New Ketamine guidelines published for acute and chronic pain management

Over the past 10 years, the use of intravenous (IV) ketamine infusions to treat chronic pain has skyrocketed, notes lead author Steven Paul Cohen, MD, director of Medical Education, Pain Medicine Division, at Johns Hopkins Medicine in Baltimore, MD. Because ketamine is a generic drug that is not FDA-approved for chronic pain, its use in this context is characterized by wide variations in indications, dosing regimens, monitoring requirements, and billing.

Guidelines published recently in Regional Anesthesia and Pain Medicine respond to calls for clarity from healthcare providers, payers, patients and their advocacy groups, and healthcare administrators regarding the use of ketamine in the chronic pain clinic setting.  The guidelines contain recommendations on a variety of issues confronting clinicians including indications, monitoring requirements, dosing regimens, contraindications and recommended pre-infusion tests, and what constitutes a positive response.

Simultaneously published are guidelines for the use of IV ketamine for acute pain. These guidelines recommend that sub-anesthetic ketamine infusions “be considered for patients undergoing large painful procedures, patients who are opioid-dependent, opioid-tolerant patients with chronic pain that have an acute exacerbation, and patients at risk of side effects from high doses of opioids such as patients with obstructive sleep apnea,” writes James P. Rathmell, MD, professor of anesthesia at Harvard Medical School and Chair of the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women’s Health Care in Boston, MA, in an editorial accompanying the guidelines.

The guidelines have been approved by the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists.