Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220044-en
Brazilian Journal of Pain
Case Report

Intravascular ketamine infusion for the treatment of chronic pain and depression. Case report

Infusão intravascular de cetamina para o tratamento de dor crônica e depressão. Relato de caso

Ledismar José da-Silva; Paulo Gabriel Balestra Silveira Ayres; Laís Martins Vasconcellos

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Abstract

BACKGROUND AND OBJECTIVES: Chronic pain and depression are two comorbidities that correlate at the molecular level in the central nervous system and cause sufering to the patient, being dificult to be managed. In recent years, several studies have shown significant analgesic and antidepressant efects from intravascular infusion of ketamine, being a promising alternative option for refractory patients. Tus, the aim of the study was to report the case of a patient with refractory chronic pain and depression submitted to serial ketamine single dose infusions.

CASE REPORT: Female patient, 33 years old, diagnosed with interstitial cystitis 13 years ago with refractory chronic pain and depression, submitted to serial infusions of intravascular ketamine. Tree serial infusions were performed, providing a significant improvement in pain and mood. However, the patient could not tolerate the adverse efects, particularly, the transient sensation of impending death and panic attack, and abandoned the treatment.

CONCLUSION: Ketamine is a safe and promising treatment option for chronic pain and depression and can promote significant, albeit transient, pain and mood relief using subanesthetic dosage. However, its adverse efects can be an important limitation for therapeutic success. Standardized clinical studies are needed to better understand the relationship between chronic pain and depression and to establish the best therapeutic approach.

HIGHLIGTS

  • Ketamine is a safe and promising treatment option for chronic pain and depression and can promote significant, albeit transient, pain and mood relief using subanesthetic dosage.
  • The present study observed that a single infusion at low doses of ketamine can quickly relieve depressive symptoms, thoughts, and suicidal actions in patients with refractory depression.
  • It is noteworthy that the serial infusion of ketamine for a certain period is a safer and more effective alternative to the treatment of pain and depression when compared to a single IV infusion regimen. 
     

Keywords

Chronic pain, Depression, Interstitial cystitis, Ketamine

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor crônica e a depressão são duas comorbidades que se correlacionam em nível molecular no sistema nervoso central e promovem sofrimento ao paciente, sendo de difícil manejo. Nos últimos anos, diversos estudos demonstraram efeitos analgésicos e antidepressivos significativos a partir da infusão intravascular de cetamina, sendo uma opção alternativa para pacientes refratários ao tratamento convencional. Assim, o objetivo do estudo foi relatar o caso de uma paciente com dor crônica e depressão refratária submetida a infusões seriadas de doses únicas de cetamina.

RELATO DO CASO: Paciente do sexo feminino, 33 anos, diagnosticada com cistite intersticial há 13 anos com refratariedade no manejo da dor e da depressão, submetida a infusões seriadas de cetamina intravascular. Foram realizadas 3 infusões seriadas que proporcionaram uma melhora significativa na dor e no humor. Entretanto, a paciente não tolerou os efeitos adversos, particularmente, de sensação de morte iminente e ataque de pânico, e abandonou o tratamento.

CONCLUSÃO: A cetamina é uma opção de tratamento promissora para dor crônica e depressão e pode promover alívio significativo, embora transitório, da dor e humor utilizando dose subanestésica. No entanto, seus efeitos adversos podem ser uma limitação para o sucesso terapêutico. Estudos clínicos padronizados são necessários para compreender melhor a relação entre dor crônica e depressão e para estabelecer a melhor abordagem terapêutica.

DESTAQUES

  • A cetamina é uma opção de tratamento segura e promissora para dor crônica e depressão e pode promover alívio significativo, ainda que transitório, da dor e do humor com a dosagem subanestésica.
  • O presente estudo observou que uma única infusão em baixas doses de cetamina pode aliviar rapidamente sintomas depressivos, pensamentos e ações suicidas em pacientes com depressão refratária.
  • Vale ressaltar que a infusão seriada de cetamina por determinado período é uma alternativa mais segura e eficaz para o tratamento da dor e da depressão quando comparada a uma única infusão intravenosa.

Palavras-chave

Cetamina, Cistite instersticial, Depressão, Dor crônica

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Submitted date:
06/22/2021

Accepted date:
09/13/2022

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