Chronic Pain Clinical Trial
Official title:
Ketamine's Efficiency in the Treatment of Chronic Pain With an Added Inflammatory Component Exploring the Kynurenin Pathway. A Randomized, Double Blind, Placebo-controlled Trial
The kynurenine pathway is involved in hyperalgesia. This pathway is activated by
inflammation. Ketamine would interact with the kynurenine pathway and inflammation. Our
working hypotheses are: the clinical effects of ketamine on neuropathic pain are greater in
the presence of systemic inflammation and the mechanism of action involves an interaction on
the kynurenine pathway.
Study design: Interventional randomized placebo-controlled clinical trial.
Main goals:
1. To show a better clinical efficacy of ketamine in chronic pain in patients with an
inflammatory component.
2. Explore the anti-inflammatory activity of ketamine through the Kynurenine pathway.
The kynurenine pathway is involved in hyperalgesia. This pathway is activated by
inflammation. Ketamine would interact with the kynurenine pathway and inflammation. Our
working hypotheses are: the clinical effects of ketamine on neuropathic pain are greater in
the presence of systemic inflammation and the mechanism of action involves an interaction on
the kynurenine pathway.
Study design: Interventional randomized placebo-controlled clinical trial.
Main goals:
1. To show a better clinical efficacy of ketamine in chronic pain in patients with an
inflammatory component.
2. Explore the anti-inflammatory activity of ketamine through the Kynurenine pathway.
Population Adult, medullary injured (BM), with chronic neuropathic pain (DN). 4 groups: BM
with DN with bedsore Ketamine Group versus Placebo Group BM with DN without bedsore group
Ketamine versus Placebo Group
Intervention Ketamine infusion 1 mg / kg IVSE over two hours versus Nacl perfusion 0.9%
 Primary judgment criterion Decrease by more than 30% the intensity of neuropathic pain
evaluated at the moment on a numerical scale of 10 points between H0 and H4. Comparison of
groups two by two.
Secondary judgment criterions:
NPSI score (Neuropathic pain symptom inventory) at H1, H4, D1, D4, J7 Sub score of NPSI; H1,
H4, J1, J4, J7 Depression Scale HADS (Hospital Anxiety Depression Scale) J0, J1, J7 Plasma
serotonin (5-HT) kynurenine (KYN), indoleamine 2,3-dioxygenase 1 (IDO1) activity (KYN / TRP
ratio), kynurenic acid ( KA) and quinolinic acid (QA), as well as 3 proinflammatory cytokines
IL-1β, IL-6, and TNF-α before perfusion and H4 perfusion.
In parallel blood samples will be collected to study the activation of the kynurenine pathway
in response to inflammation due to a pressure ulcer.
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