Actualización en el manejo del dolor crónico: Explorando el rol de la ketamina

Chronic pain is a complex and highly prevalent condition that significantly impairs quality of life and often shows limited response to conventional therapies. In this context, ketamine,a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, has emerged as a therapeutic alternative in refractory settings. An integrative narrative review was conducted through searches of major biomedical databases (PubMed, EMBASE, Cochrane Library, OVID, and ClinicalKey), including English and Spanish literature without time restrictions, focusing on clinical studies, systematic reviews, and guidelines. Available evidence suggests that ketamine may provide clinically meaningful pain reduction in selected chronic pain subtypes, including complex regional pain syndrome, fibromyalgia, neuropathic pain, and cancerrelated pain, although responses are heterogeneous. Its analgesic effects are attributed to modulation of glutamatergic neurotransmission, attenuation of neuroinflammation, andinterference with maladaptive synaptic plasticity. Ketamine represents a promising option for refractory chronic pain; however, standardized protocols and precise patient selectioncriteria are essential to ensure safe and rational clinical application.