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Case Report

Opioid-Sparing Effects of Topical Ketamine in Treating Severe Pain From Decubitus Ulcers

Pages 170-174 | Received 01 Aug 2018, Accepted 02 Nov 2018, Published online: 31 Jan 2019
 

Abstract

Pain from pressure ulcers can severely impact a patient’s quality of life. Evidence-based treatment of ulcer-related pain typically relies on systemic opioids with limiting side effects. Literature exists on the use of topical ketamine for neuropathic pain, but not for tissue injury in general and for decubitus ulcer pain specifically. Ketamine has a number of actions including blocking of the glutamate NMDA ionophore in the periphery. Preclinical evidence suggests that NMDA receptors located on peripheral sensory afferent terminals may play a role in initiating pain signaling in inflamed tissues. Topical ketamine, therefore, has the potential to provide analgesia when applied to decubitus ulcers. Here a case is reported of a 54-year-old female with diffuse large B-cell lymphoma who during a critical period in her illness experienced gangrene leading to chronic bilateral stage IV decubitus heel ulcers. The severe pain reported by the patient was poorly managed using high doses of systemic opioids and resulted in intermittent systemic side effects. Adding a compounded ketamine gel to her wound dressings twice daily over an interval of several months drastically reduced her opioid use and, more important, her pain, with minimal side effects.

Acknowledgments

Salary support was provided by the Nation Center for Leadership in Academic Medicine, UC San Diego.

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