Ketamine: The Key to Postoperative Pain Relief?

Highlights:

Central sensitization can lead to prolonged healing and persistent pain after surgery
A standardized pain test called TSP can be used to assess the degree of central sensitization in patients before surgery
Ketamine may be more effective in reducing pain after surgery in patients with a higher TSP score

Ketamine may be more effective in avoiding postoperative pain in a subset of individuals who have a higher proclivity for central sensitization as indicated by TSP (temporal summation of pain), revealed a new study. In a small group of patients with a higher TSP score before surgery, those given ketamine reported less pain after surgery than those given a placebo.

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‘New study finds ketamine may offer more effective pain relief after surgery for patients with higher TSP scores indicating central sensitization. #PainManagement #Ketamine #CentralSensitization’

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Central Sensitization and Postoperative Pain

Central sensitization (CS), a hypersensitivity to non-painful stimuli caused by heightened nervous system reactivity, may occur in some patients after surgery, prolonging healing and leading to persistent pain. A quick standardized pain test is routinely used to assess the degree of CS in patients before surgery. This test can be done before surgery to assess how a patient reacts to a painful stimulus that is repeated over time. This response, known as a temporal summation of pain (TSP), differs amongst patients, with a larger TSP being associated with severe pain following surgery.

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Ketamine and Central Sensitization

Ketamine, which is commonly used to relieve pain during surgery, can inhibit receptors that induce central sensitization. The study looked at whether ketamine reduced pain in women after breast surgery and whether it was more beneficial in those having a stronger inclination towards CS, as evaluated by a high TSP.

Women in this study were tested for their tendency towards central centralization using mechanical pinprick stimuli before surgery at Brigham and Women's Hospital, Harvard Medical School in Boston, MA, and were given a TSP score. During surgery, patients were given either ketamine or a placebo. Women reported their pain severity two weeks after surgery using a standardised Brief Pain Inventory questionnaire. Furthermore, the researchers investigated if the patients' TSP score before surgery altered the efficacy of ketamine in lowering pain after surgery.

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Implications for Pain Management with Ketamine

Overall, there was no difference in discomfort after surgery between women who received ketamine and those who received a placebo. However, in the smaller group of women who had a higher TSP score before surgery, those who got ketamine reported less pain after surgery than those who received a placebo. In contrast, there was no change in pain between women who received ketamine and those who received a placebo when they had a lower TSP score. “We hope this research will promote the personalization of pain treatments,” said investigator Sheila R. Gokul, lead author of the abstract “RCT of Ketamine in Mastectomy: Differential Analgesic Efficacy Based on a QST-Based Measure of Preoperative Central Sensitization.”

Source-Medindia

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