Lillian Irungu If you are living with chronic pain, you are not alone. Many Americans live with chronic pain. One nationwide survey by researchers affiliated with the Harvard Medical School says that 1 in 5 American adults live with chronic pain.
Over time, through science and research, there’re now many treatment options for chronic pain. These include physical therapy, nerve blocks, medications, and surgeries. A relatively new kid in the block is ketamine infusion. Although ketamine has been around, it’s only recently gained attention as a treatment for chronic pain.
Ketamine therapy is used for various mental conditions, including depression, but it holds promise as a treatment for chronic pain.
Although the FDA recognizes ketamine as an anesthetic, it’s yet to be recognized as a treatment for chronic pain management. Also, the research isn’t as robust as conventional treatments such as physical therapy.
If you are considering ketamine infusion for chronic pain, here is the most relevant information you’ll need before deciding.
What is Ketamine Infusion and How Does it Work?
Ketamine infusion, also known as racemic ketamine, is a medication that administers controlled doses of ketamine directly into the bloodstream. Ketamine can be administered as a spray, but when it’s an infusion, it’s administered directly to the blood.
Ketamine was used during the Vietnam war as an anesthetic. It was used because it helped surgery sedatives work and helped ease the pain. However, at higher doses, ketamine can produce hallucinogenic effects, such as altering someone’s sense of sight.
In clinics, intravenous ketamine is administered in small doses for conditions such as depression, anxiety, and chronic pain.
How Does Ketamine Treatment for Pain Management Work
Scientists are yet to pinpoint the exact mechanism through which ketamine infusion for chronic pain works. However, it’s thought that ketamine affects a receptor called NMDA involved in transmitting and receiving pain signals in the brain.
When you are in chronic pain, your NMDA can become hyperactive, worsening your pain. It’s thought that ketamine targets this receptor, and by blocking it, ketamine reduces the hyperactivity of pain signals, so your pain reduces. Ketamine may be exceptionally effective by producing potent analgesia when neuropathic pain is involved. Neuropathic pain is chronic pain caused by damage to the nervous system, such as nerves, the spine, or the brain.
It’s possible that ketamine also enhances anti-inflammatory effects at the major pain sites, which can help relieve pain.
How Ketamine Compares to Other Pain Management Treatments
Ketamine is typically not the first line of treatment for chronic pain. However, it holds promise as a treatment for chronic neuropathic pain. Let’s see how ketamine treatment for chronic pain compares to other approaches.
Ketamine is advantageous as a first-acting relief, but relief may not be permanent. Ketamine may be more effective when combined with other pain management interventions.
Chronic pain management is arguably at its most effective when multidisciplinary. Let’s…include the drug only as a part of a treatment plan that optimizes other (nonopioid) medications, activity-based therapies, behavioral approaches, and additional options as appropriate to reduce reliance on a single intervention.
J. David Clark, M.D., PhD, editorial commentary for Anesthesiology research journal
Chronic Pain Conditions That Ketamine Infusion Therapy Can Treat
Intravenous ketamine is already used in treating depression and anxiety. Ketamine infusion holds promise to treat various chronic pain conditions, especially those with a neuropathic component.
Here are some of the chronic pain conditions intravenous ketamine may treat:
- Chronic Migraines: ketamine may reduce chronic migraine-related pain by blocking the NMDA receptors
- Complex Regional Pain Syndrome: Only a tiny percentage of CRPS is chronic, but treating it becomes challenging when the pain syndrome becomes chronic. Ketamine infusion may help relieve the pain through peripheral and central desensitization.
- Fibromyalgia: Widespread musculoskeletal pain condition that amplifies pain by affecting how the brain processes pain and non-pain signals. Ketamine works by reducing central sensitization.
- Stump/Phantom Pain: Pain after limb amputation. Ketamine may increase the pressure threshold and reduce abnormal responses to non-stimuli (hyperpathia)
- Neuropathic Pain: chronic neuropathic pain is the most studied indication for intravenous ketamine, especially because conventional pharmacological therapies are often insufficient
- Ischemic Pain: People with critical limb ischemia are at a 13% risk of limb amputation. Ketamine holds more promise as a treatment option compared to opioids and other treatment strategies
It is essential to note that the response to ketamine infusion varies from one person to another. Talk with your pain doctor to determine if intravenous ketamine suits your condition.
How Ketamine Infusion Is Administered
Ketamine can be administered in multiple ways, and ketamine infusion is only one of the methods. There are reasons why intravenous ketamine for pain management is preferred over other methods, including:
- Fast On-set of Action: Since IV ketamine goes directly to the bloodstream, the effects set in rapidly, which is preferable, especially in emergencies and surgery
- Easier to Control: IV ketamine is administered in a healthcare setting where a healthcare professional can control the dosage, which is essential considering the potential side effects of high dosages.
- Increased Bio-availability: When you take a drug orally, it has to be absorbed by the gastrointestinal tract, then metabolized by the liver before it gets to your blood for circulation. Infusion bypasses this process and delivers the ketamine directly to the blood.
Other methods of administering ketamine include oral administration, intramuscular and subcutaneous injection, or intranasal spray. However, for chronic pain, intravenous ketamine is the most commonly used and studied method.
What Does Research Say About Ketamine Infusion for Chronic Pain?
Ketamine has been around for a long time but for anesthesia and analgesia. More recent research has evaluated different aspects of the use of intravenous ketamine for chronic pain. Here are some studies in the last five years:
- A 2018 paper published in the Regional Anesthesia & Pain Medicine concluded that evidence supports ketamine infusion for chronic pain, but more large-scale research is required to determine efficacy, enhance patient selection and determine minimum therapeutic dosage.
- Another 2018 paper published on Current Pain and Headache Reports concluded that ketamine infusion could provide clinically effective pain relief for a short term of fewer than three months when treating complex regional pain syndrome.
- A 2019 systematic review study published on Anesthesia & Analgesia concluded that intravenous ketamine provides a short-term analgesic effect on patients with chronic refractory pain, although there’s a need for more extensive studies.
- A 2020 expert review article published in the Expert Review of Clinical Pharmacology highlights that clinical evidence and animal studies suggest that a single dose of ketamine infusion can provide long-lasting but not permanent pain relief.
Most research studies on intravenous ketamine for chronic pain highlight that ketamine infusion is an effective pain reliever. However, they also indicate that responses may vary depending on chronic pain conditions and dosage. Therefore, it’s essential to note that research on using ketamine for chronic pain is still ongoing.
How Can Ketamine Infusion Improve Your Life Quality
Chronic pain can impact your quality of life, for example, by limiting your ability to perform activities of daily living. Ketamine infusion can help you manage chronic pain, especially if other treatments have failed.
It’s essential to note that the best approach to chronic pain is multimodal; thus, a pain medicine doctor may recommend combining ketamine with another pain management strategy, such as physical therapy.
Here are ways ketamine infusion for chronic pain can improve your life:
Lessening the Intensity of Pain
One of the ways ketamine infusion works is by blocking NMDA receptors involved in the transmission and perception of pain. If the ketamine relieves the pain, you can focus on other activities such as work or home chores.
Reducing Inflammation
Chronic pain conditions such as fibromyalgia and complex regional pain syndrome are often associated with inflammation. Ketamine has anti-inflammatory effects that can help reduce inflammation.
Reducing The Need for Other Medications, Especially Opioids
Some studies have found ketamine to be a suitable alternative to opioids, which are addictive. For example, a study by researchers from Hitchcock Medical Center found that when patients with formed opioid addiction used intravenous ketamine for pain management, they had lesser dependence on opioid consumption and less pain after surgery.
Providing Long-term Pain Relief
Ketamine infusion for chronic pain may provide long-term relief, although the relief may not be permanent. Ketamine may also offer immediate relief, which could be helpful when you have unbearable pain.
Improving Mental Health and Emotional Well-Being
As a bonus, ketamine infusion may improve your mood. For starters, by relieving your pain, you’ll be under less emotional distress. Ketamine has anti-depressant effects with rapid on-set action, which is helpful if, apart from chronic pain, you are also depressed or living with anxiety.
Potential Side Effects of Ketamine Infusions
Ketamine infusion for chronic pain is typically considered safe when administered by a qualified medical professional in a healthcare setting and the right doses. However, like any drug, there are some potential side effects and risks associated with ketamine infusion, including:
- Lightheadedness and changes in heart rate
- Nausea and vomiting
- Hallucinations and perceptual disturbances such as blurry vision
- In some rare cases, some people may have out-of-body experiences
- When used alongside other drugs, ketamine can cause urinary dysfunction
It’s essential to note that people react differently to drugs such as ketamine, so you should talk to your doctor if you are experiencing some side effects. Some people use ketamine but never have side effects, while others develop side effects on first use.
One research presented at the 2019 American Society of Anesthesiologists Anesthesiology Conference found that for 297 patients that received ketamine infusion, 20% of them developed side effects related directly to ketamine, while 15% had effects related to combining ketamine and other drugs.
How Ketamine Infusion Is Monitored to Minimize Risks
To minimize risks associated with ketamine infusion, your doctor may take some of the following measures and monitoring techniques:
- Administration by a Trained Professional: For safety purposes, ketamine can only be administered by a qualified medical professional, such as a pain medicine doctor or anesthesiologist
- Vital Sign Monitoring: The medical practitioner will monitor vital signs such as blood pressure, heart rate, and oxygen saturation during the ketamine infusion process
- Medical History and Physical Examination: A physician may do a physical examination to ensure you’re not at risk of gross side effects. They may also explore your medical history for cases of past ketamine effects or improper use.
- Dosage Control: Ketamine infusion allows for dosage control, so the doctor can monitor your progress and adjust the dosage to produce therapeutic effects without the adverse effects
- Post-Infusion Monitoring: The health practitioner may continue monitoring after the ketamine infusion for delayed side effects and give an okay before discharging patients
Signs You Are Not a Good Candidate for Ketamine Infusion
Ketamine may be a promising treatment that’s often better than opioids. However, it’s not for everyone. For some people with chronic pain, it would be best to avoid ketamine altogether.
Here are some tell-tale signs you are not an ideal candidate for a ketamine infusion:
- You Have High-Blood Pressure: If you have cardiovascular disease or a history of uncontrolled high blood pressure, ketamine may exacerbate your situation.
- History of Psychosis: Ketamine is a powerful psychedelic that can cause hallucinations and perceptual disturbances, which could be non-ideal for someone with a history of psychosis
- If You Are Pregnant: There isn’t enough data to recommend or restrict the usage of ketamine during pregnancy. The American Addiction Centers do not recommend using ketamine while pregnant to be on the safer side.
- Certain Medical Conditions: Some health conditions, such as severe liver or kidney disease, can make a patient a poor candidate for ketamine infusion
- History of Ketamine Abuse: Ketamine may help people overcome opioid addiction, but it can become addictive too. If you have had a history of ketamine overuse, it’d be best to avoid it altogether.
What to Expect During a Ketamine Infusion Treatment
Preparing For a Ketamine Infusion Treatment
If you settle on taking intravenous ketamine for chronic pain, preparing before can ensure the best outcomes. Your ketamine clinic may recommend some of the following tips:
- Talk to your doctor first, especially if you are going to a different clinic with a separate specialist.
- Avoid eating or drinking before the infusion to prevent the likelihood of nausea and vomiting.
- Plan for transportation because you may be unable to drive after an infusion. Ask a friend or family to pick you up.
- Dress comfortably because ketamine treatment can leave you dizzy and disoriented, so it’s best if your clothes can fit easily.
- Bring entertainment: A typical ketamine infusion for depression takes about 45-60 minutes, but an infusion for pain management may take a few hours.
What Happens During a Typical Ketamine Infusion Treatment?
Ketamine infusion for chronic pain varies by the clinic, but you’ll most likely be seated in a comfortable chair or on a bed. Some clinics may provide a soft blanket because the rooms may be cooler.
IV ketamine administration is typically slow as the solution drips and gets absorbed into your body. As a result, you may start feeling dissociated from your surroundings, changes in perception, or mild-moderate hallucinations. Don’t worry; these feelings fade off a few hours after the infusion.
After the infusion, you may still feel groggy and take some time to regain full functionality. As a result, your ketamine infusion specialist will likely ask you to rest as the effects wear off.
Some people experience immediate effects after using intravenous ketamine, while for others, the effect begins after 10-30 minutes.
Costs and Insurance Coverage for Ketamine Infusion
How Much Does Ketamine Infusion Treatment for Chronic Pain Cost?
The cost of ketamine infusion for chronic pain can vary depending on the following:
- The location of the ketamine infusion clinic
- Your insurance coverage
- The frequency of your treatment
Ketamine infusion for chronic pain typically costs more than infusions for mental health issues.
You can expect to spend between $400 to $ 1000 per infusion. Here are some quotes from different parties:
- The Ketamine Wellness Centers – $ 889 per infusion.
- Healing Maps- $300-800 per infusion, with $1000 per infusion being extreme case
- Ketamine.net- about $750 per session, with basic care costing an average of $89
The pricing range is so wide because although the treatment is the same in all clinics, other factors, such as the provider’s expertise and the location of the pain clinic, determine how much they charge.
Most ketamine clinics offer lower pricing if you do a series of infusions for about 5-6 sessions.
Here is a helpful way to determine ketamine infusion for chronic pain pricing:
Will My Policy Cover Ketamine Infusion Treatment?
The short answer is no, but it’s not that simple. There’re a few reasons why providers may not provide coverage for ketamine infusion for chronic pain:
No Specific FDA Approval:
Ketamine is FDA-approved, but for anesthesia and analgesia. That means the FDA does not approve ketamine infusion for chronic pain. But hold tight. Not getting approval from the FDA for chronic pain doesn’t make ketamine unsafe. However, getting approval is expensive and lengthy, and a pharmaceutical company must evaluate if there’s a financial incentive to fund studies.
Insurance providers such as Medicare typically do not cover treatments without FDA approval.
Experimental Drug?
Other insurance providers assert that ketamine is still an experimental drug. However, as more research pours into using intravenous ketamine for chronic pain and mood disorders, this may change.
Off-label Use
Ketamine is approved as a drug, allowing physicians to use discretion in treating conditions such as chronic pain. However, according to the Agency for Healthcare Research and Quality, 20% of drugs used to treat conditions are marked off-label.
Insurance providers may decline to cover treatments that use off-label drugs.
Exceptions to the Rule
It’s possible that your insurance provider may pay part of your ketamine infusion session costs. In some rare cases, some patients have had their complete treatment covered, but those are extreme examples. Here’re some points to note:
- You may get off-network reimbursement for your ketamine infusion session to cover costs such as office visits, cardiac monitoring during the session, and extra medications
- Some people use a superbill, an itemized breakdown of all the services and treatments. You can use this superbill to get your insurance provider to reimburse part of the costs.
- Some people may have more success getting some of their ketamine infusion costs covered by gaining authorization first. That means your healthcare provider sends a formal request to an insurance provider.
Things Are Likely to Change in the Future
Insurance coverage for ketamine infusions is currently a murky topic that may get clearer in the future. A related product, nasal esketamine (Spravato), recently got FDA approval for depression treatment. In addition, as more research dives into non-opioid treatments for chronic pain, ketamine infusions may get covered by providers. In the meantime, speaking to your healthcare and insurance providers is the best strategy. You may find there are ways you could get part of your costs covered.
Choosing a Ketamine Infusion Provider
If you’re ready to try ketamine infusion for chronic pain management, it’s time to choose a ketamine infusion provider. How do you choose?
How To Find a Reputable Ketamine Infusion Provider
An excellent place to start is the American Society of Ketamine Providers directory page, a professional but non-profit group dedicated o ensuring the safe use of ketamine for chronic pain and mental disorders.
Another tip is to ask your pain medicine doctor for recommendations. While they may not provide ketamine treatments, they may know qualified specialists near your location.
A third option is to use online directories such as Find Ketamine and Ketamine Directory, then use other factors such as doctor’s skill to filter the clinics.
Lastly, you can ask for recommendations from friends who have used ketamine providers before. You can also join online support groups like r/TherapeuticKetamine and r/ChronicPain on Reddit.
What To Look for When Evaluating a Ketamine Infusion Provider
- Expertise & Qualifications: Ensure that the ketamine specialist is licensed. Most clinics will indicate this on their website.
- Facility & Equipment: It’s best if the clinic is modern, clean, and observes best practices
- Patient Safety: Does the clinic has a plan in place for patient safety, such as vital signs monitoring and emergency equipment?
- Cost and Insurance Cover Acceptance: Some clinics may overprice their services for unnecessary overhead costs. Also, if your insurance provider can cover some of the costs, is the clinic willing to use your insurance coverage?
- Reviews and Recommendations: Sometimes, people’s past experiences with a provider can be telling. Do other people recommend the clinic?
- Treatment Plan: Is the provider clear on how your treatment will look like? You should be wary if a provider wants multiple infusions simultaneously.
Standard course of treatment is usually a three-treatment trial (IV infusion every other day or twice per week x 3) to assess responsiveness to ketamine treatment
American Psychiatric Nurses Association on Ketamine Infusion Therapy
Final Thoughts
Ketamine infusion may transform your chronic pain management. However, that depends on factors such as your chronic pain condition. While ketamine is yet to be approved by the FDA for chronic pain treatment, multiple studies have highlighted the efficacy of ketamine in pain treatment.
Key Take Aways
- Ketamine is a strong psychedelic approved by the FDA for anesthesia and analgesia.
- Recent research shows ketamine to be a promising treatment for mood disorders and pain conditions.
- Ketamine has not gained comprehensive coverage by most insurance policies
- Ketamine administration should be done only by a qualified professional
As with most drug-based chronic pain treatments, talking with your healthcare provider is the best strategy. You can also search online groups and testimonials of people who have used ketamine infusion for chronic pain to get a feel of the different experiences they may have had.
Frequently Asked Questions About Ketamine Infusion for Chronic Pain
1. How long does ketamine infusion for chronic pain relief last?
Some studies and patient surveys report that the average remission time after ketamine treatment for chronic pain is about three months. However, the response may vary from one person to another.
2. Will I be asleep during a ketamine Infusion for chronic pain?
Ketamine is a powerful anesthetic, but you’ll be awake during the procedure. The dosage is typically too small to induce anesthesia, but you may feel groggy and experience some sedation.
3. Why do I still feel pain after a ketamine infusion?
Like any medication, relief is not 100% guaranteed. Some other factors, such as ketamine tolerance, underlying conditions, and not tailoring the dosage to your specific needs, maybe the cause.
4. How many sessions of ketamine infusion for chronic pain should I have?
The number of ketamine infusions for chronic pain is typically 4 to 6 over several weeks, although this will vary by your provider, dosage, and chronic pain condition.
Sources
- American Psychiatric Nurses Association. Ketamine Infusion Therapy Treatment Considerations. https://www.apna.org/ketamine-infusion-therapy/
- American Society of Anesthesiologists. (2019, October 21). One in three pain patients suffer side effects after ketamine infusion therapy, a study finds. https://www.asahq.org/about-asa/newsroom/news-releases/2019/10/9-ketamine-side-effects
- Cohen, S. P., Bhatia, A., Buvanendran, A., et al. (2018). Consensus guidelines on using intravenous ketamine infusions for chronic pain from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Regional Anesthesia & Pain Medicine, 43(5), 521-546. https://rapm.bmj.com/content/43/5/521
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- Meisner, R.C. (2019, May 22). Ketamine for major depression: a new tool, new questions. Harvard Health Publishing. https://www.health.harvard.edu/blog/ketamine-for-major-depression-new-tool-new-questions-2019052216673
- National Institute of Neurological Disorders and Stroke. Peripheral Neuropathy. https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy
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