Ketamine for refractory chronic pain: a 1-year follow-up study

Corriger, Alexandrine; Voute, Marion; Lambert, Céline; Pereira, Bruno; Pickering, Gisèle

doi:10.1097/j.pain.0000000000002403

Cited by 16 publications

(34 citation statements)

References 42 publications

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“…Several physicians had already taken part in studies with ketamine. Moreover, the majority of experts participated as co-investigators of a national observational study in patients with chronic pain (OKAPINCT033119238, Corriger et al, 2021). With a total of 585 patients treated with ketamine, their participation provided additional information to confirm their eligibility to participate.…”

Section: Delphi Expertsmentioning

confidence: 99%

“…A recent survey on CRPS reported a variable response in the duration of pain relief (1-10 days in 25% of responders; 1-12 weeks in 33% of responders; 1-6 months in 42% of responders) (Xu et al, 2019). A variability in the responses is observed in FM patients linked to possible 'responders' or 'patients sensitive' to treatment (Ablin et al, 2016;Hoskin et al, 2018, Corriger, 2021.…”

Section: Utility Advantages and Effectivenessmentioning

confidence: 99%

“…The recent literature remains controversial with positive (Lumanauw et al, 2019) or limited results of ketamine in neuropathic pain (Pickering et al, 2020). An observational study however reports the pain trajectories of 256 patients with chronic pain, their pain relief with ketamine over 1 year and the heterogeneity of care (Corriger et al, 2021). Without any consensus in Europe and with limited recommendations for the use of ketamine in patients with chronic pain, it is necessary for good clinical practice to properly define ketamine administration criteria that can be consistently and systematically implemented for different chronic pain conditions.…”

Section: Introductionmentioning

confidence: 99%

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Ketamine in chronic pain: A Delphi survey

Voute

Riant

Amodeo

et al. 2022

European Journal of Pain

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Background: There is no recommendation in Europe for the use of ketamine in patients with chronic pain. The heterogeneity of practice highlights the need to seek the advice of experts in order to establish a national consensus. This Delphi survey aimed to reach a national consensus on the use of ketamine in chronic pain in Pain clinics.Methods: A collaborative four-round internet-based questionnaire was used. It was created after literature search on ketamine administration in chronic pain and included about 96 items. It discussed utility and advantages, adverse events and deleterious aspects, methods of administration, concomitant treatments and assessment of results.Results: Twenty-eight experts completed all rounds of the survey with a total of 81.3% items reaching a consensual answer. Neuropathic pain represents the first indication to use ketamine, followed, with a good to moderate utility, by other situations (fibromyalgia, complex regional pain syndrome, central neuropathic pain, peripheral neuropathic pain, nociceptive pain, sensitization, opioid withdrawal, palliative care, depression). Experts agreed on the rare occurrence of adverse events. Concerning routes of administration, intravenous infusion with doses of 0.5-0.9 mg/kg/d for 4 days of treatment is preferred. Place of care is hospital, as in-or out-patient, with a quarterly administration of ketamine. Finally, ketamine effectiveness is assessed 1 month after infusion, and experts encourage combination with non-pharmacological treatment.Conclusions: This Delphi survey established a consensus of pain specialists on the use of ketamine in refractory chronic pain, thus providing a basis for future comparative trials.Significance: This Delphi survey in chronic pain reached agreement on four main aspects: (1) Priority to treat neuropathic pain with evaluation of effectiveness at 1 month; (2) No deleterious effects in the majority of listed diseases/situations with the absence or <3% of suggested adverse events; (3) 0.5-0.9 mg/kg/d IV infusion; (4) Combination with non-pharmacological treatment.

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Section: Delphi Expertsmentioning

confidence: 99%

Section: Utility Advantages and Effectivenessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ketamine in chronic pain: A Delphi survey

Voute

Riant

Amodeo

et al. 2022

European Journal of Pain

Self Cite

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“…At the full-text level, 599 studies (576 published articles and 23 registered trials) did not meet the inclusion criteria. This resulted in the final number of 29 published studies included in the present review (14 clinical trials (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52), 3 observational studies (53)(54)(55), and 12 case studies (56-67)), as well as 5 registered (i.e., ongoing and planned) clinical trials (68)(69)(70)(71)(72). Figure 1 illustrates the PRISMA (36) flow chart for this systematic review.…”

Section: Study Selectionmentioning

confidence: 99%

Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review

Balachandran

Tassone²,

Adamsahib³

et al. 2022

Front. Pain Res.

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Pain and depression frequently co-occur. Due to its antidepressant and analgesic properties, ketamine has been used for the management of treatment-resistant depression and pain. This systematic review examined the literature on the efficacy of sub-anesthetic doses of ketamine in individuals experiencing comorbid depression and chronic pain (CDCP), as well as comorbid depression and acute pain (CDAP). A secondary objective was to provide an assessment of dosage, route, and adverse effects of ketamine treatment for CDCP and CDAP. A literature search was conducted on MEDLINE, PsycINFO, and Embase databases, coupled with a manual screening of the bibliography sections of included articles. In addition, registered ongoing and planned trials were searched on Clinicaltrials.gov. The end date of the search was April 9th, 2022. Included studies assessed changes in depression and pain in patients receiving at least one sub-anesthetic dose of ketamine. Assessment of quality was conducted using the GRADE checklist. Of the 7 CDCP clinical trials, 3 reported a reduction in depression and pain, 3 reported a reduction in depression or pain only, and 1 reported no improvement in either comorbidity. Among the 7 CDAP clinical trials, 4 studies found improvements in depression and pain while the remaining 3 reported improvements in only one parameter. Ten of the 12 case studies and 2 of the 3 observational studies assessing CDCP and CDAP found improvements in pain and depression scores post-treatment with effects of variable duration. The planned methodologies of the registered clinical trials are in line with those of the published research. Preliminary evidence supports the efficacy of ketamine in treating CDCP and CDAP. However, the current review identified a small number of heterogeneous studies with mixed results, preventing comprehensive conclusions. More longitudinal placebo-controlled studies are needed to identify the effects of ketamine for patients with CDCP and CDAP.

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“…In recent decades, intensified efforts are underway to develop new antidepressants. Ketamine is a non-selective N-methyl-D-aspartic acid receptor (NMDAR) antagonist with anesthetic and analgesic effects, which can effectively relieve acute and chronic pain ( 12 – 15 ). Ketamine has also been reported to have rapid antidepressant and anti-suicidal effects in patients with MDD or bipolar depression (BD) in recent years ( 16 – 18 ).…”

Section: Introductionmentioning

confidence: 99%

Pre-treatment Pain Symptoms Influence Antidepressant Response to Ketamine in Depressive Patients

et al. 2022

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BackgroundPain strongly coexists with depression. Ketamine has great analgesic and antidepressant effects, acting as a promising role in treating depression with pain. Few studies have evaluated impact of pain symptoms on antidepressant effect of ketamine infusions. Thus, present study investigated whether pain symptoms in individuals with depression moderate response to ketamine.MethodsOne hundred and four individuals with major depressive disorder and bipolar depression received six intravenous infusions of ketamine. The Montgomery–Åsberg Depression Rating Scale (MADRS) was administered at baseline, the next morning after each infusion and 2 weeks (Day 26) after the last infusion. Pain symptoms were collected at baseline using the short-form McGill Pain Questionnaire (SF-MPQ).ResultsThe prevalence of pain in patients with depression was 48.8%. Mix model analyses showed that pre-treatment pain symptoms assessed by each domain of SF-MPQ significantly moderated antidepressant response to six infusions of ketamine from baseline to day 26 (all p < 0.05). Then follow-up simple slopes analyses suggested that all patients across groups showed a significant symptomatic improvement after ketamine infusions (all p < 0.05), and patients with severe pain (across all domains of SF-MPQ) had greater improvement in depressive symptoms than those with mild pain or non-pain (all p < 0.05).ConclusionA significant and rapid improvement in depressive symptoms was observed in patients with depression and pain after ketamine treatment. Ketamine may be a novel and promising antidepressant preferentially for the therapy of depression with severe pain.

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Ketamine for refractory chronic pain: a 1-year follow-up study

Cited by 16 publications

References 42 publications

Ketamine in chronic pain: A Delphi survey

Ketamine in chronic pain: A Delphi survey

Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review

Pre-treatment Pain Symptoms Influence Antidepressant Response to Ketamine in Depressive Patients

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