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Low-dose ketamine infusion to facilitate opioid tapering in chronic non-cancer pain with opioid-use disorder: a historical cohort study.

Antoine Elyn, Anne Roussin, Cécile Lestrade, Nicolas Franchitto, Bénédicte Jullian, Nathalie Cantagrel

Regional Anesthesia & Pain Medicine May 6, 2025 DOI: 10.1136/rapm-2023-105035 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Historical cohort study Peer reviewed
Sample size 59
Population Chronic pain patients with opioid-use disorder followed by the Pain Center of the University Hospital of Toulouse
Intervention Ketamine infusion
Dose low dose
Duration 5-day hospitalisation, 12-month follow-up
Topics Addiction Esketamine Ketamine
Keywords Analgesics, opioid Opioid-related disorders Ketamine therapy Chronic pain management Opioid dependence Pain medication Addiction treatment
Citations 8
Key findings A 5-day hospitalization with low-dose ketamine infusion reduced the mean daily opioid dose from 207 mg to 92 mg morphine milligram equivalent at discharge, with sustained reductions at 3 and 12 months.

Abstract

Long-term opioid use is associated with pharmacological tolerance, a risk of misuse and hyperalgesia in patients with chronic pain (CP). Tapering is challenging in this context, particularly with comorbid opioid-use disorder (OUD). The antihyperalgesic effect of ketamine, through N-methyl-D-aspartate (NMDA) antagonism, could be useful. We aimed to describe the changes in the dose of opioids consumed over 1 year after a 5-day hospitalisation with ketamine infusion for CP patients with OUD. We performed a historical cohort study using a medical chart from 1 January 2014 to 31 December 2019. Patients were long-term opioid users with OUD and CP, followed by the Pain Center of the University Hospital of Toulouse, for which outpatient progressive tapering failed. Ketamine was administered at a low dose to initiate tapering during a 5-day hospitalisation. 59 patients were included, with 64% of them female and a mean age of 48±10 years old. The most frequent CP aetiologies were back pain (53%) and fibromyalgia (17%). The baseline opioid daily dose was 207 mg (±128) morphine milligram equivalent (MME). It was lowered to 92±72 mg MME at discharge (p<0.001), 99±77 mg at 3 months (p<0.001) and 103±106 mg at 12 months. More than 50% tapering was achieved immediately for 40 patients (68%), with immediate cessation for seven patients (12%). 17 patients were lost to follow-up. A 5-day hospitalisation with a low-dose ketamine infusion appeared useful to facilitate opioid tapering in long-term opioid users with CP and OUD. Ketamine was well tolerated, and patients did not present significant withdrawal symptoms. Prospective and comparative studies are needed to confirm our findings.

Comparable studies

Other observational and cohort studies on ketamine, most cited first.

Study Year Design Participants
Taming the Ketamine Tiger Volunteers from a prison population 2010 Observational study n = 20
Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin Humans 2017 Observational study
Disruption of Frontal–Parietal Communication by Ketamine, Propofol, and Sevoflurane Surgical patients undergoing induction of anesthesia with intravenous ketamine 2013 Observational cohort n = 30
Do the dissociative side effects of ketamine mediate its antidepressant effects? Treatment-resistant inpatients with major depressive disorder or bipolar disorder 2014 Observational cohort n = 108
Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder 2012 Observational cohort n = 30

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Addiction Esketamine Ketamine