Ketamine acute pain

Sigtermans M, et al. An observational study on the effect of S(-i-)-ketamine on chronic pain versus experimental acute pain in Complex Regional Pain Syndrome type 1 patients. Eur J Pain 2009 ... 

Substantial published literature ranging from cases and case series through meta-analyses of randomized controlled trials describes the parenteral administration of subanesthetic doses of ketamine to provide analgesia in patients with acute pain such as burn pain, chronic pain such as neuropathic pain, and cancer-related pain as both a stand-alone analgesic as well as an adjuvant to opioids [5]. 

Table 110.1. Intranasal ketamine for acute pain after extraction of impacted molars TOTPAR scores across I and 3 hours (with...

In summary, subanesthetic doses of ketamine are now used increasingly in anesthesia practice as part of multimodal regimens for acute pain, as well as add-on therapy in selected patients with chronic pain. Our intranasal ketamine product candidate provides a simple, non-invasive alternative to the present invasive (IM, IV) methods of systemic administration of low-dose ketamine, and has the potential to make this agent available on a broader scale. However, it is still under development and the final assessment of its benefits and risks will await completion and integration of the results of its entire clinical investigative program. 

Christensen K, Rogers E, Green GA, Hamilton DA, Mermelstein F, liao E, Wright C, Carr DB. Safety and efficacy of intranasal ketamine for acute postoperative pain. Acute Pain 2007 9 183-192. 

Acute phencyclidine intoxication can proceed through stages from stupor to coma with unresponsiveness to pain. Delirium lasting several days is common during recovery from coma and may occur transiently as the final phase of an episode of intoxication (Gorelick Balster, 1995). Ketamine has similar effects when abused recreationally. When used as an anaesthetic in adults, it... 

Schmid RL, Sandler AN, Katz J (1999) Use and efficacy of low-dose ketamine in the management of acute postoperative pain a review of current techniques and outcomes. Pain 82 111-125... 

A study in 11 healthy subjects found that the combination of ketamine and morphine almost abolished windup-like pain (progressive increase in pain intensity on repeated stimulation) in a skin bum injury. This effect was not found with either dmg alone. Further, ketamine done, but not morphine reduced the area of secondary hyperalgesia of the local bum and increased the pain threshold, but the combination did not appear to enhance this effect. The reduction of wind-up pain may be due to ketamine-induced prevention of acute tolerance to morphine. ... 

Another study in healthy subjects using various experimental pain models found that ketamine antagonised the respiratory depressant effect of remifentanil. Remifentanil alone produced analgesic effects with all pain tests, but ketamine only enhanced the effect of remifentanil on intramuscular electrical stimulation. Acute remifentanil-induced hyperalgesia and tolerance were detected only by the pressure pain test and were not suppressed by ketamine. The combined effects of remifentanil and ketamine probably depend on the type of pain. ... 

Carstensen M, Moller AM. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain a qualitative review of randomized trials. Br J Anaesth 2010 104(4) 401-6. 

Our intranasal ketamine product candidate is being developed for the management of acute moderate to severe pain, as well as BTP in patients on chronic opioid therapy. Pilot studies in both of these pain models, using the exploratory formulation of Ereska, have yielded encouraging results for safety and efficacy. A randomized, double-blind, singledose parallel study [3] tested 10, 30 and 50 mg IN... 

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