SynthesisThe Cochrane database of systematic reviews2003
Ketamine as an adjuvant to opioids for cancer pain.
Synthesis in The Cochrane database of systematic reviews, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01326325 (Study of the Efficiency of the Ketamine With Low Analgesic Doses, in Association With High Opioids, in the Treatment of the Rebels Pains, in Palliative Phase of the Cancerous Disease), which is not on this map. Cited by 36 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Study of the Efficiency of the Ketamine With Low Analgesic Doses, in Association With High Opioids, in the Treatment of the Rebels Pains, in Palliative Phase of the Cancerous Disease
Who cites it
36 citing papers in PubMed, 4 syntheses or guidelines pooled it, 84 citations in OpenAlex.
- The role of postoperative ketamine infusion in ERAS protocols following elective open abdominal surgeries, a systematic review and meta-analysis.BMC surgery · 2025Pooled it
- Ketamine and other NMDA receptor antagonists for chronic pain.The Cochrane database of systematic reviews · 2025Pooled it
- Ketamine as an adjuvant to opioids for cancer pain.The Cochrane database of systematic reviews · 2017Pooled it
- Neuromodulators for pain management in rheumatoid arthritis.The Cochrane database of systematic reviews · 2012Pooled it
- Effect of S-ketamine on postoperative pain sensitivity in children with preoperative chemotherapy.Pediatric research · 2026Trial
- Propofol-esketamine versus propofol-fentanyl combinations for sedation in pediatric flexible fiberoptic bronchoscopy: a randomized controlled trial.BMC anesthesiology · 2025Trial
- Estimation of the contribution of norketamine to ketamine-induced acute pain relief and neurocognitive impairment in healthy volunteers.Anesthesiology · 2012Trial
- Ketamine for Depression in Serious Illness: Evidence, Safety, and Practical Approaches.Journal of pain and symptom management · 2026Review
- A Blueprint for Implementing Ketamine-Assisted Psychotherapy in Palliative Care: Design, Process, and Treatment Patterns of a Real-World Clinical Program.Journal of palliative medicine · 2026Article
- Ketamine-From an Anesthetic to a Psychiatric Drug: Mechanisms of Action, Clinical Applications and Potential Risks.Molecules (Basel, Switzerland) · 2025Review
- Neuropathic Pain in Cancer: What Are the Current Guidelines?Current treatment options in oncology · 2024Review
- Ketamine and the neurobiology of depression: Toward next-generation rapid-acting antidepressant treatments.Proceedings of the National Academy of Sciences of the United States of America · 2023Review
- Cancer Pain Management: A Narrative Review of Current Concepts, Strategies, and Techniques.Current oncology (Toronto, Ont.) · 2023Review
- Narrative Review: Low-Dose Ketamine for Pain Management.Journal of clinical medicine · 2023Review
- Article
- The Use of Low-Dose Methadone as Add-On to Ongoing Opioid Treatment in Palliative Cancer Care-An Underrated Treatment?Life (Basel, Switzerland) · 2022Review
- Ketamine Improves Desensitization of µ-Opioid Receptors Induced by Repeated Treatment with Fentanyl but Not with Morphine.Biomolecules · 2022Article
- A Review of Nonanesthetic Uses of Ketamine.Anesthesiology research and practice · 2020Review
- Ketamine Use for Cancer and Chronic Pain Management.Frontiers in pharmacology · 2020Review
- Cancer-Related Neuropathic Pain.Cancers · 2019Review
Corrections and comments
- Updated by
Authors and funding
3 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundKetamine is a commonly used anaesthetic agent, and in subanaesthetic doses is also given as an adjuvant to opioids for the treatment of cancer pain, particularly when opioids alone prove to be ineffective. Ketamine is known to have hallucinogenic side effects. To date no systematic review of the benefits and harms of adjuvant ketamine for cancer pain has been undertaken.
objectivesTo determine the effectiveness and adverse effects of ketamine as an adjuvant to opioids in the treatment of cancer pain. SEARCH STRATEGY: Studies were identified from MEDLINE (1966-2001), EMBASE (1980-2001), CancerLit (1966-2001), the Cochrane Library (Issue 1, 2001); by handsearching reference lists from review articles, trials, and chapters from standard textbooks on pain and palliative care. The manufacturer of ketamine (Pfizer Parke-Davis) provided search results from their in-house database, PARDLARS. SELECTION CRITERIA: RCTs of adult patients with cancer and pain being treated with an opioid, and receiving either ketamine (any dose and any route of administration) or placebo or an active control. DATA COLLECTION AND ANALYSIS: Two independent reviewers identified four RCTs for possible inclusion in the review, and 32 case studies/case series reports. Quality and validity assessment was performed by three independent reviewers, and two RCTs were excluded because of inappropriate study design. Patient reported pain intensity and pain relief was assessed using visual analog scales, verbal rating scales or other validated scales, and adverse effects data were collated. MAIN
resultsTwo trials were eligible for inclusion in the review and both concluded that ketamine improves the effectiveness of morphine in the treatment of cancer pain. However, pooling of the data was not appropriate because of the small total number of patients (30), and the presence of clinical heterogeneity. Some patients experienced hallucinations on both ketamine plus morphine and morphine alone and were treated successfully with diazepam. No other serious adverse effects were reported. REVIEWER'S
conclusionsCurrent evidence is insufficient to assess the benefits and harms of ketamine as an adjuvant to opioids for the relief of cancer pain. More randomized controlled trials are needed.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.