The application of ketamine in pain management for sports injuries and other medical conditions - literature review
DOI:
https://doi.org/10.12775/QS.2025.43.61502Keywords
ketamine, pain management, chronic pain, acute painAbstract
Introduction: Ketamine is a well-established dissociative anesthetic. The discovery of its NMDA receptor antagonism revealed new potential applications in pain management. It has demonstrated promise as an analgesic for the treatment of chronic pain and has proven useful in managing acute pain, such as that resulting from sports injuries or in pediatric care settings. It is also a valuable alternative for patients who have not responded well to traditional pain medications.
Materials and methods: This article reviews promising role of ketamine in pain management, especially in chronic or cancer pain, incorporating data from Google Scholar, PubMed, using keywords such as „ketamine”,„chronic pain”, „acute pain”, „pain management”.
Summary: Current evidence supports the use of subanesthetic ketamine as an effective option for acute pain management across various clinical settings, with potential to reduce opioid dependence. Its unique antidepressant properties also make it beneficial for chronic pain patients, especially those with comorbid depression. In conditions like CRPS and sickle cell disease, low-dose ketamine has shown promising results in improving pain and function. However, its effectiveness in fibromyalgia appears limited, with short-term infusions offering only temporary relief. The pediatric population may particularly benefit from ketamine’s rapid, intranasal administration, though dosing and safety must be carefully considered. While early findings are encouraging, more research is needed to establish optimal protocols and to explore its role in managing sport-related injuries.
Conclusions: Ketamine finds various applications in pain therapy and is a promising medication due to its efficacy in both chronic and acute pain management. However, further research is necessary to precisely determine the therapeutic dosage ranges, the long-term effects of its use, and the risk of addiction associated with its administration.
References
1. Anghelescu DL, Ryan S, Wu D, Morgan KJ, Patni T, Li Y. Low-dose ketamine infusions reduce opioid use in pediatric and young adult oncology patients. Pediatr Blood Cancer. 2022;69(9):e29693. doi:10.1002/pbc.29693
2. Barrett W, Buxhoeveden M, Dhillon S. Ketamine: a versatile tool for anesthesia and analgesia. Curr Opin Anaesthesiol. 2020 Oct;33(5):633-638. doi: 10.1097/ACO.0000000000000916. PMID: 32826629.
3. Hocking G, Cousins MJ. Ketamine in chronic pain management: an evidence-based review. Anesth Analg. 2003;97(6):1730-1739. doi:10.1213/01.ANE.0000086618.28845.9B
4. Scatton B. The NMDA receptor complex. Fundam Clin Pharmacol. 1993;7(8):389-400. doi:10.1111/j.1472-8206.1993.tb01036.x
5. Zgaia AO, Fadgyas-Stanculete M, Popa L, et al. The role of ketamine in the treatment of chronic cancer pain. Med Pharm Rep. 2015;88(4):457-461. doi:10.15386/cjmed-500
6. Ma X, Yan J, Jiang H. Application of ketamine in pain management and the underlying mechanism. Pain Res Manag. 2023;2023:1928969. doi:10.1155/2023/1928969
7. Sawynok J. Topical and peripheral ketamine as an analgesic. Anesth Analg. 2014;119(1):170-178. doi:10.1213/ANE.0000000000000246
8. Sleigh J, Harvey M, Voss L, Denny B. Ketamine – more mechanisms of action than just NMDA blockade. Trends Anaesth Crit Care. 2014;4(2–3):76-81. doi:10.1016/j.tacc.2014.03.002
9. Par Pharmaceutical. Product information: KETALAR intravenous injection, intramuscular injection, ketamine HCl intravenous injection, intramuscular injection. Chestnut Ridge, NY, USA: Par Pharmaceutical; 2017.
10.Morgan CJA, Curran HV; Independent Scientific Committee on Drugs (ISCD). Ketamine use: a review. Addiction. 2012;107(1):27-38. doi:10.1111/j.1360-0443.2011.03576.x
11.Bowdle AT, Radant AD, Cowley DS, et al. Psychedelic effects of ketamine in healthy volunteers: relationship to steady-state plasma concentrations. Anesthesiology. 1998;88(1):82-88. doi:10.1097/00000542-199801000-00015
12.Schwenk ES, Viscusi ER, Buvanendran A, et al. Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018;43(5):1-13. doi:10.1097/AAP.0000000000000806
13.Shimonovich S, Sagi R, Shavit I, et al. Intranasal ketamine for acute traumatic pain in the emergency department: a prospective, randomized clinical trial of efficacy and safety. BMC Emerg Med. 2016;16(1):43. doi:10.1186/s12873-016-0107-0
14.Morgan MM, Crane CS, Pons PT, et al. Ketamine use in prehospital and hospital treatment of the acute trauma patient: a joint position statement. Prehosp Emerg Care. 2021;25(4):588-592. doi:10.1080/10903127.2020.1801920
15.Melcer T, Seim NB, Stalnaker KA, et al. Is prehospital ketamine associated with a change in the prognosis of PTSD? Mil Med. 2023;188(7–8):e2165-e2174. doi:10.1093/milmed/usac014
16.Duek O, Kelmendi B, Pietrzak RH, Harpaz-Rotem I. Modulating amygdala activation to traumatic memories with a single ketamine infusion. PsyArXiv. Published July 9, 2021. doi:10.1101/2021.07.07.21260166
17.Hetem LAB, Danion J, Diemunsch P, Brandt C. Effect of a subanesthetic dose of ketamine on memory and conscious awareness in healthy volunteers. Psychopharmacology (Berl). 2000;152(3):283-288. doi:10.1007/s002130000511
18.Melcer T, Walker GJ, Dye JL, et al. Is prehospital ketamine associated with a change in the prognosis of PTSD? Mil Med. 2023;188(7-8):e2165-e2174. doi:10.1093/milmed/usac014
19.Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743-800.
20.Treede RD, Rief W, Barke A, et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003-1007. doi:10.1097/j.pain.0000000000000160
21.Cohen SP, Bhatia A, Buvanendran A, et al. Consensus guidelines on the use of intravenous ketamine infusions for chronic pain from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018;43(5):521-546.
22.Hocking G, Cousins MJ. Ketamine in chronic pain management: an evidence-based review. Anesth Analg. 2003;97(6):1730-1739. doi:10.1213/01.ANE.0000086618.28845.9B
23.Cohen SP, Mao J. Neuropathic pain: mechanisms and their clinical implications. BMJ. 2014;348:f7656. doi:10.1136/bmj.f7656
24.Guimarães Pereira JE, Ferreira Gomes Pereira L, Mercante Linhares R, et al. Efficacy and safety of ketamine in the treatment of neuropathic pain: a systematic review and meta-analysis of randomized controlled trials. J Pain Res. 2022;15:1011-1037. doi:10.2147/JPR.S358070
25.Bruehl S, Warner DS. An update on the pathophysiology of complex regional pain syndrome. Anesthesiology. 2010;113(3):713-725.
26.Alabdaly HM, Alramadhan SAH, Almutairi AJF, et al. Overview on complex regional pain syndrome: a review. J Pharm Res Int. 2021;33(51A):257-265. doi:10.9734/jpri/2021/v33i51a33491
27.Brook P, Connell J, Pickering T. Oxford Handbook of Pain Management. Oxford: Oxford University Press; 2011.
28.de Mos M, de Bruijn AG, Huygen FJ, et al. The incidence of complex regional pain syndrome: a population-based study. Pain. 2007;129(1-2):12-20.
29.Sigtermans M, Noppers I, Sarton E, et al. An observational study on the effect of s(+)-ketamine on chronic pain versus experimental acute pain in complex regional pain syndrome type 1 patients. Eur J Pain. 2010;14(3):302-307. doi:10.1016/j.ejpain.2009.05.012
30.Patil S, Anițescu M. Efficacy of outpatient ketamine infusions in refractory chronic pain syndromes: a 5-year retrospective analysis. Pain Med. 2012;13(2):263-269. doi:10.1111/j.1526-4637.2011.01241.x
31.Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-1555. doi:10.1001/jama.2014.3266
32.Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38(1):19-28. doi:10.1002/art.1780380104
33.Siracusa R, Di Paola R, Cuzzocrea S, Impellizzeri D. Fibromyalgia: pathogenesis, mechanisms, diagnosis and treatment options update. Int J Mol Sci. 2021;22(8):3891. doi:10.3390/ijms22083891
34.Wolfe F, Clauw DJ, Fitzcharles MA, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol. 2011;38(6):1113-1122. doi:10.3899/jrheum.100594
35.Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-610. doi:10.1002/acr.20140
36.O’Brien AT, Deitos A, Trinanes Pego Y, Fregni F, Carrillo-de-la-Peña MT. Defective endogenous pain modulation in fibromyalgia: a meta-analysis of temporal summation and conditioned pain modulation paradigms. J Pain. 2018;19(8):819-836.
37.Graven-Nielsen T, Kendall SA, Henriksson KG, et al. Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients. Pain. 2000;85(3):483-491. doi:10.1016/S0304-3959(99)00308-5
38.Moore RA, Wiffen PJ, Derry S, Toelle T, Rice AS. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014;(4):CD007938. doi:10.1002/14651858.CD007938.pub3
39.Cording M, Derry S, Phillips T, Moore RA, Wiffen PJ. Milnacipran for pain in fibromyalgia in adults. Cochrane Database Syst Rev. 2015;(10):CD008244. doi:10.1002/14651858.CD008244.pub3
40.Gaskell H, Moore RA, Derry S, Stannard C. Oxycodone for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014;(6):CD010692. doi:10.1002/14651858.CD010692.pub2
41.Pastrak M, Abd-Elsayed A, Ma F, Vrooman B, Visnjevac O. Systematic review of the use of intravenous ketamine for fibromyalgia. Ochsner J. 2021;21(4):387-394. doi:10.31486/toj.21.0038
42.Gupta R, Bhar S. Maintenance IV ketamine therapy in the fibromyalgia patient: a case report. Health Psychol Res. 2023;11:89640. doi:10.52965/001c.89640
43.Noppers I, Niesters M, Swartjes M, et al. Absence of long-term analgesic effect from a short-term S-ketamine infusion on fibromyalgia pain: a randomized, prospective, double blind, active placebo-controlled trial. Eur J Pain. 2011;15(9):942-949. doi:10.1016/j.ejpain.2011.03.008
44.Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet. 2010;376(9757):2018-2031. doi:10.1016/S0140-6736(10)61029-X
45.Elendu C, Amaechi DC, Alakwe-Ojimba CE, et al. Understanding sickle cell disease: causes, symptoms, and treatment options. Medicine (Baltimore). 2023;102(38):e35237. doi:10.1097/MD.0000000000035237
46.Brandow AM, Liem RI. Advances in the diagnosis and treatment of sickle cell disease. J Hematol Oncol. 2022;15(1):20. doi:10.1186/s13045-022-01237-z
47.Darbari DS, Sheehan VA, Ballas SK. The vaso-occlusive pain crisis in sickle cell disease: definition, pathophysiology, and management. Eur J Haematol. 2020;105(3):237-246. doi:10.1111/ejh.13430
48.Rollé A, Vidal E, Laguette P, et al. Pain control for sickle cell crisis, a novel approach? A retrospective study. Medicina (Kaunas). 2023;59(12):2196. doi:10.3390/medicina59122196
49.Bawany MH, Motov S. Subdissociative-dose ketamine for sickle cell vaso-occlusive crisis: a narrative review for the emergency physician. Clin Exp Emerg Med. 2022;9(3):169-175. doi:10.15441/ceem.22.326
50.Neri C, Pestieau S, Young H, Elmi A, Finkel J, Darbari D. Low-dose ketamine for children and adolescents with acute sickle cell disease related pain: a single center experience. J Anesth Clin Res. 2014;5(3). doi:10.4172/2155-6148.1000394
51.Krauss BS, Calligaris L, Green SM, Barbi E. Current concepts in management of pain in children in the emergency department. Lancet. 2016;387(10013):83-92. doi:10.1016/S0140-6736(14)61686-X
52.Del Pizzo J, Callahan JM. Intranasal medications in pediatric emergency medicine. Pediatr Emerg Care. 2014;30(7):496-501; quiz 502-4. doi:10.1097/PEC.0000000000000171
53.Murphy A, O’Sullivan R, Wakai A, et al. Intranasal fentanyl for the management of acute pain in children. Cochrane Database Syst Rev. 2014;(10):CD009942. doi:10.1002/14651858.CD009942.pub2
54.Oliveira JESL, Lee JY, Bellolio F, Homme JL, Anderson JL. Intranasal ketamine for acute pain management in children: a systematic review and meta-analysis. Am J Emerg Med. 2020;38(9):1860-1866. doi:10.1016/j.ajem.2020.05.094
55.Asadi H, Nikooseresht M, Noori L, Behnoud F. The effect of administration of ketamine and paracetamol versus paracetamol singly on postoperative pain, nausea and vomiting after pediatric adenotonsillectomy. Anesthesiol Pain Med. 2016;6(1). doi:10.5812/aapm.31210
56.Sheehy KA, Lippold C, Rice AL, Nobrega R, Finkel JC, Quezado ZMN. Subanesthetic ketamine for pain management in hospitalized children, adolescents, and young adults: a single-center cohort study. J Pain Res. 2017;10:787-795. doi:10.2147/jpr.s131156
57.Reynolds S, Bryant K, Studnek JR, et al. Randomized controlled feasibility trial of intranasal ketamine compared to intranasal fentanyl for analgesia in children with suspected extremity fractures. Acad Emerg Med. 2017;24(12):1430-1440. doi:10.1111/acem.13313
58.Rhodes AJ, Fagan MJ, Motov S, Zerzan J. Nebulized ketamine for managing acute pain in the pediatric emergency department. Turk J Emerg Med. 2021;21(2):75-78. doi:10.4103/2452-2473.313334
59.White MC, Shah N, Lindley K, Lloyd-Thomas A, Thomas M. Pain management in fulminating ulcerative colitis. Pediatr Anesth. 2006;16(11):1148-1152. doi:10.1111/j.1460-9592.2006.01913.x
60.Correll GE, Maleki J, Gracely EJ, Muir JJ, Harbut RE. Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome. Pain Med. 2004;5(3):263-275. doi:10.1111/j.1526-4637.2004.04043.x
61.Al‐Aown A, Fligou F, Kallidonis P, et al. Deep sedation in GreenLight laser prostatectomy. Urol Ann. 2016;8(2):203. doi:10.4103/0974-7796.177195
62.Liester M, Wilkenson R, Patterson B, Liang B. Very low-dose sublingual ketamine for borderline personality disorder and treatment-resistant depression. Cureus. 2024. doi:10.7759/cureus.57654
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Katarzyna Nowicka, Wiktor Klimek, Marta Ignatiuk-Chilkiewicz, Monika Olszańska, Dominika Hakało, Joanna Kałuska, Tomasz Suprun, Aleksandra Sokół, Klaudia Mościszko, Maria Majewska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 264
Number of citations: 0
