Low-dose ketamine as an adjuvant for pain control in a cancer patient: a case report

Introduction: Cancer patients often suffer from pain related problems such as under-treatment of pain, ineffective and persistent opioid administration as well as adverse opioid use outcomes. There is a growing need for non-opioid analgesic alternatives for patients undergoing treatment for obstinate pain. Ketamine is a fast-acting N-methyl-D-aspartate (NMDA) receptor antagonist that has been emerging as an effective medication for pain alleviation. While protocols have been established for the use of Low-Dose Ketamine (LDK) for post-operative pain, there is growing evidence for using LDK as a clinical alternative to opioids in a palliative care setting.Methods: This case study involves monitoring the efficacy of LDK treatment in combination with opioid analgesics in a cancer patient in a hospital setting. This is a very selected case of a patient with Metastatic Prostate Cancer (Gleason 9 Adenocarcinoma) where LDK was shown to be efficacious at reducing pain when opioids and standard pain medications were not satisfactory.Results: While the study involved using a relatively novel pharmacological protocol and close patient monitoring, the patient reported a sustained reduction in pain level based on the Numerical Rating Scale for months after the termination of LDK infusions. Moreover, the treatment also resulted in a reduction of total opioid usage after the addition of LDK.Discussion: Although additional research is needed to ascertain optimal dosing schedules and route of Ketamine, given these promising findings, Ketamine may be a useful option for improving the treatment of refractory pain in patients with cancer and a good tool in palliative medicine for treating neoplastic pain.