A scoping review for published guidelines for use of ketamine in chronic non-cancer pain

Off-label ketamine infusions are often used to manage chronic non-cancer pain (CNCP), including neuropathic pain, central sensitisation and opioid dose reduction. There are variable treatment regimens and routes of delivery based on clinical trials but there is the distinct lack of any clearly defined treatment guidelines. The goal of the scoping review was to determine whether there has been progress with the availability of published guidelines. Our inclusion criteria were publications that contained ketamine infusion, chronic pain and guidelines or protocols. We excluded publications that contained only acute pain, cancer pain or the paediatric population. A literature search was conducted on 10 May 2024 and included the medical scholarly literature databases MEDLINE and Embase and the evidence-based database Trip (formerly Turning Research into Practice; now Trip only; Trip Database Ltd, UK) Pro and limited to English language papers. Additional publications that were encountered during background reading were also included. A total of 42 publications were examined against the inclusion/exclusion criteria by the first three authors. The included full-text publications were then reviewed to determine whether they were considered a guideline. The three identified publications were then comparatively reviewed against the National Health and Medical Research Council standards for guidelines as a qualitative assessment, with 34-76% of standards met. This review found no published guidelines in Australia for use of ketamine in CNCP, despite ongoing clinical use. The authors' conclusion is that this is an area that should be addressed. Efficacy and adverse effects of off-label ketamine use should be able to be measured against an established guideline. Without a consistent and standard approach, the role of ketamine in this setting is unable to be thoroughly assessed. Such a guideline may be developed through expert consensus.