Intranasal ketamine for chronic cancer-related pain in the outpatient setting: a double-edged sword.

INTRODUCTION

Of the 11.9 million Americans living with cancer, 44% experience cancer-related pain. High-dose opioids remain the mainstay of treatment but often reduce quality-of-life (QoL) due to side effect burden, and 40% of patients do not achieve adequate analgesia. Intranasal ketamine offers analgesia without the dose-limiting gastrointestinal or respiratory effects of opioids. It's intranasal formulation allows easier self-administration. This case series highlights the adverse effects of self-administered intranasal ketamine.

OBJECTIVES

Describe the impact of self-administered intranasal racemic ketamine on adverse effects, pain intensity, and perceived QoL in patients with cancer-related pain.

METHODS

Three patients followed by palliative care and pain medicine services at a tertiary academic center were prescribed intranasal racemic ketamine. Pain scores, opioid consumption (oral morphine equivalents (OME), and adverse effect burden were summarized from clinical encounters.

RESULTS

All three patients reported analgesic benefit, including reductions in OME up to 90%. Despite this, each patient developed adverse effects: fatigue, cognitive slowing, and dissociation warranting termination of therapy. Treatment duration ranged from 1 to 8 months with dosing from 50 mg TID to 100 mg QID.

CONCLUSION

Intranasal ketamine may reduce opioid requirements in cancer-related pain, but adverse effects can limit tolerability. Future research should identify high-risk patients and develop risk mitigation strategies.