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Is it safe to use ketamine as a pain drug?

Asked by Cindy, Texas

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What about ketamine as a pain drug? Could it be used to get someone off methadone who previously took Oxycontin and then got sent to a methadone clinic? Is ketamine more addictive than methadone as a pain drug? What are the risks vs. benefits of ketamine?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Ketamine has been around for years but was largely neglected by the medical profession until recently. The drug was developed as an anesthetic agent, and it is still used as such in special circumstances, although its usefulness is limited by the fact that at high doses it produces hallucinations and bizarre feelings of dissociation. It is also used as a drug of abuse for these properties, which have given it a bad name.

Recently there has been a resurgence of interest in ketamine because of studies showing that at much lower doses than required for anesthesia, it appears to be a rapid and powerful antidepressant agent, presumably because it blocks an important type of receptor in the brain, known as the NMDA receptor.

To get to your question, the antidepressant potential of ketamine was discovered serendipitously in patients receiving the drug for the treatment of complex regional pain syndrome, or CRPS, a miserable condition characterized by severe pain, swelling and changes in the skin. Ketamine is also used to treat acute pain after significant tissue trauma, either as the result of surgery or an accident.

Does it work? As with so many things in medicine, the answer is not altogether clear. Certainly there are many reports of people with various types of chronic pain getting relief from one or more infusions of ketamine. But in the best done studies its effectiveness is not as clear. A recent meta-analysis found that ketamine worked for pain after amputation of a limb but not for CRPS. Similarly, a recent investigation found that ketamine was not beneficial for treating fibromyalgia.

So my best answer for your first question is that yes, ketamine might help your pain, depending on what type of pain problem you've got. Ketamine does not cross-react with opiates, however, so you wouldn't be able to use it to withdraw safely from methadone, even if you found it useful for pain control. You'd still have to go through an appropriate opiate withdrawal procedure.

Ketamine is a drug of abuse, but like other hallucinogenics it is not as powerfully addictive as opiates. But it does have a number of side effects. When given at low doses, its psychological effects (i.e. hallucinations and feelings of dissociation) tend to be minimal, but they do occasionally occur. When used for chronic pain, ketamine has also been reported to cause dizziness, lightheadedness and nausea. Repeated use has been associated with cases of liver damage and may impair one's memory.

I think the take-home point of all this is that ketamine may be worth exploring if you've really tried all the other more common options for managing pain and getting off opiates, which have their own significant long-term problems in many people. But ketamine is not widely used and has not always found to be helpful for all types of pain.

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