Ontology highlight
ABSTRACT: Purpose
Intravenous ketamine is often prescribed in severe neuropathic pain. Oral N-methyl-D-aspartate receptor (NMDAR) antagonists might prolong pain relief, reducing the frequency of ketamine infusions and hospital admissions. This clinical trial aimed at assessing whether oral dextromethorphan or memantine might prolong pain relief after intravenous ketamine.Patients and methods
A multicenter randomized controlled clinical trial included 60 patients after ketamine infusion for refractory neuropathic pain. Dextromethorphan (90 mg/day), memantine (20 mg/day) or placebo was given for 12 weeks (n=20 each) after ketamine infusion. The primary endpoint was pain intensity at one month. Secondary endpoints included pain, sleep, anxiety, depression, cognitive function and quality of life evaluations up to 12 weeks.Results
At 1 month, dextromethorphan maintained ketamine pain relief (Numeric Pain Scale: 4.01±1.87 to 4.05±2.61, p=0.53) and diminished pain paroxysms (p=0.03) while pain intensity increased significantly with memantine and placebo (p=0.04). At 3 months, pain remained lower than at inclusion (p=0.001) and was not significantly different in the three groups. Significant benefits were observed on cognitive-affective domains and quality of life for dextromethorphan and memantine (p<0.05).Conclusions
Oral dextromethorphan given after ketamine infusion extends pain relief during one month and could help patients to better cope with pain. Future studies should include larger populations stratified on pharmacogenetics screening. Optimization of an oral drug that could extend ketamine antihyperalgesia, with fewer hospital admissions, remains a prime challenge in refractory neuropathic pain.
SUBMITTER: Martin E
PROVIDER: S-EPMC6683947 | biostudies-literature | 2019
REPOSITORIES: biostudies-literature
Martin Elodie E Sorel Marc M Morel Véronique V Marcaillou Fabienne F Picard Pascale P Delage Noémie N Tiberghien Florence F Crosmary Marie-Christine MC Najjar Mitra M Colamarino Renato R Créach Christelle C Lietar Béatrice B Brumauld de Montgazon Géraldine G Margot-Duclot Anne A Loriot Marie-Anne MA Narjoz Céline C Lambert Céline C Pereira Bruno B Pickering Gisèle G
Drug design, development and therapy 20190802
<h4>Purpose</h4>Intravenous ketamine is often prescribed in severe neuropathic pain. Oral <i>N</i>-methyl-D-aspartate receptor (NMDAR) antagonists might prolong pain relief, reducing the frequency of ketamine infusions and hospital admissions. This clinical trial aimed at assessing whether oral dextromethorphan or memantine might prolong pain relief after intravenous ketamine.<h4>Patients and methods</h4>A multicenter randomized controlled clinical trial included 60 patients after ketamine infus ...[more]