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The Role of Ketamine in Hospice and Palliative Care

Updated: Nov 19, 2023

elderly man and woman holding hands

Hospice and palliative care aim to provide comfort, relief, and emotional support to patients with life-limiting illnesses and their families. In recent years, healthcare professionals have been exploring innovative approaches to enhance the quality of life for patients in these settings. One such approach that has gained attention is the use of ketamine, traditionally known as an anesthetic but increasingly recognized for its potential in managing pain and distress in hospice and palliative care. Here we will explore the role of ketamine in these care settings.

Understanding Ketamine

Ketamine is a dissociative anesthetic that has been used in medical practice for multiple decades. It is well-known for its ability to induce a trance-like state of consciousness, providing pain relief and sedation. In hospice and palliative care, ketamine is administered in lower doses compared to surgical settings, with the aim of alleviating various distressing symptoms without causing complete sedation. Ketamine inhibits the excitatory effects of glutamate and aspartate by entering and blocking the open channel at the phencyclidine site.

The Role of Ketamine in Hospice and Palliative Care

1. Pain Management

One of the primary reasons ketamine is being explored in hospice and palliative care is its effectiveness in managing pain. It is particularly useful for patients who have developed opioid tolerance or are experiencing neuropathic pain. Ketamine's mechanism of action differs from opioids, making it a valuable adjunct to conventional pain management strategies. It can be administered as an intravenous infusion or other forms tailored to the patient's needs. Some other forms of administration include oral, nasal, intramuscular (IM), and topical as a gel. Oral rinse has also been described to treat mucositis. Research has shown efficacy and safety for the use of ketamine in a population of patients with refractory cancer pain.

2. Management of Depression and Anxiety

Patients in hospice and palliative care often experience severe emotional distress, including depression and anxiety. Ketamine has shown promise in rapidly alleviating these symptoms. It is believed to work by promoting the growth of new neural connections and enhancing mood regulation. This makes it a valuable tool for addressing the emotional suffering that can accompany end-of-life care.

3. Reduced Opioid Use

By supplementing or even reducing the need for opioids, ketamine can help mitigate the side effects and complications associated with prolonged opioid use, such as constipation, respiratory depression, and sedation. This approach minimizes the risk of opioid-related complications while still providing adequate pain relief. When opioid therapy is not sufficient to improve quality of life within hospice environment, clinicians may consider ketamine for adjunctive therapy.

Challenges and Considerations

While ketamine has shown great promise in hospice and palliative care, it is not without its challenges. Healthcare professionals must carefully monitor and adjust the dosage to decrease risk of hallucinations and other side effects. Patient selection and evaluation are crucial to ensure the appropriate candidates receive this treatment.

Additionally, ketamine may not be suitable for all patients due to their medical history, allergies, or potential interactions with other medications. The use of ketamine in hospice and palliative care requires a multidisciplinary approach involving physicians, nurses, and pharmacists, and clear communication with the patient and their family.

Ketamine is emerging as a valuable tool in hospice and palliative care for pain management, mood regulation, and symptom control. Its unique mechanism of action and potential to reduce opioid use make it a promising addition to the comprehensive care provided in these settings. However, its use should be carefully considered and closely monitored by a healthcare team, and discussions with patients and their families are essential to make informed decisions regarding ketamine therapy. As research in this field continues, ketamine may become an even more vital component of compassionate end-of-life care.

Further reading/references:

Cheung, Ka Wai Alice, Po Chung Chan, and Sing Hung Lo. "The use of ketamine in the management of refractory cancer pain in a palliative care unit." Ann Palliat Med 9.6 (2020): 4478-89.

Goldman N, Frankenthaler M, Klepacz L. The Efficacy of Ketamine in the Palliative Care Setting: A Comprehensive Review of the Literature. J Palliat Med. 2019 Sep;22(9):1154-1161. doi: 10.1089/jpm.2018.0627. Epub 2019 May 15. PMID: 31090477.

Legge J, Ball N, Elliott DP. The potential role of ketamine in hospice analgesia: a literature review. Consult Pharm. 2006 Jan;21(1):51-7. doi: 10.4140/tcp.n.2006.51. PMID: 16524352.

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