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Subanesthetic ketamine infusions for the treatment of children and adolescents with chronic pain: a longitudinal study

机译：亚麻醉氯胺酮输液治疗慢性疼痛儿童和青少年的纵向研究

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Chronic pain is common in children and adolescents and is often associated with severe functional disability and mood disorders. The pharmacological treatment of chronic pain in children and adolescents can be challenging, ineffective, and is mostly based on expert opinions and consensus. Ketamine, an N-methyl-D-aspartate receptor antagonist, has been used as an adjuvant for treatment of adult chronic pain and has been shown, in some instances, to improve pain and decrease opioid-requirement. We examined the effects of subanesthetic ketamine infusions on pain intensity and opioid use in children and adolescents with chronic pain syndromes treated in an outpatient setting. Longitudinal cohort study of consecutive pediatric patients treated with subanesthetic ketamine infusions in a tertiary outpatient center. Outcome measurements included self-reported pain scores (numeric rating scale) and morphine-equivalent intake. Over a 15-month period, 63 children and adolescents (median age 15, interquartile range 12–17 years) with chronic pain received 277 ketamine infusions. Intravenous administration of subanesthetic doses of ketamine to children and adolescents on an outpatient basis was safe and not associated with psychotropic effects or hemodynamic perturbations. Overall, ketamine significantly reduced pain intensity (p <0.001) and yielded greater pain reduction in patients with complex regional pain syndrome (CRPS) than in patients with other chronic pain syndromes (p?=?0.029). Ketamine-associated reductions in pain scores were the largest in postural orthostatic tachycardia syndrome (POTS) and trauma patients and the smallest in patients with chronic headache (p?=?0.007). In 37?% of infusions, patients had a greater than 20?% reduction in pain score. Conversely, ketamine infusions did not change overall morphine-equivalent intake (p?=?0.3). These data suggest that subanesthetic ketamine infusion is feasible in an outpatient setting and may benefit children and adolescents with chronic pain. Further, patients with CRPS, POTS, and a history of trauma-related chronic pain are more likely to benefit from this therapeutic modality.
机译：慢性疼痛在儿童和青少年中很常见，通常与严重的功能障碍和情绪障碍有关。儿童和青少年慢性疼痛的药物治疗可能具有挑战性，无效，并且主要基于专家的意见和共识。氯胺酮是一种N-甲基-D-天冬氨酸受体拮抗剂，已被用作治疗成人慢性疼痛的佐剂，并已显示出在某些情况下可改善疼痛并减少阿片类药物的需求。我们检查了亚麻醉氯胺酮输注对门诊治疗的慢性疼痛综合征儿童和青少年疼痛强度和阿片类药物使用的影响。在三级门诊中心对连续接受小儿氯胺酮输注治疗的小儿患者进行纵向队列研究。结果测量包括自我报告的疼痛评分（数字评分量表）和等效吗啡摄入量。在15个月的时间内，向63位患有慢性疼痛的儿童和青少年（中位年龄为15岁，四分位间距为12-17岁）注射了277氯胺酮。在儿童门诊静脉注射亚麻醉剂量的氯胺酮是安全的，并且与精神作用或血液动力学扰动无关。总体而言，与其他慢性疼痛综合症患者相比，复杂区域疼痛综合症（CRPS）患者的氯胺酮可显着降低疼痛强度（p <0.001），并且减轻疼痛的程度更大（p≤0.029）。与氯胺酮相关的疼痛评分降低在体位性体位性心动过速综合征（POTS）和创伤患者中最大，而在慢性头痛患者中最小（p = 0.007）。在37％的输液中，患者的疼痛评分降低了20％以上。相反，氯胺酮输注并没有改变吗啡当量的总体摄入量（p = 0.3）。这些数据表明亚麻醉氯胺酮输注在门诊病人中是可行的，可能使患有慢性疼痛的儿童和青少年受益。此外，具有CRPS，POTS以及有与创伤有关的慢性疼痛病史的患者更有可能从这种治疗方式中受益。

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