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Original research
Low-dose ketamine infusion to facilitate opioid tapering in chronic non-cancer pain with opioid-use disorder: a historical cohort study
  1. Antoine Elyn1,2,3,
  2. Anne Roussin4,5,6,
  3. Cécile Lestrade1,
  4. Nicolas Franchitto6,7,8,
  5. Bénédicte Jullian7 and
  6. Nathalie Cantagrel1
  1. 1Chronic Pain Center, University Hospital of Toulouse, Toulouse, France
  2. 2General and Family Medicine University Department, University of Toulouse III - Paul Sabatier, Toulouse, France
  3. 3RECaP F-CRIN - Réseau national de Recherche en Épidémiologie Clinique et en Santé Publique, Inserm, Toulouse, France
  4. 4Clinical Pharmacology, University Hospital of Toulouse, Toulouse, France
  5. 5INSERM UMR1295, Pharmaco-épidémiologie, University of Toulouse III - Paul Sabatier, Toulouse, France
  6. 6University of Medicine, University of Toulouse III - Paul Sabatier, Toulouse, France
  7. 7Clinical Addictology Center, University Hospital of Toulouse, Toulouse, France
  8. 8INSERM UMR1295, EQUITY “Embodiment, social inequalities, lifecourse epidemiology, cancer and chronic diseases, interventions, methodology”, University of Toulouse III - Paul Sabatier, Toulouse, France
  1. Correspondence to Dr Antoine Elyn, Département des Neurosciences, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; elyn.a{at}chu-toulouse.fr

Abstract

Background 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.

Methods 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.

Results 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.

Conclusions 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.

  • CHRONIC PAIN
  • Opioid-Related Disorders
  • Analgesics, Opioid

Data availability statement

No data are available.

https://doi.org/10.1136/rapm-2023-105035

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    Data availability statement

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    Footnotes

    • Contributors AE collected the data, built the database, performed the statistical analyses and wrote the manuscript. AR participated in the bibliographic research and the statistical analysis and helped to write the manuscript. CL, NF and BJ participated in the bibliographic research and helped to write the manuscript. NC contributed to the identification of patients who could be included in this study, helped to define the variables collected during the data collection, helped formulate the outcomes of the study and then participated in writing the manuscript. AE acts as a guarrantor and accepts full responsibility for the work, had access to the data, and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.