Highlights
- •Opioid-utilizing subjects had decreased in changes in temporal summation after a ketamine infusion.
- •Similar changes were not observed in non-opioid utilizing subjects.
- •Other QST parameters were not different following ketamine infusion when compared to placebo.
- •Subtle changes in altered QST profiles may suggest evidence of opioid-induced hyperalgesia.
Abstract
The long-term effects of opioids on sensitization processes are believed to be mediated
through the N-methyl-D-aspartate receptor. Quantitative sensory testing (QST) changes
observed after a ketamine infusion have been previously described but the effect that
chronic opioids will have is not known. The results of this prospective randomized
factorial trial compared the thermal QST changes observed after a .05 mg/kg ketamine
infusion or a saline placebo in chronic pain subjects who were either opioid-naive
or were chronically using opioids for chronic noncancer pain are presented. No baseline
QST differences were noted between the 4 groups at baseline. Comparison of changes
preinfusion with postinfusion QST measurements resulted in decreased average change
in temporal summation response between opioid subjects who received a placebo compared
with those who received a ketamine infusion (−5.22, SD = 9.96 vs 13.81, SD = 19.55;
P = .004). Additionally, the average change in temporal summation was decreased among
subjects who received a ketamine infusion and were not chronically using opioids compared
with subjects who were using chronic opioids and received a placebo infusion (−1.91,
SD = 13.25 vs 13.81, SD = 19.55; P = .007). The results indicate that low-dose ketamine infusions produce subtle changes
in QST phenotypes that are modified by the chronic use of opioids. This illustrates
the potential diagnostic and therapeutic value of ketamine in the setting of chronic
opioid use.
Perspective
The presented data further our understanding of modulation of sensory perception in
the setting of chronic opioid use and the role of the N-methyl-D-aspartate receptor.
The use of low-dose ketamine infusions may be useful for the treatment as well as
diagnosis of opioid-related neuropathic conditions.
Key words
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Article info
Publication history
Published online: August 09, 2017
Accepted:
July 23,
2017
Received in revised form:
July 7,
2017
Received:
April 16,
2017
Footnotes
Funding for this study was provided by National Institute on Drug Abuse/National Institutes of Health grant 5-R01-DA22576.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 by the American Pain Society
