The Efficacy of Ketamine in the Palliative Care Setting: A Comprehensive Review of the Literature
Frankenthaler, M., Goldman, N., Klepacz, L.
This comprehensive review (2019) compared the efficacy of ketamine treatment for pain and depression within palliative care across administration route and dosing regimen. Efficacy of pain treatment exhibited generally inconclusive and mixed results, but studies that administered ketamine either epidurally or intrathecally demonstrated significant analgesia, in contrast, to subcutaneously or intravenous administration routes. Depression was improved across all relevant studies and was sustained the longest during a daily dosing regimen, whereas a single or a multidose did not exert effects beyond 7 days after administration.
Abstract
Background: Previous literature suggests that ketamine may be an effective drug in the palliative care population as this drug has been shown to treat multiple conditions that are common in these patients.Objective: This review examines the efficacy of ketamine for the treatment of depression and physical pain in palliative care patients.Methods: Eleven studies were included on the topic of ketamine as an antidepressant in the palliative care population. Additionally, 5 RCT studies were included on the topic of physical pain in this population.Results: All 11 studies, including one RCT, found antidepressant effects of ketamine in this patient population. Ketamine’s effect on treating physical pain was mixed with the largest and most recent RCTs suggesting no significant analgesic effect.Discussion: This review suggests that starting qualified patients on intravenous (IV) ketamine and switching to oral or intranasal administration may be the most effective and convenient for treating depression, especially for patients who wish to receive treatment at home. Significant analgesia was found in patients who received epidural or intrathecal ketamine as well as in one study using intravenous administration. More research is necessary to determine which palliative care patients may benefit from ketamine treatment.