EFFECT OF ORAL KETAMINE AS ADJUVANT FOR TREATMENT OF NEUROPATHIC PAIN IN CANCER PATIENTS

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EFFECT OF ORAL KETAMINE AS ADJUVANT FOR TREATMENT OF NEUROPATHIC PAIN IN CANCER PATIENTS

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 7

Abstract

BACKGROUND The study was done to evaluate the effect of oral ketamine when it is used as an adjuvant in 35 cancer patients (19 men and 16 women) experiencing neuropathic pain. The patients were already on maximally tolerable doses of morphine and pregabalin for neuropathic pain and had a pain score > 6 on a 0 - 10 scale. Oral ketamine 0.5 mg/kg thrice daily was added to their regular medication. Patients were instructed to maintain a pain diary to record their pain score and record any other adverse effects. A decrease of ≥ 3 from initial score or a score of ≤ 3 was considered to be adequate response. Nine patients experienced nausea, out of which two had vomiting and five developed loss of appetite. Twenty-three patients complained of drowsiness initially, but it gradually decreased over 2 - 3 weeks among twenty of them. 2 of them withdrew (one on the 8th and the other on the 12th day) citing excessive sedation. 30 out of 35 patients experienced adequate pain relief. There were no complaints of visual or auditory hallucinations from any of the patients. The above study suggests that low-dose oral ketamine is potent and helpful in management of intractable neuropathic pain in cancer patients; however, we have to be observant regarding its side effects. MATERIALS AND METHODS This is a prospective observational study conducted by the Department of Anaesthesiology, Critical Care and Pain Management along with Department of Oncology of Hi-Tech Medical College and Hospital in the period from May 2016 - June 2017. After obtaining Institutional Ethical Committee clearance, we proceeded with the study. Cancer patients diagnosed with neuropathic pain based on clinical criteria were enrolled for the study. RESULTS In this study, 35 patients (19 men, 16 women) with neuropathic pain were included (Table 1 and 2). The mean average pain score prior to treatment was 8.03 ± 0.68 (Table 4). Twenty out of thirty-five patients had remarkable pain relief by the 10th day. The mean NRS reduced to 5.06 ± 1.43 (p < 0.001) by the 10th day of intervention. Thirty out of thirty-five patients had a decrease of more than 3 in NRS over the study period. The pain scores of these 30 patients varied between 3.0 ± 0.78 and 4.83 ± 1.23 over the next three weeks, i.e. till the end of the study. CONCLUSION In the above study, it can be seen that oral ketamine in low doses has been effective in treatment of neuropathic pain in cancer patients. The adverse effects of parenteral ketamine are much lesser when administered orally. Hence, the positive outcome lays the foundation for larger studies, which can help in setting up guidelines regarding indications for ketamine as an adjuvant to analgesic regimens.

Authors and Affiliations

Santanu Kumar Dash, Shakya Mohanty, Diganta Mohanty

Keywords

NEONATAL DERIVED MESENCHYMAL STEM CELLS CAN BE ISOLATED FROM HUMAN UMBILICAL CORD WHARTON’S JELLY BUT NOT FROM HUMAN UMBILICAL CORD BLOOD

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EP ID EP399110
DOI 10.14260/jemds/2018/204
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