{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T19:16:06Z","timestamp":1793042166193,"version":"4.5.0"},"reference-count":50,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,3,4]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Long-term opioid use is associated with pharmacological tolerance, a risk of misuse and hyperalgesia in patients with chronic pain (CP). Tapering is challenging in this context, particularly with comorbid opioid-use disorder (OUD). The antihyperalgesic effect of ketamine, through N-methyl-D-aspartate (NMDA) antagonism, could be useful. We aimed to describe the changes in the dose of opioids consumed over 1 year after a 5-day hospitalisation with ketamine infusion for CP patients with OUD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a historical cohort study using a medical chart from 1 January 2014 to 31 December 2019. Patients were long-term opioid users with OUD and CP, followed by the Pain Center of the University Hospital of Toulouse, for which outpatient progressive tapering failed. Ketamine was administered at a low dose to initiate tapering during a 5-day hospitalisation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>59 patients were included, with 64% of them female and a mean age of 48\u00b110 years old. The most frequent CP aetiologies were back pain (53%) and fibromyalgia (17%). The baseline opioid daily dose was 207 mg (\u00b1128) morphine milligram equivalent (MME). It was lowered to 92\u00b172\u2009mg MME at discharge (p&lt;0.001), 99\u00b177\u2009mg at 3 months (p&lt;0.001) and 103\u00b1106\u2009mg at 12 months. More than 50% tapering was achieved immediately for 40 patients (68%), with immediate cessation for seven patients (12%). 17 patients were lost to follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A 5-day hospitalisation with a low-dose ketamine infusion appeared useful to facilitate opioid tapering in long-term opioid users with CP and OUD. Ketamine was well tolerated, and patients did not present significant withdrawal symptoms. Prospective and comparative studies are needed to confirm our findings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-105035","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T13:55:17Z","timestamp":1710770117000},"page":"421-428","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Low-dose ketamine infusion to facilitate opioid tapering in chronic non-cancer pain with opioid-use disorder: a historical cohort study"],"prefix":"10.1136","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2764-4351","authenticated-orcid":false,"given":"Antoine","family":"Elyn","sequence":"first","affiliation":[{"name":"Chronic Pain Center, University Hospital of Toulouse, Toulouse, France"},{"name":"General and Family Medicine University Department, University of Toulouse III - Paul Sabatier, Toulouse, France"},{"name":"RECaP F-CRIN - R\u00e9seau national de Recherche en \u00c9pid\u00e9miologie Clinique et en Sant\u00e9 Publique, Inserm, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Roussin","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology, University Hospital of Toulouse, Toulouse, France"},{"name":"INSERM UMR1295, Pharmaco-\u00e9pid\u00e9miologie, University of Toulouse III - Paul Sabatier, Toulouse, France"},{"name":"University of Medicine, University of Toulouse III - Paul Sabatier, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Lestrade","sequence":"additional","affiliation":[{"name":"Chronic Pain Center, University Hospital of Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Franchitto","sequence":"additional","affiliation":[{"name":"University of Medicine, University of Toulouse III - Paul Sabatier, Toulouse, France"},{"name":"Clinical Addictology Center, University Hospital of Toulouse, Toulouse, France"},{"name":"INSERM UMR1295, EQUITY \u201cEmbodiment, social inequalities, lifecourse epidemiology, cancer and chronic diseases, interventions, methodology\u201d, University of Toulouse III - Paul Sabatier, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e9n\u00e9dicte","family":"Jullian","sequence":"additional","affiliation":[{"name":"Clinical Addictology Center, University Hospital of Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Cantagrel","sequence":"additional","affiliation":[{"name":"Chronic Pain Center, University Hospital of Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,18]]},"reference":[{"key":"2025101110400985000_50.5.421.1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/ejp.1291","article-title":"Prescription opioid analgesic use in France: trends and impact on morbidity-mortality","volume":"23","author":"Chenaf","year":"2019","journal-title":"Eur J Pain"},{"key":"2025101110400985000_50.5.421.2","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1097\/j.pain.0000000000000170","article-title":"Opioid-induced hyperalgesia in community-dwelling adults with chronic pain","volume":"156","author":"Hooten","year":"2015","journal-title":"Pain"},{"key":"2025101110400985000_50.5.421.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.7789"},{"key":"2025101110400985000_50.5.421.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-066375","article-title":"Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis","volume":"377","author":"Avery","year":"2022","journal-title":"BMJ"},{"key":"2025101110400985000_50.5.421.5","unstructured":"French Health Authority . 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