Journal of pain & palliative care pharmacotherapy
-
J Pain Palliat Care Pharmacother · Dec 2016
Case ReportsSuccessful Treatment of Opioid-Refractory Cancer Pain with Short-Course, Low-Dose Ketamine.
Opioids remain the mainstay of treatment for severe cancer pain, but up to 20% of patients have persistent or refractory pain despite rapid and aggressive opioid titration, or develop refractory pain after long-term opioid use. In these scenarios, alternative agents and mechanisms for analgesia should be considered. ⋯ As this patient's pain and opioid regimen escalated, he likely experienced some component of central sensitization and hyperalgesia. Administration of ketamine reduced opioid consumption by 99% and potentially "reset" neuronal hyperexcitability and reduced pain signaling, allowing for improved pain control.
-
Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The effects of long-term opioid use on testosterone production, associated comorbidities, and medication-based and natural testosterone replacement therapies are considered.