CRPS and other sorts of neuropathic pain. Understandably, this is driven by the desperation of both patients and clinicians searching for answers and relief in this terrible disease. There is some evidence for its effectiveness but no standard protocols, validated guidelines, or randomized controlled trials [4]. In hopes of spurring more and better research, we offer a Virtual Issue containing some of the preliminary studies, surveys, pragmatic and systematic reviews, and consensus reports on ketamine published over the past several years in Pain Medicine [4–12]: https://academic.oup.com/painmedicine/pages/ketamine.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.