Successful Treatment of Opioid-Refractory Cancer Pain with Short-Course, Low-Dose Ketamine

Julie M. Waldfogel, Suzanne Nesbit, Steven Cohen, Sydney E Dy

Research output: Contribution to journalArticle

Abstract

Opioids remain the mainstay of treatment for severe cancer pain, but up to 20% of patients have persistent or refractory pain despite rapid and aggressive opioid titration, or develop refractory pain after long-term opioid use. In these scenarios, alternative agents and mechanisms for analgesia should be considered. This case report describes a 28-year-old man with metastatic pancreatic neuroendocrine cancer with severe, intractable pain despite high-dose opioids including methadone and a hydromorphone patient-controlled analgesia (PCA). After treatment with short-course, low-dose ketamine, his opioid requirements decreased by 99% and pain ratings by 50%, with the majority of this decrease occurring in the first 48 hours. As this patient's pain and opioid regimen escalated, he likely experienced some component of central sensitization and hyperalgesia. Administration of ketamine reduced opioid consumption by 99% and potentially “reset” neuronal hyperexcitability and reduced pain signaling, allowing for improved pain control.

Original languageEnglish (US)
Pages (from-to)1-4
Number of pages4
JournalJournal of Pain and Palliative Care Pharmacotherapy
DOIs
StateAccepted/In press - Oct 17 2016

    Fingerprint

Keywords

  • cancer pain
  • ketamine
  • NMDA
  • opioid-refractory

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pharmacology (medical)

Cite this