Intranasal Ketamine for Episodic Neuropathic Pain in a Cancer Patient: A Case Report.
Kyle Brown, Tayyaba Irshad
✦ AI-curated · Sources linked
Case in brief
A 49-year-old patient with metastatic lung adenocarcinoma presented to an outpatient palliative care clinic with severe, uncontrolled episodic neuropathic pain in the lower extremity. For breakthrough episodes, compounded racemic ketamine 20–30 mg was prescribed intranasally as needed at onset, alongside scheduled oral methadone and a buprenorphine patch for longer-acting pain management. The patient reported that episodes became less frequent, less intense, and shorter in duration with intranasal ketamine, with no reported adverse effects.
What made this case unusual
Intranasal ketamine was used as an as-needed adjunct for unpredictable episodic cancer-related neuropathic pain, rather than as scheduled long-acting analgesia.
Diagnostic / clinical pearl
For severe episodic breakthrough pain, this case describes patient-reported improvement with as-needed intranasal ketamine added to existing long-acting analgesia; monitor for adverse effects, which were not reported here.