Kosin Med J.  2022 Mar;37(1):37-45. 10.7180/kmj.21.003.

The effects of ketamine on pain control in stage IV cancer patients receiving palliative care

• Kim S
• Kang J
• Choi J
• Kong E

• KMID: 2527693
• DOI: http://doi.org/10.7180/kmj.21.003

Abstract

Background
We evaluated the effects of intravenous ketamine on cancer pain in stage IV cancer patients receiving palliative care.
Methods
In total, 253 stage IV cancer patients with cancer pain hospitalized at a single tertiary hospital palliative care unit were included. The ketamine group contained 112 patients receiving ketamine, and the control group comprised 141 non-ketamine users. To evaluate the odds ratios (ORs) for favorable pain control, optimal pain control, and opioid-sparing effect among ketamine users, we used multivariable logistic regression adjusted for age and objective prognosis score. Differences in the visual analog scale (VAS) score, oral morphine equivalents, inter-dose frequency, and inter-dose amount were compared between both groups at the time of ketamine introduction (T0), after 24 hours (T1), and after 48 hours (T2) using repeated-measures analysis of covariance.
Results
The ketamine group was more likely to show favorable pain control (OR, 3.84; 95% confidence interval [CI], 1.76–8.37) and an optimal response (OR, 3.99; 95% CI, 1.73–9.22) than the control group. Compared to the control group, the ketamine group showed a higher VAS score at T0, but a more evident VAS score reduction at T1 and T2 (pint<0.001). The ketamine group was less likely than the control group to experience depressive mood (OR, 0.31; 95% CI, 0.10–0.92), but had a higher risk of delirium (OR, 2.06; 95% CI, 1.12–3.91).
Conclusion
Our findings suggest that ketamine can effectively reduce refractory cancer pain in stage IV cancer patients.

Keyword

Adverse effects; Cancer pain; Ketamine; Palliative care

Figure

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  Fig. 1. Changes in VAS score, OME, inter-dose frequency, and inter-dose amount over time in the two groups: T0, ketamine or placebo introduction time; T1, 24 hours after treatment initiation; and T2, 48 hours after treatment initiation. (A) Change in VAS score after ketamine initiation. (B) Change in OME after ketamine use. (C) Change in inter-dose frequency after ketamine use. (D) Change in inter-dose amount after ketamine use. VAS, visual analog scale; OME, oral morphine equivalent.

Reference

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