{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T12:26:12Z","timestamp":1780489572904,"version":"3.54.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T00:00:00Z","timestamp":1646092800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Navamindradhiraj University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>ketamine has potential advantages over morphine for musculoskeletal pain relief. The aim of this study was to compare the analgesic efficacy and safety of intranasal (IN) ketamine to intravenous (IV) morphine for older adults with musculoskeletal pain in the emergency department (ED).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>this was a non-inferiority, double-blind, randomised controlled trial of ED patients aged of 65 and older presenting with acute moderate to severe musculoskeletal pain defined as a score \u22655 on an 11-point numeric rating scale (NRS). Patients were randomly assigned to receive IN ketamine or IV morphine. The primary outcome was comparative reduction of NRS pain scores between ketamine and morphine groups at 30\u00a0min post-treatment. Secondary outcomes were incidence of adverse events and requirement for rescue therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>seventy-four patients were eligible for analysis (37 in the IN ketamine and 37 in the IV morphine group). Mean pain score at 30\u00a0min did not differ significantly between IN ketamine and IV morphine groups (6.03 versus 5.81). Similarly, the difference in mean NRS change from baseline between IN ketamine and IV morphine groups [(\u22122.14, 95% CI: \u22122.79 to \u22121.48) and (\u22120.81, 95% CI: \u22122.36 to \u22121.26)\u2009=\u2009\u22120.32, 95% CI: \u22121.17 to \u22120.52] did not reach the non-inferiority margin of 1.3. Adverse events and incidence of rescue therapy also did not differ between groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>intranasal ketamine can provide a non-inferior analgesic effect compared to intravenous morphine for acute musculoskeletal pain in older adults with mild adverse effects and low incidence of rescue analgesic treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afac073","type":"journal-article","created":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T12:06:54Z","timestamp":1647259614000},"source":"Crossref","is-referenced-by-count":24,"title":["Non-inferiority of intranasal ketamine compared to intravenous morphine for musculoskeletal pain relief among older adults in an emergency department: a randomised controlled trial"],"prefix":"10.1093","volume":"51","author":[{"given":"Suchada","family":"Tongbua","sequence":"first","affiliation":[{"name":"The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8853-2567","authenticated-orcid":false,"given":"Jiraporn","family":"Sri-on","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwannapa","family":"Thong-on","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thitiwan","family":"Paksophis","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,29]]},"reference":[{"key":"2022032915450725200_ref1","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/j.1533-2500.2008.00204.x","article-title":"Opioids and the management of chronic severe pain in the elderly: consensus statement of an international expert panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone)","volume":"8","author":"Pergolizzi","year":"2008","journal-title":"Pain Pract"},{"key":"2022032915450725200_ref2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.tjem.2017.08.001","article-title":"Determinants of inappropriate acute pain management in old people unable to communicate verbally in the emergency department","volume":"17","author":"Allione","year":"2017","journal-title":"Turk J Emerg Med"},{"key":"2022032915450725200_ref3","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1111\/1742-6723.13562","article-title":"Emergency department pain management in older patients","volume":"32","author":"Tyler","year":"2020","journal-title":"Emerg Med Australas"},{"key":"2022032915450725200_ref4","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1111\/j.1532-5415.2009.02376.x","article-title":"American Geriatrics Society panel on pharmacological management of persistent pain in older persons. Pharmacological management of persistent pain in older persons","volume":"57","year":"2009","journal-title":"J Am Geriatr Soc"},{"key":"2022032915450725200_ref5","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1111\/j.1526-4637.2010.00983.x","article-title":"Causes and consequences of inadequate management of acute pain","volume":"11","author":"Sinatra","year":"2010","journal-title":"Pain Med"},{"key":"2022032915450725200_ref6","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/S0749-0690(05)70081-1","article-title":"Opioid analgesic drugs in older people","volume":"17","author":"Fine","year":"2001","journal-title":"Clin Geriatr Med"},{"key":"2022032915450725200_ref7","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1016\/j.clinthera.2013.09.008","article-title":"Medication pain management in the elderly: unique and underutilized analgesic treatment options","volume":"35","author":"Atkinson","year":"2013","journal-title":"Clin Ther"},{"key":"2022032915450725200_ref8","first-page":"31","article-title":"Intravenous subdissociative-dose ketamine versus morphine for acute traumatic pain in geriatric patients in the emergency department: a case series","volume":"4","author":"Motov","year":"2018","journal-title":"Int J Crit Care Emerg Med"},{"key":"2022032915450725200_ref9","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1080\/14656566.2017.1289176","article-title":"What are the advantages of non-opioid analgesic techniques in the management of acute and chronic pain?","volume":"18","author":"White","year":"2017","journal-title":"Expert Opin Pharmacother"},{"key":"2022032915450725200_ref10","doi-asserted-by":"crossref","first-page":"e2016858","DOI":"10.1001\/jamanetworkopen.2020.16858","article-title":"Association of current opioid use with serious adverse events among older adult survivors of breast cancer","volume":"3","author":"Winn","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2022032915450725200_ref11","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1513\/AnnalsATS.201901-024OC","article-title":"Association of opioid and benzodiazepine use with adverse respiratory events in older adults with chronic obstructive pulmonary disease","volume":"16","author":"Baillargeon","year":"2019","journal-title":"Ann Am Thorac Soc"},{"key":"2022032915450725200_ref12","doi-asserted-by":"crossref","first-page":"290","DOI":"10.15585\/mmwr.mm6911a4","article-title":"Drug and opioid-involved overdose deaths\u2014United States, 2017\u20132018","volume":"69","author":"Wilson","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2022032915450725200_ref13","first-page":"145","article-title":"Procedural sedation and analgesia in the emergency department","volume":"17","author":"Innes","year":"1999","journal-title":"Canadian Consensus Guidelines J Emerg Med"},{"key":"2022032915450725200_ref14","first-page":"27","article-title":"Ketamine as an analgesic: parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration","volume":"16","author":"Kronenberg","year":"2002","journal-title":"J Pain Palliat Care Pharmacother"},{"key":"2022032915450725200_ref15","doi-asserted-by":"crossref","first-page":"283","DOI":"10.4103\/0259-1162.143110","article-title":"Ketamine: current applications in anesthesia, pain, and critical care","volume":"8","author":"Kurdi","year":"2014","journal-title":"Anesth Essays Res"},{"key":"2022032915450725200_ref16","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/B978-0-443-06959-8.00026-1","volume-title":"Miller\u2019s Anaesthesia","author":"Reves","year":"2010","edition":"7th"},{"key":"2022032915450725200_ref17","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1038\/aps.2016.5","article-title":"Ketamine use in current clinical practice","volume":"37","author":"Mei","year":"2016","journal-title":"Acta Pharmacol Sin"},{"key":"2022032915450725200_ref18","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.ajem.2018.05.030","article-title":"Intravenous subdissociative-dose ketamine versus morphine for acute geriatric pain in the emergency department: a randomized controlled trial","volume":"37","author":"Motov","year":"2019","journal-title":"Am J Emerg Med"},{"key":"2022032915450725200_ref19","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.tjem.2017.05.006","article-title":"Comparing the analgesic effect of intranasal with intravenous ketamine in isolated orthopedic trauma: a randomized clinical trial","volume":"17","author":"Parvizrad","year":"2017","journal-title":"Turk J Emerg Med"},{"key":"2022032915450725200_ref20","first-page":"2088","article-title":"Nose to brain transport pathways an overview: potential of nanostructured lipid carriers in nose to brain targeting","volume":"46","author":"Selvaraj","year":"2018","journal-title":"Artif Cells Nanomed Biotechnol"},{"key":"2022032915450725200_ref21","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.ajem.2017.03.004","article-title":"A prospective randomized, double-dummy trial comparing IV push low dose ketamine to short infusion of low dose ketamine for treatment of pain in the ED","volume":"35","author":"Motov","year":"2017","journal-title":"Am J Emerg Med"},{"key":"2022032915450725200_ref22","article-title":"Approaching acute pain in emergency settings: European Society for Emergency Medicine (EUSEM) guidelines-part 1: assessment","volume":"15","author":"Hachimi-Idrissi","year":"2020","journal-title":"Intern Emerg Med"},{"key":"2022032915450725200_ref23","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.1016\/j.ajem.2020.05.094","article-title":"Intranasal ketamine for acute pain management in children: a systematic review and meta-analysis","volume":"38","author":"Silva","year":"2020","journal-title":"Am J Emerg Med"},{"key":"2022032915450725200_ref24","author":"MAD Nasal\u2122 intranasal mucosal device"},{"key":"2022032915450725200_ref25","first-page":"S371","article-title":"Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"2020","author":"Panchal","journal-title":"Circulation"},{"key":"2022032915450725200_ref26","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1111\/acem.13428","article-title":"Slow infusion of low-dose ketamine reduces bothersome side effects compared to intravenous push: a double-blind, double-dummy, randomized controlled trial","volume":"25","author":"Clattenburg","year":"2018","journal-title":"Acad Emerg Med"},{"key":"2022032915450725200_ref27","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1164\/rccm.2107138","article-title":"The Richmond agitation sedation scale: validity and reliability in adult intensive care unit patients","volume":"166","author":"Sessler","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"2022032915450725200_ref28","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1197\/aemj.10.4.390","article-title":"Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department","volume":"10","author":"Bijur","year":"2003","journal-title":"Acad Emerg Med"},{"key":"2022032915450725200_ref29","first-page":"441","article-title":"Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain","volume":"15","author":"Holdgate","year":"2003","journal-title":"Emerg Med Australas"},{"key":"2022032915450725200_ref30","doi-asserted-by":"crossref","first-page":"2594","DOI":"10.1001\/jama.2012.87802","article-title":"Reporting of noninferiority and equivalence randomized trial: extension of the CONSORT 2010 statement","volume":"308","author":"Piaggio","year":"2012","journal-title":"JAMA"},{"key":"2022032915450725200_ref31","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.ajem.2006.11.016","article-title":"Management of severe acute pain in emergency settings: ketamine reduces morphine consumption","volume":"25","author":"Galinski","year":"2007","journal-title":"Am J Emerg Med"},{"key":"2022032915450725200_ref32","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.ajem.2014.12.058","article-title":"Low-dose ketamine vs morphine for acute pain in the ED: a randomized controlled trial","volume":"33","author":"Miller","year":"2015","journal-title":"Am J Emerg Med"},{"key":"2022032915450725200_ref33","doi-asserted-by":"crossref","first-page":"e0165461","DOI":"10.1371\/journal.pone.0165461","article-title":"The effects of low-dose ketamine on acute pain in an emergency setting: a systematic review and meta-analysis","volume":"11","author":"Lee","year":"2016","journal-title":"PLoS One"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/51\/3\/afac073\/43114177\/afac073.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/51\/3\/afac073\/43114177\/afac073.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T18:57:17Z","timestamp":1648580237000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/doi\/10.1093\/ageing\/afac073\/6555266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,1]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afac073","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,3]]},"published":{"date-parts":[[2022,3,1]]},"article-number":"afac073"}}