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

J Pain Palliat Care Pharmacother. 2016 Dec;30(4):294-297. doi: 10.1080/15360288.2016.1231732. Epub 2016 Oct 18.

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.

Keywords: NMDA; cancer pain; ketamine; opioid-refractory.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Analgesics / administration & dosage
  • Analgesics / therapeutic use*
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use*
  • Cancer Pain / drug therapy*
  • Dose-Response Relationship, Drug
  • Humans
  • Ketamine / administration & dosage
  • Ketamine / therapeutic use*
  • Male
  • Neoplasm Metastasis
  • Neuroendocrine Tumors / pathology
  • Pain, Intractable / drug therapy
  • Pancreatic Neoplasms / pathology
  • Treatment Outcome

Substances

  • Analgesics
  • Analgesics, Opioid
  • Ketamine