THE off-label use of ketamine to treat chronic pain is not supported by scientific evidence, a new Cochrane review led by UNSW researchers has found.
The anaesthetic, which is commonly used to sedate people for medical procedures and for short-term pain relief, is also frequently prescribed off-label to manage chronic pain conditions, such as nerve pain, fibromyalgia and complex regional pain syndrome.
The team looked at 67 trials of therapeutics in the same class - ketamine, memantine, dextromethorphan, amantadine and magnesium.
The studies involved more than 2,300 participants with a range of chronic pain conditions, and compared the drugs to placebo or other medicines.
The results showed no clear evidence of benefit for ketamine in chronic pain and identified an increased risk of adverse effects such as delusions, delirium, paranoia, nausea and vomiting.
Studies tended to be small and of poor quality.
"We want to be clear - we're not saying ketamine is ineffective, but there's a lot of uncertainty," said first author Michael Ferraro, a doctoral candidate at UNSW and NeuRA.
"The data could point to a benefit or no effect at all - right now, we just don't know."
The review also found that none of the studies reported on whether ketamine reduced depressive symptoms or opioid use - even though it is often proposed for patients with depressive symptoms or opioid tolerance.
The review highlighted the urgent need for high-quality trials to understand whether ketamine has a role in treatment of chronic pain.
Read the paper HERE. KB
The above article was sent to subscribers in Pharmacy Daily's issue from 21 Aug 25
To see the full newsletter, see the embedded issue below or CLICK HERE to download Pharmacy Daily from 21 Aug 25
