Background: Chronic non-cancer pain (CNCP) is a prevalent condition, imposing significant burden on healthcare systems. Ketamine is suggested as a potential intervention for CNCP management. We conducted a systematic review and network meta-analysis to assess ketamine's effects in adults with CNCP. Methods: We searched Medline, Embase, CINAHL, and Cochrane CENTRAL up to January-2024 for randomized trials involving adults with CNCP, comparing ketamine with placebo, usual care, or other interventions. Reviewers independently assessed trial eligibility, extracted data, and evaluated risk-of-bias using the Cochrane tool. A random-effects network meta-analysis was performed. We assessed evidence certainty using GRADE. Results: We included 38 trials, with the following comparisons made between ketamine and placebo, using 0-10 VAS: At <30 minutes, ketamine may slightly reduce pain intensity (-1.32, 95% CI: [-1.73 to -0.90], low-certainty). At 1-3 hours follow-up, ketamine may slightly reduce pain intensity (MD: -1.25, (95% CI: [-1.76 to -0.74], low-certainty). At 3-to-7 days follow-up, ketamine may have little to no effect on pain intensity (MD: -1.34, 95% CI: [-2.29 to -0.39], low-certainty). At 3-to-5 weeks follow-up, ketamine likely results in no pain reduction (MD: -0.99, 95% CI: [-2.00 to 0.03], moderate-certainty). At beyond 5 weeks the evidence about ketamine pain reduction is very uncertain (MD: -1.09, 95% CI: [-1.86 to -0.32], very-low-certainty). Ketamine had no effect on physical functioning. Compared to placebo, ketamine may result in a slight increase in the risk of gastrointestinal adverse events (RR: 3.97, 95% CI: [2.18 to 7.22], RD: 12%, 95% CI: [5% to 25%], very-low-certainty), an increase in risk of dizziness (RR: 3.66, 95% CI: [1.25 to 10.74], RD: 11%, 95% CI: [1% to 40%], low-certainty), may increase the risk of fatigue, somnolence, and sedation (RR: 2.89, 95% CI: [1.84 to 4.53], RD: 27%, 95% CI: [12% to 50%], low-certainty), may increase of the incidence of dissociative symptoms (RR: 4.22, 95% CI: [2.20 to 8.10], RD: 17%, 95% CI: [6% to 37%], low- M.Sc. Thesis – Sara Moradi; McMaster University – Health Research Methodology iv certainty), and it may result in a slight increase in the risk of visual impairment (RR: 10.21, 95% CI: [2.86 to 36.42], RD: not evaluable, very-low-certainty). We did not have enough data to pool effect estimates for other outcomes. Conclusion: Ketamine may provide small but important benefit in CNCP patients at immediate-to-short follow-up, but it probably has little to no benefit at beyond 3-weeks. Ketamine is likely to provide similar benefits compared to alternative active interventions; however, these benefits may be associated with important side-effects. / Thesis / Master of Science (MSc)

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

National rates of chronic non-cancer pain (CNCP) are rising alongside increasing reports of prescription opioid abuse and mortality. Associations between the rise in CNCP and in opioid abuse seem logical, yet research on CNCP among individuals with opioid dependence is currently limited due to the complicated nature of comorbid conditions in research and treatment. This study aims to expand the CNCP knowledge base by responding to the question: Do individuals with CNCP participating in an opiate treatment program have better or worse treatment outcomes than individuals without CNCP? This study used a secondary dataset including 483 adults from Kentucky’s Opiate Recovery Treatment Outcome Study. Individuals in the sample met DSM-IV-TR criteria for opioid dependence and were in treatment at a licensed opiate treatment program (OTP). Analysis compared cases with and without CNCP on national treatment outcome measures including substance use, recovery support, education, employment, mental health symptoms, and criminal justice system involvement. Results indicated no differences at follow-up between the CNCP (n=163) and non-CNCP (n=320) individuals on substance abstinence, recovery supports, education level, or criminal justice system involvement. At baseline and follow-up there were more unemployed individuals and individuals receiving disability benefits in the CNCP group than the non-CNCP group. Reported anxiety and depression symptoms increased at follow-up, while use of prescription medicine for mental health symptoms declined for both groups (non-significant differences). The only predictors for CNCP cases in this sample were tobacco use and presence of a chronic medical condition. Recommendations include expansion of smoking cessation programs in substance abuse treatment settings. Future research might examine integrated treatment and medical home health models to better address biopsychosocial components of clients with comorbid conditions like opioid dependence and CNCP.