Alisher R. Dadabayev,1,2 Sonalee A. Joshi,3 Mariam H. Reda,4 Tamar Lake,1,2 Mark S. Hausman,1,2 Edward Domino,5 and Israel Liberzon6
1Department of Anesthesiology, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
2Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA
3Department of Psychology, The University of Michigan, Ann Arbor, MI, USA
4Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
5Department of Pharmacology, The University of Michigan, Ann Arbor, MI, USA
6Department of Psychiatry, Texas A&M University, College Station, TX, USA
Alisher R. Dadabayev, VA Ann Arbor Healthcare System, 2215 Fuller Rd/11A, Ann Arbor, MI 48105, USA. Email: VOG.AV@veyabadaD.rehsilA
Abstract
Objective
To date, treatment options (i.e. psychotherapy, antidepressant medications) for patients with posttraumatic stress disorder (PTSD), are relatively few, and considering their limited efficacy, novel therapies have gained interest among researchers and treatment providers alike. Among patients with chronic pain (CP) about one third experience comorbid PTSD, which further complicates their already challenging pharmacological regimens. Low dose ketamine infusion has shown promise in PTSD, and in treatment of CP, however they have not been studied in comorbid population and under rigorous control conditions.
Methods
We compared the effects of a single dose of either ketamine (0.5 mg/kg) or ketorolac (15 mg) over a 40-minute of IV infusion in CP patients with and without PTSD, in double blind, randomized study. Measures were collected before, during, one day and seven days after the infusion. A planned sample size of 40 patients randomly assigned to treatment order was estimated to provide 80% power to detect a hypothesized treatment difference after the infusion.
Main Outcome and Measures: The primary outcome measures were change in PTSD symptom severity assessed with the Impact of Event Scale–Revised (IES-R) and Visual Analogue Scale (VAS) for pain administered by a study clinician 24 hours post infusion. Secondary outcome measures included Impact of Event Scale–Revised (IES-R), VAS and Brief Pain Inventory (Short Form) for pain 1 week after the infusion.
Results
Both treatments offered comparable improvement of PTSD and CP symptoms that persisted for 7 days after the infusion. Patients with comorbid PTSD and CP experienced less dissociative side effects compared to the CP group. Surprisingly, ketorolac infusion resulted in dissociative symptoms in CP patients only.
Conclusions
This first prospective study comparing effects of subanesthetic ketamine versus ketorolac infusions for comorbid PTSD and CP, suggests that both ketamine and ketorolac might offer meaningful and durable response for both PTSD and CP symptoms.
Keywords: chronic pain, IV infusion, ketamine, posttraumatic stress disorder
