Disclosures: No funding has been reported by any authors for this review. This review was unfunded.
Ketamine for Pain in Adults and Children with Cancer: A Systematic Review and Synthesis of the Literature
Article first published online: 5 AUG 2013
Wiley Periodicals, Inc
Volume 14, Issue 10, pages 1505–1517, October 2013
How to Cite
Bredlau, A. L., Thakur, R., Korones, D. N. and Dworkin, R. H. (2013), Ketamine for Pain in Adults and Children with Cancer: A Systematic Review and Synthesis of the Literature. Pain Medicine, 14: 1505–1517. doi: 10.1111/pme.12182
Conflict of Interest Statement:
AL Bredlau has no potential financial conflict to report.
R Thakur has no potential financial conflict to report.
DN Korones has no potential financial conflict to report.
RH Dworkin has received in the past 12 months research grants from US Food and Drug Administration and US National Institutes of Health, and compensation for activities involving clinical trial research methods from Adynxx, Analgesic Solutions, Anika, Avanir, Axsome, Bayer, Biogen, Bioness, Bristol-Myers Squibb, Collegium, Eli Lilly, Flexion, Genentech, Johnson & Johnson, Merck, Omeros, Pfizer, Prolong, Q-Med, Regenesis, Spinifex, Takeda, Taris, Teva, and Xenon.
- Issue published online: 16 OCT 2013
- Article first published online: 5 AUG 2013
- Cancer Pain;
- Chronic Pain;
- Adverse Events
Chronic cancer pain is often refractory and difficult to treat. Ketamine is a medication with evidence of efficacy in the treatment of chronic pain.
This article presents a synthesis of the data on ketamine for refractory cancer pain in adults and children.
There are five randomized, double-blind, controlled trials of ketamine use in cancer pain that demonstrate improvement in pain for some patients. There are six prospective, uncontrolled trials in cancer pain that also demonstrate improvement in pain scores for some patients. There are no randomized, controlled trials in children with cancer pain, although there are a few studies reflecting improved pain control with ketamine for children with cancer pain. Adverse events for adults on ketamine are most commonly somnolence, feelings of insobriety, nausea/vomiting, hallucinations, depersonalization/derealization, and drowsiness. However, when ketamine is combined with benzodiazepines, feelings of insobriety, hallucinations, and depersonalization/derealization are not reported. Children on ketamine have had few reported adverse effects, which include sedation, anorexia, urinary retention, and myoclonic movements. Recommended ketamine infusion dosages are from 0.05 to 0.5 mg/kg/h (intravenous or subcutaneous). Recommended oral dosages of ketamine are 0.2–0.5 mg/kg/dose two to three times daily with a maximum of 50 mg/dose three times daily.
Despite limitations in the breadth and depth of data available, there is evidence that ketamine may be a viable option for treatment-refractory cancer pain.