Beyond Anesthesia: Ketamine's Expanding Role in Chronic Pain and Psychiatric Disorders.
Level 1 - systematic review of randomized trials
Systematic review synthesizing randomized controlled trials, observational studies, and systematic reviews
PubMed 40767004 · doi:10.31083/JIN26766
What was done
A systematic review was conducted by searching PubMed, Cochrane Library, and Scopus databases to evaluate ketamine's pharmacology, efficacy, and safety across chronic pain syndromes and psychiatric conditions. The synthesis included randomized controlled trials, observational studies, and existing systematic reviews covering both off-label ketamine applications and FDA-approved esketamine.
What was found
The abstract reports no numerical effect sizes or meta-analytic statistics. It notes that up to 50% of chronic pain populations experience comorbid depression or anxiety. Qualitatively, ketamine demonstrated efficacy in treatment-resistant neuropathic pain, fibromyalgia, and complex regional pain syndrome (CRPS). NMDA receptor antagonism was linked to rapid antidepressant effects in treatment-resistant depression and acute suicidal ideation, with emerging evidence in post-traumatic stress disorder, obsessive-compulsive disorder, anxiety disorders, and substance use disorders. Psychomimetic side effects and safety concerns were highlighted.
Why it matters
This review highlights ketamine's dual utility as both an analgesic and rapid-acting psychiatric intervention, which is especially relevant for patients suffering from co-occurring treatment-resistant chronic pain and mood disorders.
Limits
The abstract provides no quantitative data, pooled effect estimates, or study counts (n). The review synthesizes heterogeneous study designs across broad, distinct clinical indications. Long-term safety, optimal dosing regimens, and protocols for managing psychomimetic adverse effects remain undefined.
Cited by
- context Ketamine is FDA-approved for treatment-resistant depression.