Intranasal Ketamine for Episodic Neuropathic Pain in a Cancer Patient: A Case Report
Year: 2025
Type: article
Study design: Case Report
Abstract: BACKGROUND: Ketamine is an N-methyl-D-aspartate receptor antagonist traditionally used for dissociative sedation that has also been used for the treatment of pain. Ketamine can have a higher bioavailability when administered intranasally. OBJECTIVE: To present a case in which intranasal (IN) ketamine was used for unpredictable, episodic, cancer-related neuropathic pain. CASE PRESENTATION: We present a 49-year-old patient with metastatic adenocarcinoma of the lung who presented to our outpatient palliative care clinic with uncontrolled severe episodic neuropathic pain of the lower extremity. CASE MANAGEMENT: We prescribed compounded racemic ketamine 20-30 mg intranasally as needed at the onset of severe episodes of breakthrough pain, in addition to scheduled use of oral methadone and a buprenorphine patch for long-acting pain management. CASE OUTCOME: The patient reported a decrease in frequency, intensity, and duration of episodic breakthrough pain with use of IN ketamine without any reported negative adverse effects. CONCLUSION: Low-dose compounded racemic IN ketamine may be a useful and safe adjunct in alleviating severe breakthrough pain in cancer patients in the outpatient setting.
Source: Journal of Palliative Medicine
Authors: Kyle Brown, Tayyaba Irshad
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4415914837