Zaki Christopher
Department of Anesthesiology, Division of Chronic Pain Management, University of Arizona College of Medicine Tucson, Tucson, AZ 85724, USA.
J Integr Neurosci. 2025 Jul 25;24(7):26766. doi: 10.31083/JIN26766.
This review explores ketamine's expanding role in managing both chronic pain and mental health conditions, focusing on its pharmacologic mechanisms, clinical applications, and therapeutic potential. We assess its analgesic properties, FDA-approved application in the form of Spravato (esketamine) for depression, and off-label use for analgesia and psychiatric disorders.
A systematic search of PubMed, Cochrane Library, and Scopus databases identified studies on ketamine's efficacy and safety in chronic pain and psychiatric disorders. The analysis included randomized controlled trials (RCTs), observational studies, and systematic reviews.
Ketamine has demonstrated significant efficacy in managing chronic pain in neuropathic pain, fibromyalgia, and complex regional pain syndrome (CRPS), especially in treatment-resistant cases. Mental health comorbidities are common in chronic pain populations, with up to 50% experiencing depression or anxiety. Ketamine's N-methyl-D-aspartate (NMDA) receptor antagonism not only underlies its analgesic effects but also contributes to rapid antidepressant responses in treatment-resistant depression (TRD) and acute suicidal ideation, as evidenced by its FDA-approved formulation, Spravato (esketamine). Beyond depression, emerging evidence supports ketamine's potential use in anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and certain substance use disorders. However, its psychomimetic effects, safety concerns, and unclear long-term impact warrant careful clinical oversight.
Ketamine presents a versatile therapeutic strategy for managing chronic pain and a wide range of mental health disorders, signifying its potential to bridge the gap in treatment-resistant cases. Ongoing research is needed to optimize dosing strategies, assess long-term safety, and integrate ketamine into multidisciplinary care models. This approach emphasizes personalized patient care and comprehensive monitoring to navigate the complexities of coexisting chronic pain and mental health challenges.
本综述探讨氯胺酮在慢性疼痛和精神健康状况管理中不断扩大的作用，重点关注其药理机制、临床应用和治疗潜力。我们评估其镇痛特性、美国食品药品监督管理局（FDA）批准的以艾氯胺酮（Spravato）形式用于治疗抑郁症的应用，以及其在镇痛和精神疾病方面的非标签用途。
对PubMed、Cochrane图书馆和Scopus数据库进行系统检索，以确定关于氯胺酮在慢性疼痛和精神疾病中的疗效和安全性的研究。分析包括随机对照试验（RCT）、观察性研究和系统评价。
氯胺酮在治疗神经性疼痛、纤维肌痛和复杂性区域疼痛综合征（CRPS）的慢性疼痛方面已显示出显著疗效，尤其是在难治性病例中。慢性疼痛人群中精神健康合并症很常见，高达50%的人患有抑郁症或焦虑症。氯胺酮对N-甲基-D-天冬氨酸（NMDA）受体的拮抗作用不仅是其镇痛作用的基础，也有助于在难治性抑郁症（TRD）和急性自杀意念中产生快速抗抑郁反应，其FDA批准的制剂艾氯胺酮（Spravato，艾氯胺酮）就证明了这一点。除抑郁症外，新出现的证据支持氯胺酮在焦虑症、强迫症（OCD）、创伤后应激障碍（PTSD）和某些物质使用障碍中的潜在用途。然而，其拟精神效应、安全问题以及尚不清楚的长期影响需要谨慎的临床监督。
氯胺酮为管理慢性疼痛和多种精神健康障碍提供了一种通用的治疗策略，表明其在难治性病例中弥合治疗差距的潜力。需要持续的研究来优化给药策略、评估长期安全性，并将氯胺酮纳入多学科护理模式。这种方法强调个性化的患者护理和全面监测，以应对慢性疼痛和精神健康挑战并存的复杂性。
