Editor-in-Chief: Kenneth D. Candido, MD
Chronic pain is a disease that affects hundreds of millions of Americans and costs the United States billions of dollars a year. It is a disease that has both physical and psychological effects, posing a difficult therapeutic challenge. Innovations in interventional treatments continue to improve, but our pharmacological options have yet to catch up, with opioids remaining as one of the more effective treatments still available. Unfortunately, its rapid onset of pain relief coupled with its highly addictive potential has directly contributed to our current opioid crisis. One way to curb the epidemic is the use of a well-established opioid replacement treatment, buprenorphine, which has a high degree of efficacy in chronic pain and minimal risk of intoxication and overdose. A major limitation to its use is the initial induction stage, whereby the patient experiences severe withdrawal, cravings, and worsening pain. A novel solution in treating chronic pain patients with comorbid addiction may be the use of a low dose series of sub-anesthetic intravenous ketamine infusions as a bridge to buprenorphine therapy during the induction phase. There is emerging evidence that subanesthetic doses of ketamine may be a better option in treating these complex patients, as it has been shown to display robust analgesic activity, favorable effects on mood, reductions in relapse rates, and minimal side effects. Here we review the currently available literature supporting this. Given the current opioid crisis and the lack of safe and effective alternative pharmacological treatments, developing a better pain management strategy would be of great clinical and societal value.
Key words: Ketamine, opioid withdrawal, chronic pain, opioid addiction, buprenorphine, opioid epidemic