The out -of -the -market use of ketamine to treat chronic pain is not supported by scientific evidence, revealed a new Cochrane review.
Ketamine is an anesthetic commonly used for procedural sedation and short -term pain relief. Ketamine is also frequently prescribed out of AMM to manage chronic pain conditions such as nervous pain, fibromyalgia and complex regional pain syndrome. This is one of the many antagonists of NMDA receptors – a group of drugs considered to reduce pain by blocking certain strokes involved in pain signaling.
The journal, led by researchers from the Unsw Sydney, neuroscience Research Australia (Neura) and the Brunel University of London, examined 67 trials involving more than 2,300 adult participants. He assessed five NMDA receptor antagonists: ketamine, memantine, dextromethorphane, amantadine and magnesium.
The results show no clear evidence of the benefit for chronic pain and have identified an increased risk of undesirable effects such as delusions, delirium, paranoia, nausea and vomiting. The evidence was noted weak to a very low certainty, due to small study and poor methodological quality.
We want to be clear – we do not say that ketamine is ineffective, but there is a lot of uncertainty. The data could indicate an advantage or no effect. Right now, we just don’t know. “”
Michael Ferraro, first author of the study and doctoral candidate, New South Wales University
The researchers examined the effects in various chronic conditions of pain and dosage strategies, but found no clear evidence of profit in a specific condition or dose. Side effects were a major concern, especially with intravenous use.
“The most common adverse events we have seen were the psychotomimetic effects such as delusions, delirium and paranoia, as well as nausea and vomiting,” said Ferraro. “These effects are painful for many patients. Clinicians often try to balance the dose of pain relief without triggering these symptoms, but it is not always achieved. »»
The journal has also found no study which reported two key results: if ketamine has reduced depressive symptoms or the use of opioids. This is notable because ketamine is often offered for patients with depressive symptoms or tolerance to opioids.
“This group of drugs, and ketamine in particular, is in relatively common use for chronic pain in the world. However, we have no convincing evidence that they offer significant advantages for people with pain, even in the short term, “said Neil O’Connell, professor at Brunel University in London, Co-Senior author of The Review. “It seems a good reason to be careful in the clinic and clearly indicates an urgent need to take high quality trials. »»
The authors hope that the examination will help inform patients and clinicians to weigh potential advantages and damage and will guide future research. Although more evidence is necessary, this review highlights the importance of high quality trials to understand if ketamine has a role in chronic pain care.
“We have seen the evil that can come from taking medication developed for acute pain and applying them to chronic pain, opioids are an excellent example. We now see a similar model with ketamine, ”said author Co-Senor James McAuley, professor at UNSW and principal researcher at Neura. “As the prescription of opioids is slowly reduced, there is an increasing demand for alternatives, but we must be careful not to rush into generalized use without solid evidence. »»