{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:09:28Z","timestamp":1760242168086,"version":"build-2065373602"},"reference-count":16,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,6,27]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Ketamine has garnered increased interest for its promising applications in chronic pain treatment, particularly in cases where conventional therapies have proven insufficient. Nevertheless, despite its potential advantages, ketamine remains classified as a third-line medication for pain management. While there are well-documented reactions to ketamine such as hypertension and tachycardia, not much is known about its relationship to cortisol. In this case report, we explicate the administration of ketamine in a patient presenting with atypical facial pain, examining its multifaceted effects on cortisol levels and concurrent pain management.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>A patient with a history of Cushing\u2019s disease underwent multiple resections of a pituitary tumor. Afterwards, the patient began experiencing a burning-like pain on the left side of the face. The discomfort was initially treated with a variety of neuromodulatory and anti-inflammatory medications, which caused intolerable side effects and were not effective for pain. As a final recourse, we initiated a regimen of oral compounded ketamine at 5\u201310 mg three times daily as needed. The patient exhibited marked amelioration in their pain symptoms; however, there was an elevation in their baseline cortisol. In view of the potential risk of inducing Cushing\u2019s syndrome, the administration of daily ketamine was discontinued.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>While ketamine is primarily known to control pain through the antagonization of N-methyl-D-aspartate receptors, its effects on cortisol may also contribute to its analgesic properties. Physicians should be aware of the potential for these interactions, particularly when treating patients with a predisposition to hormonal imbalances.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-104482","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T01:25:15Z","timestamp":1688693115000},"page":"572-574","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Ketamine for atypical facial pain and hormonal dysregulation: a case report"],"prefix":"10.1136","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7304-5475","authenticated-orcid":false,"given":"Yousef","family":"Darwish","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Johns Hopkins Medical Center, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sierra","family":"Willeford","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Johns Hopkins Medical Center, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krithika","family":"Mahesh","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Johns Hopkins Medical Center, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Van","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Johns Hopkins Medical Center, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,7,6]]},"reference":[{"key":"2025101110040802000_48.11.572.1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00045.2019"},{"key":"2025101110040802000_48.11.572.2","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1213\/ANE.0000000000004185","article-title":"Ketamine infusions for chronic pain: a systematic review and meta-analysis of randomized controlled trials","volume":"129","author":"Orhurhu","year":"2019","journal-title":"Anesth Analg"},{"key":"2025101110040802000_48.11.572.3","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2020.590221","article-title":"Corticosterone as a potential confounding factor in delineating mechanisms underlying ketamine\u2019s rapid antidepressant actions","volume":"11","author":"Wegman-Points","year":"2020","journal-title":"Front Pharmacol"},{"key":"2025101110040802000_48.11.572.4","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev135"},{"key":"2025101110040802000_48.11.572.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0893-133X(00)00194-9"},{"key":"2025101110040802000_48.11.572.6","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318287b7c8"},{"key":"2025101110040802000_48.11.572.7","doi-asserted-by":"publisher","DOI":"10.1159\/000087655"},{"key":"2025101110040802000_48.11.572.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2009.02761.x"},{"key":"2025101110040802000_48.11.572.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2011.01.001"},{"key":"2025101110040802000_48.11.572.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-0511(01)00092-8"},{"key":"2025101110040802000_48.11.572.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2005.04.006"},{"key":"2025101110040802000_48.11.572.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-4530(99)00035-9"},{"key":"2025101110040802000_48.11.572.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2009.09.032"},{"key":"2025101110040802000_48.11.572.14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s13318-011-0077-2","article-title":"Stress can affect drug pharmacokinetics via serum\/tissues protein binding and blood flow rate alterations","volume":"37","author":"Antonia","year":"2012","journal-title":"Eur J Drug Metab Pharmacokinet"},{"key":"2025101110040802000_48.11.572.15","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.jss.2021.08.040","article-title":"Relationship between decreased cortisol and development of chronic pain in traumatically injured","volume":"270","author":"Trevino","year":"2022","journal-title":"J Surg Res"},{"key":"2025101110040802000_48.11.572.16","unstructured":"Tennant F . Cortisol screening in chronic pain patients. Pract Pain Manag 2012;12."}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2023-104482","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T17:04:16Z","timestamp":1760202256000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2023-104482"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,6]]},"references-count":16,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,9,21]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/rapm-2023-104482"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2023-104482","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"type":"print","value":"1098-7339"},{"type":"electronic","value":"1532-8651"}],"subject":[],"published":{"date-parts":[[2023,7,6]]}}}