Focus of the Report: This report focuses on the use of intravenous (IV) ketamine for the treatment of chronic nonmalignant pain.

Technology Description: The hydrochloride (HCl) acid salt of ketamine is a rapid-acting phencyclidine anesthetic indicated for the induction of anesthesia prior to the administration of other general anesthetic agents, as a sole anesthetic agent, or as a supplement to low-potency anesthetic agents such as nitrous oxide. Ketamine has been used off-label in subanesthetic doses as an analgesic via IV, intramuscular (IM), oral, rectal, subcutaneous, epidural, and transnasal formulations.

Controversy: Monitoring of vital signs is mandatory during IV ketamine infusions and resuscitative equipment must be available if intubation is required. Ketamine is associated with psychotomimetic effects (e.g., euphoria, dysphoria, psychomotor retardation, hallucinations, vivid dreams, and nightmares), which must be considered as part of the risk-benefit in the treatment of chronic pain. In recreational abusers of ketamine, the drug can produce decreases in attention, memory, and judgment.

Key Questions:

  • Does IV ketamine improve pain outcomes in adult patients with chronic nonmalignant pain compared with placebo?

  • How does ketamine compare with alternative interventions for chronic nonmalignant pain?

  • Are there any immediate or long-term safety complications associated with the use of ketamine for the treatment of chronic nonmalignant pain?

  • Have definitive patient selection criteria been established for the use of ketamine for chronic nonmalignant pain management?

If you have a Hayes login, click here to view the full report on the Knowledge Center.