Knox, Matt; (2018) Comparing the Effects of Ketamine and Lidocaine on Mood, Subjective Drug Effects, and Pain. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Aim: To explore the effects of sub-anaesthetic intravenous infusions of ketamine compared to lidocaine in chronic neuropathic pain patients. The study examined the effects of ketamine treatment on mood, subjective drug effects and pain. The association between pain and mood was also evaluated. Method: A between subject’s design was used to compare patients receiving ketamine treatment (n=24) with a control group receiving lidocaine treatment (n=34) over four-time points (baseline, mid-infusion, post-infusion and one-week follow-up). Mood was assessed using the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-2 (PHQ-2) and an 11-point Numerical Rating Scale (NRS). Pain was assessed over three indices (intensity, distress and interference) using 11-point NRS and similar scales were used for patient ratings of subjective drug effects. Results: Both ketamine and lidocaine treatments yielded similar reductions in pain intensity at the one-week follow-up. Ketamine provided a greater reduction in pain intensity during the infusion. Subjective drug effect scales indicated that the ketamine treatment group felt significantly higher, felt a stronger sensation of drug effect, and liked the drug effect more than the lidocaine group. Data from mood measures were inconclusive. PHQ-2 and depression NRS showed reductions in scores of depression at the one-week follow-up for both treatment groups. However, HADS depression scores showed no significant differences. HADS anxiety data indicated that both ketamine and lidocaine groups showed significant reductions in anxiety at one-week follow-up. Further correlational analysis indicated a relationship between a reduction in both pain intensity and interference scores (baseline and one-week follow-up) with a reduction in HADS anxiety scores for the ketamine treatment group. Conclusion: The findings support previous literature showing the efficacy of ketamine treatment for chronic neuropathic pain. Results indicated that participants experienced the acute reinforcing effects of ketamine (feeling high and liking the drug effect) but did not want more of the drug. This may indicate a reduced abuse potential in the chronic pain population. Findings also indicated that ketamine did not produce anti-depressant effects in patients with chronic neuropathic pain. Therefore, that the rapid-acting anti-depressant effects found in populations of treatment-resistant depressed patients may not extend to those with chronic pain.

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