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Low-dose ketamine adjuvant treatment for refractory pain in children, adolescents and young adults with cancer: a pilot study
  1. Magali Courade1,
  2. Amandine Bertrand2,
  3. Lea Guerrini-Rousseau3,
  4. Anne Pagnier4,
  5. Dominique Levy5,
  6. Cyril Lervat6,
  7. Nadine Cojean7,
  8. Alice Ribrault8,
  9. Sophie Dugue9,
  10. Sandrine Thouvenin10,
  11. Christophe Piguet11,
  12. Claudine Schmitt12 and
  13. Perrine Marec-Berard1
  1. 1Unité de Traitement de la Douleur de l' Enfant, Centre Leon Berard, Lyon, France
  2. 2Pediatric Home Care Unit, Centre Leon Berard, Lyon, France
  3. 3Oncologie pédiatrique, Gustave Roussy, Villejuif, France
  4. 4Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
  5. 5Oncologie pédiatrique, Institut Curie, Paris, France
  6. 6Oncologie pédiatrique, Centre Oscar Lambret, Lille, France
  7. 7CHU de Strasbourg, Strasbourg, France
  8. 8Hopital Lapeyronie, Montpellier, France
  9. 9Oncologie pédiatrique, Hopital Universitaire Robert-Debre, Paris, France
  10. 10Oncologie pédiatrique, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
  11. 11Oncologie pédiatrique, CG+HU Limoges, Limoges, France
  12. 12Hématologie Oncologie et Centre de la Douleur pédiatrique, Centre Hospitalier Universitaire de Nancy, Nancy, France
  1. Correspondence to Dr Perrine Marec-Berard, Unité de Traitement de la Douleur de l' Enfant, Centre Leon Berard, Lyon 69373, France; perrine.marec-berard{at}ihope.fr

Abstract

Objectives Ketamine, an N-methyl-D-aspartate receptor antagonist, is effective at relieving adult cancer pain, although there have been very few reports to date regarding its use in children and in adolescents and young adults (AYA). This study assessed the efficacy, safety and opioid-sparing effects of low doses of ketamine added to opioid analgesics to alleviate persistent cancer pain.

Methods This prospective, multicentre, observational trial collected data regarding demographics, pain characteristics, pain score assessment within the first 48 hours of ketamine administration, tolerance and satisfaction from 38 patients aged 2–24 years prescribed with ketamine as an adjuvant antalgic for refractory cancer pain in 10 French paediatric oncology centres.

Results The mean visual analogue scale pain score decreased from 6.7 to 4.3 out of 10 (n=39, p<0.001) from day 1 to day 3 and by at least 2 points in 56% of the patients (n=22) 48 hours after initiation of ketamine. Nine patients experienced poor tolerance (≥2 side effects), all with infusion rates lower than 0.05 mg/kg/hour. None had limiting toxicities. An opioid-sparing effect was highlighted in four patients. Fifty-four per cent of the prescribers and 47% of the patients found the addition of ketamine ‘very helpful’.

Conclusions Low doses of ketamine as an adjuvant to opioids significantly reduced the intensity of pain in half of the study population. A tendency towards better pain control is shown, although a lack of statistical power somewhat limits our conclusions, especially in children. Nevertheless, ketamine may be a useful option for improving the treatment of refractory pain in children and AYA with cancer.

  • cancer
  • children, adolescents and young adults
  • ketamine
  • opioid analgesics
  • pain control
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Footnotes

  • Contributors LG-R, AP, DL, CL, NC, AR, SD, ST, CP and CS: patient inclusions; AB: statistical analysis; MC and PMB: planning, realisation and writing of the study.

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval Our study received ethics approval from the investigational review board, Comité Consultatif sur le Traitement de l’Information en Matière de Recherche (case number 14.655 bis) and from the Comité National de l’Informatique et des Libertés (case number MMS/CWR/AR156082). All of the procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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

  • Data availability statement Data are available on reasonable request.

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