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Multi-day low dose ketamine infusion as adjuvant to oral gabapentin in spinal cord injury related chronic pain: a prospective, randomized, double blind trial.
Pain Physician 2010 May-Jun; 13(3):245-9PP

Abstract

BACKGROUND

Severe, intractable, chronic pain is a significant management problem for those involved in the long-term care of spinal cord injury (SCI) patients . Gabapentin, an anticonvulsant, is widely used for treating chronic pain. Ketamine, an NMDA receptor antagonist, has been available in clinical practice for 35 years. Its usefulness in pathological pain states is known. Despite this, no formal research on its effectiveness in treating neuropathic SCI pain exists.

OBJECTIVES

This double-blind study sought to determine the safety and efficacy of adding a multi-day low dose ketamine infusion to oral gabapentin for treating chronic pain related to post spinal cord injury.

STUDY DESIGN

Randomized, controlled, double blind trial.

SETTING

Hospital, in-patient setting.

METHODS

Forty patients diagnosed with neuropathic pain secondary to spinal cord injury were randomized into 2 equal groups. Group I received an 80 mg intravenous ketamine infusion diluted in 500 cc normal saline over a 5 hour period daily for one week and 300 mg of gabapentin 3 times daily. Group II received a placebo infusion and 300 mg of gabapentin 3 times daily (continued) after 300 mg of gabapentin 3 times daily. Using the visual analogue scale, pain was assessed prior to treatment, daily following ketamine or placebo infusions for 7 days, and then weekly for one month after infusion termination. Side effects, specifically those related to ketamine or gabapentin, were reported.

RESULTS

Both groups demonstrated significantly reduced pain scores compared with pre-treatment values (P < 0.05). Group I showed significant pain score improvements over Group II at all measurements (P < 0.0001) during infusion and 2 weeks after infusion termination. There was no statistical difference between the groups at 3 weeks and 4 weeks after infusion termination (P = 0.54 and P = 0.25 respectively). Both drugs were tolerated by all patients; no side effects required intervention.

CONCLUSION

Multi-day low dose ketamine infusion as adjuvant to gabapentin in post-spinal cord injury related chronic pain is safe and efficacious in reducing pain, but the effect compared to placebo ceased 2 weeks after infusion termination.

LIMITATIONS

Study size limited to 40 patients.

Authors+Show Affiliations

Anesthesia Department, Tanta University Hospital, Tanta, Egypt. yasser.amr@gmail.com

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

20495588

Citation

Amr, Yasser Mohamed. "Multi-day Low Dose Ketamine Infusion as Adjuvant to Oral Gabapentin in Spinal Cord Injury Related Chronic Pain: a Prospective, Randomized, Double Blind Trial." Pain Physician, vol. 13, no. 3, 2010, pp. 245-9.
Amr YM. Multi-day low dose ketamine infusion as adjuvant to oral gabapentin in spinal cord injury related chronic pain: a prospective, randomized, double blind trial. Pain Physician. 2010;13(3):245-9.
Amr, Y. M. (2010). Multi-day low dose ketamine infusion as adjuvant to oral gabapentin in spinal cord injury related chronic pain: a prospective, randomized, double blind trial. Pain Physician, 13(3), pp. 245-9.
Amr YM. Multi-day Low Dose Ketamine Infusion as Adjuvant to Oral Gabapentin in Spinal Cord Injury Related Chronic Pain: a Prospective, Randomized, Double Blind Trial. Pain Physician. 2010;13(3):245-9. PubMed PMID: 20495588.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multi-day low dose ketamine infusion as adjuvant to oral gabapentin in spinal cord injury related chronic pain: a prospective, randomized, double blind trial. A1 - Amr,Yasser Mohamed, PY - 2010/5/25/entrez PY - 2010/5/25/pubmed PY - 2010/8/21/medline SP - 245 EP - 9 JF - Pain physician JO - Pain Physician VL - 13 IS - 3 N2 - BACKGROUND: Severe, intractable, chronic pain is a significant management problem for those involved in the long-term care of spinal cord injury (SCI) patients . Gabapentin, an anticonvulsant, is widely used for treating chronic pain. Ketamine, an NMDA receptor antagonist, has been available in clinical practice for 35 years. Its usefulness in pathological pain states is known. Despite this, no formal research on its effectiveness in treating neuropathic SCI pain exists. OBJECTIVES: This double-blind study sought to determine the safety and efficacy of adding a multi-day low dose ketamine infusion to oral gabapentin for treating chronic pain related to post spinal cord injury. STUDY DESIGN: Randomized, controlled, double blind trial. SETTING: Hospital, in-patient setting. METHODS: Forty patients diagnosed with neuropathic pain secondary to spinal cord injury were randomized into 2 equal groups. Group I received an 80 mg intravenous ketamine infusion diluted in 500 cc normal saline over a 5 hour period daily for one week and 300 mg of gabapentin 3 times daily. Group II received a placebo infusion and 300 mg of gabapentin 3 times daily (continued) after 300 mg of gabapentin 3 times daily. Using the visual analogue scale, pain was assessed prior to treatment, daily following ketamine or placebo infusions for 7 days, and then weekly for one month after infusion termination. Side effects, specifically those related to ketamine or gabapentin, were reported. RESULTS: Both groups demonstrated significantly reduced pain scores compared with pre-treatment values (P < 0.05). Group I showed significant pain score improvements over Group II at all measurements (P < 0.0001) during infusion and 2 weeks after infusion termination. There was no statistical difference between the groups at 3 weeks and 4 weeks after infusion termination (P = 0.54 and P = 0.25 respectively). Both drugs were tolerated by all patients; no side effects required intervention. CONCLUSION: Multi-day low dose ketamine infusion as adjuvant to gabapentin in post-spinal cord injury related chronic pain is safe and efficacious in reducing pain, but the effect compared to placebo ceased 2 weeks after infusion termination. LIMITATIONS: Study size limited to 40 patients. SN - 2150-1149 UR - https://www.unboundmedicine.com/medline/citation/20495588/Multi_day_low_dose_ketamine_infusion_as_adjuvant_to_oral_gabapentin_in_spinal_cord_injury_related_chronic_pain:_a_prospective_randomized_double_blind_trial_ L2 - http://www.painphysicianjournal.com/linkout?issn=1533-3159&amp;vol=13&amp;page=245 DB - PRIME DP - Unbound Medicine ER -