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lüll Ketamine: an introduction for the pain and palliative medicine physician Okon TPain Physician 2007[May]; 10 (3): 493-500A history of an escalating chronic intractable pain in a patient with cryoglobulinemia, vasculitis, and severe cutaneous ulcerations is presented. A strategy of progressive, multi-agent, N-methyl-D-aspartate-receptor (NMDA-R) blockade that resulted in adequate pain control and a three-fold reduction in opioid consumption is described. Diagnostic process of neuropathic pain and the role of NMDA-R in the development of hyperalgesia are briefly reviewed. Thereafter, existing clinical literature describing the use of Ketamine, a major NMDA-R antagonist for management of malignant pain, is reviewed. Lastly, evidence-based original protocol for intravenous adjuvant Ketamine analgesia for severe cancer pain is presented.|Adult[MESH]|Amines/therapeutic use[MESH]|Analgesics, Opioid/therapeutic use[MESH]|Analgesics/*administration & dosage[MESH]|Central Nervous System/*drug effects/physiopathology[MESH]|Cryoglobulinemia/complications[MESH]|Cyclohexanecarboxylic Acids/therapeutic use[MESH]|Drug Therapy, Combination[MESH]|Excitatory Amino Acid Antagonists/*administration & dosage[MESH]|Female[MESH]|Gabapentin[MESH]|Hepatitis C/complications/surgery[MESH]|Humans[MESH]|Ketamine/*administration & dosage[MESH]|Methadone/therapeutic use[MESH]|Methylphenidate/therapeutic use[MESH]|Oxycodone/therapeutic use[MESH]|Pain, Intractable/*drug therapy/etiology/physiopathology[MESH]|Receptors, N-Methyl-D-Aspartate/*antagonists & inhibitors/metabolism[MESH]|Treatment Outcome[MESH]|Ulcer/complications[MESH]|Vasculitis/complications[MESH]|gamma-Aminobutyric Acid/therapeutic use[MESH] |