Ketamine for chronic noncancer pain: concerns regarding toxicity.

PURPOSE OF REVIEW Ketamine misuse and abuse is on the increase. This review focuses on recent studies on ketamine toxicity in recreational users and possible implications for the use of ketamine in chronic pain therapy. RECENT FINDINGS Urological toxicity, hepatotoxicity and cognitive deficits are all reported as adverse effects of the recreational use of ketamine. Urological toxicity and hepatotoxicity have been reported as adverse effects of ketamine in pain therapy. SUMMARY These findings may have implications for the clinical use of ketamine in chronic noncancer pain conditions. Until safety issues are resolved, it is suggested that chronic pain treatment involving higher doses and repeated exposure to ketamine be restricted to the context of randomized, controlled trials or clinical audits.