Pharmacokinetic and pharmacodynamic considerations for NMDA-receptor antagonist ketamine in the treatment of chronic neuropathic pain: an update of the most recent literature.

Pharmacokinetic and pharmacodynamic considerations for NMDA-receptor antagonist ketamine in the treatment of chronic neuropathic pain: an update of the most recent literature.

Publication date: Nov 06, 2019

Introduction: Chronic neuropathic pain (NP) is an incapacitating illness caused by alesion of the somatosensory nervous system and is associated with several disease or syndromes. Since current treatment options lack adequate efficacy in the majority of patients, ketamine is often administered to treat refractory NP.Areas covered: This review gives an overview of new ketamine pharmacokinetic data including data on intranasal and inhaled ketamine. The outcome of seven systematic reviews and meta-analyses, published since 2012, on ketamine efficacy in NP is discussed. The reader will additionally get an understanding of ketamine’s complex metabolism with emphasis on the metabolite hydroxynorketamine.Expert opinion: Proof of sustained, large effects of ketamine in the treatment of NP from randomized controlled clinical trials is lacking, although we cannot exclude selective ketamine efficacy in patients with central sensitization, opioid-induced hyperalgesia or opioid tolerance. Interestingly, data from observational trials and case series do suggest efficacy of ketamine in producing effective pain relief in NP with positive patient-related outcome measures. Additional randomized trials in often ill-defined groups of chronic pain patients are not useful and we suggest to conduct future studies in NP patients with central sensitization and/or with opioid refractory severe NP.

Kamp, J., van Velzen, M., Olofsen, E., Boon, M., Dahan, A., and Niesters, M. Pharmacokinetic and pharmacodynamic considerations for NMDA-receptor antagonist ketamine in the treatment of chronic neuropathic pain: an update of the most recent literature. 04199. 2019 Expert Opin Drug Metab Toxicol.

Concepts Keywords
Central Sensitization Groups chronic pain
Chronic Pain Hyperalgesia
Clinical Trials Illness
Hyperalgesia Pain management
Intranasal Psychoactive drugs
Ketamine Neurochemistry
Metabolism Amines
Metabolite Ketones
Nervous System Antidepressants
Neuropathic Pain Nicotinic antagonists
NMDA Receptor Antagonist General anesthetics
NP Ketamine
Opioid Neuropathic pain
Pain Opioid-induced hyperalgesia
Pharmacodynamic Norketamine
Pharmacokinetic
Refractory
Somatosensory

Semantics

Type Source Name
drug DRUGBANK Ketamine
disease MESH neuropathic pain
drug DRUGBANK Epinastine
disease MESH syndromes
pathway BSID Metabolism
gene UNIPROT LARGE1
disease MESH central sensitization
disease MESH hyperalgesia
disease MESH chronic pain

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