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PainExam PodcastAuthor: David Rosenblum, MD
David Rosenblum, MD, creator of PainExam.com and Director of Pain Management at New York Based, AABP Pain Management discusses Pain Board Review and issues relevant to pain physicians. Marketing, practice management and Board Prep are discussed. For more information and CME Credit's go to PainExam.com Also, be sure to check out Dr. Rosenblum's children's book: Welwyn Ardsley and the Cosmic Ninjas: Preparing your child and yourself for anesthesia and surgery. Available at Amazon.com and www.MyKidsSurgery.com Language: en Genres: Courses, Education, Health & Fitness, Medicine Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Low Dose Ketamine for Chronic Pain: What is the Evidence?
Wednesday, 5 August, 2026
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, 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 60-70% of chronic pain patients - How ketamine works as an NMDA receptor antagonist, and why that mechanism is likely an oversimplification - Typical SDKI dosing (~0.35-0.5 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 with higher efficacy but more side effects at higher doses - Key trials, including Corriger et al.'s 1-year follow-up (256 patients) and Orhurhu et al.'s systematic review and meta-analysis - Common side effects (nausea, psychomimetic symptoms) versus rare but serious adverse events, and how premedication with clonidine/midazolam affects risk - Why blinding failure may be inflating reported effect sizes - The absence of standardized protocols, guidelines, or a clear "exit strategy" for long-term SDKI therapy Bottom line: SDKIs offer a promising but still under-evidenced option for refractory chronic pain, 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 This episode is brought to you by NRAP Academy and PainExam - visit www.NRAPpain.org for CME in neuromodulation, regional anesthesia, and pain medicine.
