{"title":"Opioid-refractory rectal tenesmus treated with burst ketamine.","authors":"David Murphy, Hannah O'Brien, Mary Jane O'Leary","doi":"10.1136/spcare-2025-005552","DOIUrl":null,"url":null,"abstract":"<p><p>Rectal tenesmus is the painful sensation of incomplete evacuation of the bowels, which is distressing and difficult to manage. Tenesmus is often caused by rectal carcinoma. It is thought there is a significant neuropathic component to tenesmus pain. Ketamine is an antagonist to the N-methyl D-aspartate receptor and has been used for neuropathic pain. We describe the case of a man with difficult-to-manage rectal tenesmus who experienced adverse effects to several medications, limiting titration. A trial of 'burst' ketamine over seven days via a continuous subcutaneous infusion, combined with midazolam and dexamethasone, resulted in a decrease in his pain, as shown by his improved self-reported pain scores and reduced PRN and background opioid requirements. To the authors' knowledge, this is the first report of using ketamine for rectal tenesmus.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Supportive & Palliative Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/spcare-2025-005552","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Rectal tenesmus is the painful sensation of incomplete evacuation of the bowels, which is distressing and difficult to manage. Tenesmus is often caused by rectal carcinoma. It is thought there is a significant neuropathic component to tenesmus pain. Ketamine is an antagonist to the N-methyl D-aspartate receptor and has been used for neuropathic pain. We describe the case of a man with difficult-to-manage rectal tenesmus who experienced adverse effects to several medications, limiting titration. A trial of 'burst' ketamine over seven days via a continuous subcutaneous infusion, combined with midazolam and dexamethasone, resulted in a decrease in his pain, as shown by his improved self-reported pain scores and reduced PRN and background opioid requirements. To the authors' knowledge, this is the first report of using ketamine for rectal tenesmus.
期刊介绍：
Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance.
We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication.
In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
