ketorolac and Pain, Chronic studies

Ketorolac: A pyrrolizine carboxylic acid derivative structurally related to INDOMETHACIN. It is an NSAID and is used principally for its analgesic activity. (From Martindale The Extra Pharmacopoeia, 31st ed)
ketorolac : A racemate comprising equimolar amounts of (R)-(+)- and (S)-(-)-5-benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid. While only the (S)-(-) enantiomer is a COX1 and COX2 inhibitor, the (R)-(+) enantiomer exhibits potent analgesic activity. A non-steroidal anti-inflammatory drug, ketorolac is mainly used (generally as the tromethamine salt) for its potent analgesic properties in the short-term management of post-operative pain, and in eye drops to relieve the ocular itching associated with seasonal allergic conjunctivitis. It was withdrawn from the market in many countries in 1993 following association with haemorrhage and renal failure.
5-benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid : A member of the class of pyrrolizines that is 2,3-dihydro-1H-pyrrolizine which is substituted at positions 1 and 5 by carboxy and benzoyl groups, respectively.

Research Excerpts

Excerpt	Relevance	Reference
"Ketorolac was given at the end of surgery, and meloxicam was prescribed in the postoperative period to all patients in both groups."	6.82	Preventive Analgesic Efficacy of Nefopam in Acute and Chronic Pain After Breast Cancer Surgery: A Prospective, Double-Blind, and Randomized Trial. ( Han, JW; Koo, BW; Lim, DJ; Na, HS; Oh, AY; Ryu, JH, 2016)
"Ketorolac or weak opioids are equally effective on acute pain and on persistent postsurgical pain development after IHR, and drug choice should be based on their potential side effects and patient's comorbidities."	5.20	Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. ( Allegri, M; Ambrosoli, AL; Braschi, A; Bugada, D; Fanelli, G; Klersy, C; Lavand'homme, P; Saccani Jotti, GM, 2015)
"Ketorolac was given at the end of surgery, and meloxicam was prescribed in the postoperative period to all patients in both groups."	2.82	Preventive Analgesic Efficacy of Nefopam in Acute and Chronic Pain After Breast Cancer Surgery: A Prospective, Double-Blind, and Randomized Trial. ( Han, JW; Koo, BW; Lim, DJ; Na, HS; Oh, AY; Ryu, JH, 2016)
"The 17 patients treated for acute or chronic pain during the opioid-free shift were managed mainly with i."	1.42	Development of an opioid reduction protocol in an emergency department. ( Bosoy, D; Cohen, V; Fromm, C; Hossain, R; Jellinek-Cohen, SP; Likourezos, A; Marshall, J; Motov, S; Rockoff, B; Smith, A, 2015)

Research

Studies (8)

Authors

Clinical Trials (4)

Trial Overview

Trial Outcomes

Area of Hypersensitivity to Mechanical Stimuli Surrounding the Wound 48 Hours After Surgery

Timeframe	Studies, this research(%)	All Research%
pre-1990	0 (0.00)	18.7374
1990's	0 (0.00)	18.2507
2000's	0 (0.00)	29.6817
2010's	7 (87.50)	24.3611
2020's	1 (12.50)	2.80

Authors	Studies
da Silva, J	1
Gingras, A	1
Wang, L	1
Bauer, M	1
Curry, R	1
Larsson, A	1
Sessler, DI	1
Eisenach, JC	1
Yamamoto, T	1
Bugada, D	2
Lavand'homme, P	2
Ambrosoli, AL	2
Klersy, C	1
Braschi, A	1
Fanelli, G	2
Saccani Jotti, GM	2
Allegri, M	2
Cohen, V	1
Motov, S	1
Rockoff, B	1
Smith, A	1
Fromm, C	1
Bosoy, D	1
Hossain, R	1
Likourezos, A	1
Jellinek-Cohen, SP	1
Marshall, J	1
Vygonskaya, MV	1
Filatova, EG	1
Cappelleri, G	1
Meschi, T	1
Na, HS	1
Oh, AY	1
Koo, BW	1
Lim, DJ	1
Ryu, JH	1
Han, JW	1

Trial	Phase	Enrollment	Study Type	Start Date	Status
Effect of Intrathecal Ketorolac on Mechanical Hypersensitivity After Total Hip Arthroplasty[NCT00621530]	Phase 2	62 participants (Actual)	Interventional	2008-03-31	Terminated (stopped due to Terminated due to discontinuation of Acular PF (investigational medication))
Randomized, Prospective Study of the Assessment, Prevention and Management of Acute Post-herniotomy Pain[NCT01345162]	Phase 4	200 participants (Actual)	Interventional	2010-03-31	Completed
Perioperative Pain Management With Multi-discipline Team(pMDT) in Thoracic Surgery: a Multi-center，Prospective, Observational Study--The Process Implementation Stage[NCT03761550]		480 participants (Actual)	Observational	2018-12-01	Completed
Perioperative Pain Management With Multi-discipline Team(pMDT) in Thoracic Surgery: a Multi-center，Prospective, Observational Study--------For the Baseline Investigation and Technical Preparation Stage[NCT03759275]		480 participants (Actual)	Observational	2018-09-01	Completed
[information is prepared from clinicaltrials.gov, extracted Sep-2024]

Hyperalgesia (using a von Frey filament) and allodynia (using a cotton swab) were evaluated around the surgical site 48 hours after surgery. (NCT00621530)
Timeframe: 48 hours

McGill Affective Pain

Intervention	area in centimeters squared (Median)
Ketorolac	0
Placebo	0

Pain was assessed 2 days, and 2 and 6 months after surgery using a validated questionnaire wherein subjects rate the degree to which adjectives describe the emotional component of their pain experience. This is termed the McGill Pain Affective Score and is scored from 0 to 12 with 12 being the highest pain emotional impact. (NCT00621530)
Timeframe: 6 months

McGill Pain Intensity

Intervention	units on a scale (Mean)
	Postoperative: 2 days	Postoperative: 2 months	Postoperative: 6 months
Ketorolac	2.3	0.4	0.1
Placebo	2.3	0.5	0.4

Pain was assessed 2 days and 2 and 6 months after surgery using a validated questionnaire wherein subjects rate the degree to which adjectives describe the intensity of their pain experience. This is termed the McGill Pain Intensity Score and is scored from 0 to 33 with 33 being the highest pain intensity. (NCT00621530)
Timeframe: 6 months

Neuropathic Pain Symptom Inventory

Intervention	units on a scale (Mean)
	Postoperative: 2 days	Postoperative: 2 months	Postoperative: 6 months
Ketorolac	11	2.3	1.4
Placebo	10	3.1	1.2

Pain was assessed 2 days, and 2 and 6 months after surgery using a validated questionnaire to assess the degree of neuropathic characteristics of pain. This is termed the Neuropathic Pain Symptom Inventory which is scored 0-100 with 100 being the worst possible pain. (NCT00621530)
Timeframe: 6 months

Present Pain Intensity

Intervention	units on a scale (Mean)
	Postoperative: 2 days	Postoperative: 2 months	Postoperative: 6 months
Ketorolac	13	2.9	2.4
Placebo	21	4.5	1.4

Pain was assessed preoperatively, 2 days, and 2 and 6 months after surgery using a 0-10 (10 being worse) verbal Present Pain Intensity (PPI) scale (NCT00621530)
Timeframe: 6 months

Analgesic Efficacy

Intervention	units on a scale (Mean)
	Preoperative	Postoperative: 2 days	Postoperative: 2 months	Postoperative: 6 months
Ketorolac	1.7	2.1	0.6	0.4
Placebo	1.6	2.5	0.2	0.1

"percentage of patients with NRS≥4. (NRS=numeric rating scale; o quantify pain from0=no pain to 10=worst pain possible).~NRS≥4 is cosidered as suboptimal pain control worth to be treated with adjunctive analgesics. We therefore condidered the difference in percentage of patients experiencing not optimal pain control in the two groups to understand, if any, the difference in analgesic efficacy between the two drugs." (NCT01345162)
Timeframe: 4 days postherniotomy

Intervention	percentage of patients with NRS≥4 (Number)
Ketorolac	26.5
Acetaminophene + Tramadol	32.3

Article	Year
Intrathecal ketorolac does not improve acute or chronic pain after hip arthroplasty: a randomized controlled trial. Journal of anesthesia, 2014, Volume: 28, Issue:5 Topics: Acute Pain; Anesthesia, Spinal; Arthroplasty, Replacement, Hip; Bupivacaine; Chronic Pain; Double-Bl	2014
Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. Journal of clinical anesthesia, 2015, Volume: 27, Issue:8 Topics: Acute Pain; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain;	2015
Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. Journal of clinical anesthesia, 2015, Volume: 27, Issue:8 Topics: Acute Pain; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain;	2015
Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. Journal of clinical anesthesia, 2015, Volume: 27, Issue:8 Topics: Acute Pain; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain;	2015
Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. Journal of clinical anesthesia, 2015, Volume: 27, Issue:8 Topics: Acute Pain; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain;	2015
Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. Journal of clinical anesthesia, 2015, Volume: 27, Issue:8 Topics: Acute Pain; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain;	2015
Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. Journal of clinical anesthesia, 2015, Volume: 27, Issue:8 Topics: Acute Pain; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain;	2015
Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. Journal of clinical anesthesia, 2015, Volume: 27, Issue:8 Topics: Acute Pain; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain;	2015
Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. Journal of clinical anesthesia, 2015, Volume: 27, Issue:8 Topics: Acute Pain; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain;	2015
Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. Journal of clinical anesthesia, 2015, Volume: 27, Issue:8 Topics: Acute Pain; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain;	2015
Preventive Analgesic Efficacy of Nefopam in Acute and Chronic Pain After Breast Cancer Surgery: A Prospective, Double-Blind, and Randomized Trial. Medicine, 2016, Volume: 95, Issue:20 Topics: Acute Pain; Adult; Aged; Analgesics, Non-Narcotic; Axilla; Breast Neoplasms; Chemoradiotherapy, Adju	2016

Article	Year
Usage analysis of ketorolac in the emergency department. The American journal of emergency medicine, 2021, Volume: 45 Topics: Acute Pain; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain; Emergency Service, Hospital; Huma	2021
When will we get a new class of analgesic agent based on animal study data? Journal of anesthesia, 2014, Volume: 28, Issue:3 Topics: Acute Pain; Bupivacaine; Chronic Pain; Humans; Ketorolac	2014
Development of an opioid reduction protocol in an emergency department. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 2015, Dec-01, Volume: 72, Issue:23 Topics: Acute Pain; Adult; Analgesics; Analgesics, Opioid; Chronic Pain; Emergency Service, Hospital; Humans	2015
Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair. Mediators of inflammation, 2016, Volume: 2016 Topics: Acetaminophen; Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pai	2016

ketorolac and Pain, Chronic