Authors: Mahrley T. Provido-Aljibe, Choon Meng Yee, Zhi Jun Carin Low, Allyn Hum

Published in: Progress in Palliative Care 2021; doi: 10.1080/09699260.2021.1922146

Summary points:

• Patient selection is very important. A positive response to ketamine is based on careful identification of patients with predominantly neuropathic mechanism of pain.
• Our study used ketamine for patients demonstrating central sensitisation reflected on the ECS-CP. Ketamine as a NMDA- receptor agent winds down opioid effect decreasing opioid tolerance at a lower dose, an effect of ketamine on patients with neuropathic pain syndromes. 
• The well-defined STEP PROTOCOL is safe and effective method to standardised the titration of ketamine and duration of its use. The use of psychotropic medications increases the tolerability of ketamine with none to low severity of side effects.