First Ketamine Guidelines for Pain Released

June 15, 2018 -- New research shows that ketamine can be effective for treating pain, and could be an alternative to opioids.

Ketamine has captured headlines recently as a possible treatment for severe depression and posttraumatic stress syndrome. Ketamine is also being used more in inpatient and outpatient settings to manage pain.

A driving force behind this is the growing effort to find a long-term replacement for opioids, an addictive painkiller that has plunged the country into an epidemic of death and addiction. Yet, before this study, there had been few recommendations on how to use ketamine as a possible alternative.

"The goal of this document is to provide a framework for doctors, for institutions and for payers on use of ketamine for acute pain, who should get it and who should not get it," guideline author Steven Cohen, MD, from Johns Hopkins School of Medicine in Baltimore, told Medscape Medical News.

The guidelines were published online June 7 in Regional Anesthesia and Pain Medicine.

Less Need for Opioids

Development of the guidelines on using ketamine for acute pain was a joint effort, spearheaded by the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine, which approved the document, as did the American Society of Anesthesiologists' Committees on Pain Medicine and Standards and Practice Parameters.

The guidelines say ketamine IVs should be considered for patients having painful surgery and may be considered for opioid-dependent or opioid-tolerant patients having surgery.

Ketamine may also be considered for opioid-dependent or opioid-tolerant patients with acute or chronic sickle cell pain. For patients with sleep apnea, ketamine may be used to help limit opioids, the guidelines note.

The use of ketamine in lower doses has "exploded, and there definitely seems to be a strong signal that ketamine is effective for acute pain, and a lot of patients don't have other options," Cohen said.

‘Powerful and Inexpensive Tool’

Researchers concluded that "despite its drawbacks, ketamine remains a powerful and inexpensive tool for practitioners who manage acute pain. We believe its use will continue to expand as more institutions treat increasingly challenging patients … while trying to combat the opioid epidemic."

They say more research is needed to "refine selection criteria for the treatment of acute pain and possible prevention of chronic pain, to determine the ideal dosing and treatment regimen to include co-administration of ketamine with opioids and adjuvants, and to better understand the long-term risks of ketamine in patients who receive serial treatments for frequent acute pain exacerbations."