{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Low Dose Ketamine for Pain","description":"Ketamine clinics have exploded worldwide, offering low-dose intravenous infusions for chronic pain patients who've run out of options. But is this practice actually backed by evidence, or has off-label use outpaced the science? In this episode of the PainExam Podcast, Dr. David Rosenblum reviews the current literature on subanaesthetic-dose ketamine infusions (SDKIs) for chronic pain, drawing on the 2023 British Journal of Pain review by Harry M. Griffiths, "Low-dose ketamine infusions for chronic pain management: Does this qualify as evidence-based practice?" Topics covered: Why conventional analgesics (opioids, anticonvulsants, antidepressants) fail in 60\u201370% of chronic pain patients How ketamine works as an NMDA receptor antagonist, and why that mechanism is likely an oversimplification Typical SDKI dosing (~0.35\u20130.5 mg\/kg) versus anesthetic dosing, and why the IV route dominates the evidence base What the meta-analyses actually show: modest, time-limited pain reduction (mean difference around -1.83 on a 0\u201310 scale) with higher efficacy but more side effects at higher doses Key trials \u2014 Corriger et al.'s 1-year follow-up (256 patients), Orhurhu et al.'s systematic review and meta-analysis, and smaller RCTs in CRPS, fibromyalgia, and ischemic limb pain Common side effects (nausea, psychomimetic symptoms) versus rare but serious adverse events (hepatic, cardiac, urogenital) \u2014 and how dose and premedication with clonidine\/midazolam affect risk Why blinding failure (up to 93% of patients correctly guessing their treatment in one trial) may be inflating reported effect sizes The absence of standardized protocols, guidelines, or a clear "exit strategy" for patients on long-term SDKI therapy What needs to happen next: larger multicenter RCTs, ketamine clinic registries, and better outcome measures beyond simple pain scores Bottom line: SDKIs offer a promising but still under-evidenced option for refractory chronic pain \u2014 reserved for the right patient, with modest expectations and careful monitoring. Reference: Griffiths HM. Low-dose ketamine infusions for chronic pain management: Does this qualify as evidence-based practice? Br J Pain. 2023;17(5). https:\/\/journals.sagepub.com\/doi\/full\/10.1177\/20494637231182804 Show Image About the Host David Rosenblum, MD is Director of Pain Management at Maimonides Medical Center and Co-Owner\/Clinic Director of AABP Integrative Pain Care and Wellness in Brooklyn, NY. Dual board-certified in Anesthesiology and Pain Medicine, he is a co-author of the ASIPP Peripheral Nerve Stimulation (PNS) guidelines and a widely recognized educator in regenerative pain medicine (PRP, BMAC, amniotic therapies). As founder of NRAP Academy, he has trained 3,500+ physicians for pain board certification since 2008, and hosts the PainExam, AnesthesiaExam, and PMRExam podcasts. He has been named a New York Magazine "Top Doctor" from 2016\u20132026. Living with chronic pain? Dr. Rosenblum sees patients for interventional and regenerative pain treatment \u2014 including epidurals, nerve blocks, spinal cord & peripheral nerve stimulation, and PRP\/BMAC \u2014 at his Brooklyn, NY office. Visit RosenblumPain.com for more information. For Physicians & APPs \u2014 Continue Your Education: CME Course Calendar: https:\/\/www.nrappain.org\/pages\/upcoming-pain-management-conferences Virtual Pain Fellowship: https:\/\/www.nrappain.org\/bundles\/Virtual-Pain-Fellowship PainExam Board Prep: https:\/\/www.nrappain.org\/pages\/pain-management-cme-cou\u00e5\u00e7rses This episode is brought to you by NRAP Academy and PainExam \u2014 visit www.NRAPpain.org for CME in neuromodulation, regional anesthesia, and pain medicine. ","author_name":"The PMRExam Podcast","author_url":"http:\/\/pmrexampodcast.libsyn.com\/podcast","html":"