Credit score: Kindel Media from Pexels
The off-label use of ketamine to deal with persistent ache just isn’t supported by scientific proof, a brand new Cochrane assessment has discovered.
Ketamine is an anesthetic generally used for procedural sedation and short-term ache aid. Ketamine can also be ceaselessly prescribed off-label to handle persistent ache circumstances akin to nerve ache, fibromyalgia and sophisticated regional ache syndrome. It’s certainly one of a number of NMDA receptor antagonists—a bunch of medicine thought to cut back ache by blocking sure mind receptors concerned in ache signaling.
The assessment, carried out by researchers from UNSW Sydney, Neuroscience Analysis Australia (NeuRA), and Brunel College of London, examined 67 trials involving over 2,300 grownup members. It assessed 5 NMDA receptor antagonists: ketamine, memantine, dextromethorphan, amantadine, and magnesium.
The outcomes, revealed within the Cochrane Database of Systematic Opinions, present no clear proof of profit for ketamine in persistent ache and establish an elevated danger of antagonistic results akin to delusions, delirium, paranoia, nausea, and vomiting. Proof was rated low to very low certainty, as a consequence of small examine sizes and poor methodological high quality.
“We want to be clear—we’re not saying ketamine is ineffective, but there’s a lot of uncertainty,” stated Michael Ferraro, Doctoral Candidate at UNSW and NeuRA, first creator of the assessment. “The data could point to a benefit or no effect at all. Right now, we just don’t know.”
Researchers regarded on the results throughout numerous persistent ache circumstances and dosing methods however discovered no clear proof of profit in any particular situation or dose. Unwanted side effects have been a significant concern, notably with intravenous use.
“The most common adverse events we saw were psychotomimetic effects such as delusions, delirium and paranoia, as well as nausea and vomiting,” stated Ferraro. “These effects are distressing for many patients. Clinicians often try to balance the dose for pain relief without triggering those symptoms, but this isn’t always achieved.”
The assessment additionally discovered no research that reported on two key outcomes: whether or not ketamine diminished depressive signs or opioid use. That is notable, as ketamine is commonly proposed for sufferers with depressive signs or opioid tolerance.
“This group of drugs, and ketamine in particular, are in relatively common use for chronic pain around the world. Yet we have no convincing evidence that they are delivering meaningful benefits for people with pain, even in the short term,” stated Neil O’Connell, Professor at Brunel College of London, co-senior creator of the assessment.
“That seems a good reason to be cautious in the clinic and clearly indicates an urgent need to undertake high-quality trials.”
The authors hope the assessment will assist inform sufferers and clinicians weighing up potential advantages and harms, and information future analysis. Whereas extra proof is required, this assessment highlights the significance of high-quality trials to grasp whether or not ketamine has a task in persistent ache care.
“We’ve seen the harm that can come from taking medicines developed for acute pain and applying them to chronic pain. Opioids are a prime example. Now we’re seeing a similar pattern with ketamine,” stated co-senior creator James McAuley, Professor at UNSW and senior researcher at NeuRA.
“As opioid prescribing is slowly reduced, there’s a growing demand for alternatives, but we need to be careful not to rush into widespread use without strong evidence.”
Extra info:
Ketamine and different NMDA receptor antagonists forchronic ache, Cochrane Database of Systematic Opinions (2025). DOI: 10.1002/14651858.CD015373.pub2
Supplied by
Cochrane
Quotation:
Ketamine use in persistent ache unsupported by proof, assessment finds (2025, August 17)
retrieved 17 August 2025
from https://medicalxpress.com/information/2025-08-ketamine-chronic-pain-unsupported-evidence.html
This doc is topic to copyright. Aside from any truthful dealing for the aim of personal examine or analysis, no
half could also be reproduced with out the written permission. The content material is supplied for info functions solely.
