INTRODUCTION: Of the 11.9 million Americans living with cancer, 44% experience cancer-related pain. High-dose opioids remain the mainstay of treatment but often reduce quality-of-life (QoL) due to side effect burden, and 40% of patients do not achieve adequate analgesia. Intranasal ketamine offers analgesia without the dose-limiting gastrointestinal or respiratory effects of opioids. It's intranasal formulation allows easier self-administration. This case series highlights the adverse effects of self-administered intranasal ketamine.
OBJECTIVES: Describe the impact of self-administered intranasal racemic ketamine on adverse effects, pain intensity, and perceived QoL in patients with cancer-related pain.
METHODS: Three patients followed by palliative care and pain medicine services at a tertiary academic center were prescribed intranasal racemic ketamine. Pain scores, opioid consumption (oral morphine equivalents (OME), and adverse effect burden were summarized from clinical encounters.
RESULTS: All three patients reported analgesic benefit, including reductions in OME up to 90%. Despite this, each patient developed adverse effects: fatigue, cognitive slowing, and dissociation warranting termination of therapy. Treatment duration ranged from 1 to 8 months with dosing from 50 mg TID to 100 mg QID.
CONCLUSION: Intranasal ketamine may reduce opioid requirements in cancer-related pain, but adverse effects can limit tolerability. Future research should identify high-risk patients and develop risk mitigation strategies.
