The Role of Special K in Pain Management

Ketamine, known on the street as "special K," is a dissociative anesthetic with hallucinogenic properties and is classified as a controlled substance. Its unique mechanism as an N-methyl-Daspartate (NMDA) receptor antagonist is thought to be responsible for many of the drug's most promising properties. Stimulation of the NMDA receptor results in central sensitization (wind up phenomenon), hyperalgesia, reduced sensitivity to opioids, and the development of opioid tolerance. This can result in allodynia, hyperalgesia, and prolonged pain response. Ketamine partially reverses the previously mentioned complications that can restore the effectiveness of opioids in various settings and often allows for reduced opioid doses and improved pain control. With the appropriate clinical knowledge and patient monitoring, ketamine at subanesthetic doses can play a role in the treatment of complex regional pain syndrome (CRPS), cancer pain, and even neuropathic or chronic pain refractory to typical treatment options. Depending on the clinical setting, ketamine can be administered via either intravenous or oral routes. Clinical monitoring is required to ensure that side effects, such as dysphoria, do not adversely impact the patient. (Recorded at PAINWeek 2016)