The role of ketamine in pain management

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Biomed Pharmacother. 2006 Jul 5

The role of ketamine in pain management.

Visser E, Schug SA.

Department of Anaesthesia and Pain Medicine, Royal Perth Hospital,

GPO Box X 2213, Perth, WA 6847, Australia.

Ketamine is a dissociative anaesthetic; its mechanism of action is

primarily an antagonism of the N-methyl-d-aspartate (NMDA) receptor.

The role of ketamine, in particular in lower sub-anaesthetic doses,

has recently gained increasing interest in pain management. It has

been studied in a considerable number of trials and analysed in meta-

analyses and systematic reviews. Based on these data, the primary

role of ketamine in such low doses is as an 'anti-

hyperalgesic', 'anti-allodynic' or 'tolerance-protective' agent. It

therefore has a role in the treatment of opioid resistant

or 'pathological' pain (central sensitisation with hyperalgesia or

allodynia, opioid induced hyperalgesia, neuropathic pain) rather than

as an 'analgesic' in its own right. Low dose ketamine also

has 'preventive analgesia' properties. Furthermore, in higher doses

it provides effective and safe sedation and analgesia for painful

procedures. The place of ketamine in the treatment of chronic pain

and the effects of long-term medicinal use remain unclear.