Ketamine may be superior to clonidine as an adjunct to epidural steroid injection of triamcinolone for patients with chronic low back pain, according to a study to be presented at the 17th World Congress on Pain in Boston, Massachusetts.
Although epidural injection of both clonidine and ketamine has been used successfully for the treatment of several chronic pain conditions, their use for chronic low back pain has not been studied extensively.
Participants in both groups reported reductions in VAS scores from baseline at 90 days (ketamine: 79.5 at baseline to 21.5 at 90 days; clonidine: 81.5 at baseline to 21.5 at 90 days; P <.05 for both). Reductions in VAS scores were comparable between the 2 groups. Participants receiving ketamine vs clonidine reported a longer mean pain-free duration (85.5 days vs 60.75 days, respectively; P<.05). A repeat block was needed in 4 vs 11 patients who had received ketamine vs clonidine, respectively (P <.05), with a second repeat block required by 1 vs 4 patients, respectively.
Despite comparable VAS score reduction between the 2 groups, ketamine had the added benefit of prolonging the analgesic effect and being associated with fewer repeat blocks needed.
Gupta R, Kaur T. To compare efficacy of epidural ketamine vs clonidine as an adjunct to triamcinolone for chronic low backache: a pilot study. Presented at: World Congress on Pain 2018; September 12-16, 2018; Boston, MA. Poster 64056.