Ketamine: When Delirium and Desperation Call for a Hero

Abstract

The use of ketamine in palliative care is becoming more common for challenging symptom management, namely cancer related pain and psychiatric conditions. However, there is much that remains unstudied and uncertain about ketamine’s clinical utility. In this case we examine a young cancer patient who was struggling with challenging neuropathic pain and significant existential anguish in the setting of metastatic pancreatic cancer and delirium. Despite concerns regarding baseline delirium we successfully used ketamine to better manage neuropathic pain, decrease overall opioid need, without exacerbating the preexisting delirium. Our case highlights the benefits of ketamine for neuropathic pain control in the face of delirium.

Keywords:

• ketamine
• cancer-associated pain
• neuropathic pain
• delirium
• psychosocial suffering
• end-of-life symptom management

Acknowledgements

We would like to thank the UC San Diego Health Palliative Care multi-disciplinary teams including but not limited to the nurses, pharmacists, social workers, and physicians. We would also like to acknowledge the faculty and program directors of the UCSD/Scripps Hospice and Palliative Medicine Fellowship program.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.