OBJECTIVE: The objective of this review is to examine the role of ketamine as an analgesic for palliative treatment in the hospice care setting. DATA SOURCES: The sources referenced in this review were found September 22, 2005, via an Internet search of the MEDLINE database and Cochrane Database of Systematic Reviews. Search terms included analgesia, cancer pain, dextromethorphan, hospice, ketamine, opioids, palliative care, neuropathic pain, and morphine. Articles and case reports were included that relate to ketamine use as an analgesic agent and not as an anesthetic. DATA EXTRACTION: Because of patient variability with ketamine use and dosing, focus was placed on analgesic benefit versus no analgesic benefit. Because of the lack of controlled trials, application of all analgesic data related to ketamine use was relevant to this review. The strength of evidence is currently moderate, but the available trials and reports reviewed in this paper describe compelling results. DATA SYNTHESIS: Ketamine has been effective in producing analgesia in patients receiving palliative care, especially when used in combination with opioids. CONCLUSION: When opioid therapy is no longer sufficient to improve quality of life in the hospice setting, the addition of ketamine may be considered as adjunctive therapy.
OBJECTIVE: The objective of this review is to examine the role of ketamine as an analgesic for palliative treatment in the hospice care setting. DATA SOURCES: The sources referenced in this review were found September 22, 2005, via an Internet search of the MEDLINE database and Cochrane Database of Systematic Reviews. Search terms included analgesia, cancer pain, dextromethorphan, hospice, ketamine, opioids, palliative care, neuropathic pain, and morphine. Articles and case reports were included that relate to ketamine use as an analgesic agent and not as an anesthetic. DATA EXTRACTION: Because of patient variability with ketamine use and dosing, focus was placed on analgesic benefit versus no analgesic benefit. Because of the lack of controlled trials, application of all analgesic data related to ketamine use was relevant to this review. The strength of evidence is currently moderate, but the available trials and reports reviewed in this paper describe compelling results. DATA SYNTHESIS: Ketamine has been effective in producing analgesia in patients receiving palliative care, especially when used in combination with opioids. CONCLUSION: When opioid therapy is no longer sufficient to improve quality of life in the hospice setting, the addition of ketamine may be considered as adjunctive therapy.