Document resource
We read the article by Elyn et al, published in the March issue of Regional Anesthesia & Pain Medicine with keen interest. The authors report the findings of a historical cohort study gauging effectiveness of low-dose ketamine infusions for facilitating opioid tapering in chronic pain (CP) patients with opioid use disorder.1 The study included 59 patients, 42 of which completed 12-month follow-up. CP etiologies included chronic back pain (CBP) (52.5%), fibromyalgia (FM) (17%), postoperative pain (35.6%), peripheral neuropathic pain (50.8%), and widespread pain (49.2%). Ketamine was delivered via continuous slow bolus infusion over 5 days, with doses ranging from 0.15 to 0.45 mg/kg. Adverse events were mild and uncommon. Prior to infusions, the mean opioid dose was 207 mg MME (±128), this was reduced to 92 mg MME (±72) following infusions. This effect was sustained at 12-month follow-up, with a mean dose of 103 mg MME (± 106). 10 patients (23%) eliminated their opioid intake. This study makes important contributions to understanding applications for ketamine infusions, especially considering significant benefits seen from very low doses. We congratulate the authors for their conduct of a practical study with high ecological validity.