Esketamine infusion therapy: A promising alternative in the treatment of chronic endometriosis-associated pain

Introduction: Esketamine infusion therapy is currently used to reduce the process of sensitization in patients with chronic pain syndromes. Given its anti-inflammatory, anti-depressive, and analgesic properties, this drug could be effective to treat chronic endometriosis-associated pain as well. The aim of this study was (1) to provide an overview of the available literature and (2) to present the results of our retrospective cohort study on the efficacy of esketamine infusion therapy to alleviate pain symptoms in this cohort. Methods: PubMed and EMBASE were searched to select publications on this topic. For our retrospective cohort study, all patients with chronic endometriosis-associated pain that underwent esketamine infusion therapy between January 2010 and 2023 in the Isala hospital in Zwolle, the Netherlands, were reviewed. Results: PubMed and EMBASE identified no publications on this topic, except our own case report. Retrospective analysis of 17 patients (who underwent 57 esketamine infusions in total) revealed a positive effect in 64.7% of patients. Overall the treatment was considered save and well-tolerated. Currently, eight patients continue to receive esketamine infusion therapy, others underwent endometriosis surgery ( n = 2), switched pain treatment ( n = 1), or were non-responders ( n = 6). Conclusions: Esketamine infusion therapy could be a potential and a viable option to treat chronic endometriosis-associated pain in patients who are resistant to current treatment options. Our findings encourage to conduct future studies, including randomized trials. This is the first cohort study to report outcomes on the efficacy of esketamine infusion therapy for women with chronic endometriosis-associated pain.