Ketamine Use for Cancer and Chronic Pain Management

Ketamine, an N-methyl-D-aspartate receptor antagonist, is widely known as a dissociative anesthetic and phencyclidine derivative. Due to an undesirable adverse event profile when used as an anesthetic it had widely fallen out of human use in favor of more modern agents. However, it has recently been explored for several other indications such as treatment resistant depression and chronic pain. Several recent studies and case reports compiled here show that ketamine is an effective analgesic in chronic pain conditions including cancer-related neuropathic pain. Of special interest is ketamine’s opioid sparing ability by counteracting the central nervous system sensitization seen in opioid induced hyperalgesia. Furthermore, at the sub-anesthetic concentrations used for analgesia ketamine’s safety and adverse event profiles are much improved. In this article, we review both the basic science and clinical evidence regarding ketamine’s utility in chronic pain conditions as well as potential adverse events.

Influence of Gender on pain: In Temporomandibular Disorders

<p><span style="font-size: medium;">Most patients with TMD disorders will respond to non-operative therapy involving; control of parafunctional behaviors, exercises to restore good jaw function, and use of analgesics and muscle relaxers during episodes of acute pain and dysfunction. But up to 20% of TMD patients will not respond to these conventional treatments and multiple factors influenced by gender can be responsible for this poor response.</span><span style="font-size: medium;">Prolonged nociception in such patients can lead to the peripheral and central nervous system sensitization, as evidenced by low pain thresholds and temporal summation, routinely encountered in patients with chronic TMD symptoms, but also female patients in general. Tailoring treatment to address these gender –based contributing factors is the challenge that providers must meet for successful management of chronic TMD patients. This chapter evaluates</span><span style="font-family: 'Arial','sans-serif';"><span style="font-size: medium;"> gender as an initiating, predisposing, or perpetuating factor for TMD via the role of sex hormones, muscle activity and parafunctional behaviors, pain perception, and genetics.</span></span></p><p> </p><br clear="all" /><p><span style="font-size: medium;"> </span></p>