Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2018
Case ReportsOpioid-Sparing Effects of Topical Ketamine in Treating Severe Pain From Decubitus Ulcers.
Pain from pressure ulcers can severely impact a patient's quality of life. Evidence-based treatment of ulcer-related pain typically relies on systemic opioids with limiting side effects. Literature exists on the use of topical ketamine for neuropathic pain, but not for tissue injury in general and for decubitus ulcer pain specifically. ⋯ Here a case is reported of a 54-year-old female with diffuse large B-cell lymphoma who during a critical period in her illness experienced gangrene leading to chronic bilateral stage IV decubitus heel ulcers. The severe pain reported by the patient was poorly managed using high doses of systemic opioids and resulted in intermittent systemic side effects. Adding a compounded ketamine gel to her wound dressings twice daily over an interval of several months drastically reduced her opioid use and, more important, her pain, with minimal side effects.