Absence of proof for ketamine's efficacy in managing persistent pain, according to comprehensive study
In a comprehensive analysis, a recent Cochrane review has raised concerns about the widespread use of ketamine as a treatment for chronic pain. The review, which assessed data from 67 clinical trials involving over 2,300 people, found no clear evidence that ketamine provides meaningful or sustained relief for chronic pain conditions such as neuropathic pain, fibromyalgia, and complex regional pain syndrome (CRPS).
Key points from the review include:
- Temporary relief, limited benefit: Ketamine often produces short-term pain relief lasting days to a few weeks, particularly for fibromyalgia, diabetic neuropathy, and migraines. However, the pain typically returns, requiring repeated treatments. There is limited and mostly anecdotal evidence for sustained relief in select cases, but large-scale, high-quality trials showing consistent benefit are lacking.
- CRPS may be an exception: Intensive ketamine infusion protocols, such as 10-day continuous low-dose infusions, have demonstrated pain relief lasting around 8–12 weeks in CRPS patients, suggesting some potential utility in this difficult-to-treat syndrome.
- Adverse effects: Ketamine use was associated with side effects such as delusions, hallucinations, paranoia, nausea, and vomiting, which raise concerns about its safety profile in chronic pain treatment. These side effects are particularly pronounced when ketamine is given through a vein.
- Lack of evidence for opioid reduction or antidepressant effects: Despite off-label use, ketamine has not shown strong evidence to reliably reduce opioid use or improve depression symptoms in chronic pain populations.
James McAuley, one of the review's authors and a UNSW professor, emphasized the need for caution, stating, "We should be careful not to rush into widespread use of ketamine without strong evidence." He added that the existing evidence base is too poor to draw any solid conclusions on whether ketamine can help patients suffering from chronic pain.
Ketamine has gained popularity as a potential treatment for chronic pain and mental health problems. In addition to ketamine, the review included multiple drugs that are NMDA receptor antagonists, namely memantine, dextromethorphan, amantadine, and magnesium. However, the review found no evidence of any benefits from these drugs for chronic pain.
The lack of evidence has not deterred the growth of ketamine clinics across Europe. Despite the concerns raised by this review, further research is needed to determine the role of ketamine and other NMDA receptor antagonists in the treatment of chronic pain. The analysis was carried out by Cochrane, an influential nonprofit research group, which underscores the importance of these findings.
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