American Association of Nurse Anesthetists Journal. September 2016.
Use for Chronic Pain Treatment: Chronic pain is most effectively treated using a patient- centered, interdisciplinary, multimodal approach. Ketamine may be used for chronic pain management for a range of disorders, including complex regional pain syndrome (CRPS), ischemic limb pain, phantom limb pain, fibromyalgia, and other neuropathic conditions. Ketamine has also been shown to treat depression and anxiety in the context of chronic pain and other chronic illnesses. As part of a multimodal approach, ketamine is not considered as the first or second choice in treatment for neuropathic pain, irrespective of the cause. Since potential long-term effects on memory and cognition in chronic pain patients require further study, ketamine should be restricted to patients with therapy-resistant neuropathic pain, such as in refractory CRPS pain. Ketamine may have a role as an opiate adjunct for cancer pain, primarily of neuropathic origin, and may be a treatment option for patients who cannot tolerate opioids or those with problems with opioid responsiveness. Ketamine can reduce the incidence and severity of opioid side effects, which is an important factor in patient compliance. For example, an opioid-ketamine combination may be effective in non-neuropathic pain or in mixed nociceptive/neuropathic pain.