Four years' treatment with ketamine and a trial of dextromethorphan in a patient with severe post-herpetic neuralgia.

Abstract

N-methyl-D-aspartate (NMDA) receptors are involved in the development of neuropathic pain. Ketamine, a non-competitive NMDA receptor antagonist, has in several case reports given pain relief but efficacy in dosages tolerated in long-term ketamine treatment is unknown. Another substance with an antagonist action at NMDA receptors and which is approved for peroral administration is dextromethorphan. In a randomized study dextromethorphan was no better than placebo for neuropathic pain but this does not exclude efficacy in selected patients. We report a patient with severe post-herpetic pain resistant to conventional pain treatment which was treated with ketamine for 4 years with good pain relief. The practical application of long-term treatment in different administration forms of ketamine is described. The patient also responded with pain relief in a double-blind trial with oral dextromethorphan.

• Authors: P Klepstad, P C Borchgrevink
• Journal: Acta anaesthesiologica Scandinavica (Acta Anaesthesiol Scand) Vol. 41 Issue 3 Pg. 422-6 (Mar 1997) ISSN: 0001-5172 [Print] England
• PMID: 9113190 (Publication Type: Case Reports, Journal Article)

Chemical References

• Excitatory Amino Acid Antagonists
• Receptors, N-Methyl-D-Aspartate
• Ketamine
• Dextromethorphan

Topics

• Aged
• Dextromethorphan (administration & dosage)
• Excitatory Amino Acid Antagonists (administration & dosage, adverse effects)
• Herpes Zoster (complications)
• Humans
• Ketamine (administration & dosage, adverse effects)
• Male
• Neuralgia (drug therapy, etiology)
• Pain Measurement
• Receptors, N-Methyl-D-Aspartate (antagonists & inhibitors)
• Time Factors