Summary: Ketamine infusion can be life-changing for people with chronic or intractable pain, providing prolonged relief and even changing the course of the disease. Doctors believe that it not only suppresses pain sensation but also helps rewire the brain, resulting in prolonged relief. There are many painful, debilitating conditions that would not benefit from regular painkillers and even from opioids. People living with chronic pain continue to suffer. Constant pain increases the risk of depression and causes other changes in the brain.
Millions are being treated for intractable or chronic pain. However, for many, treatment benefits are nothing close to satisfactory. Doctors keep changing medications and treatments. However, for some people, nothing seems to help with their pain. Chronic pains often start in unexpected ways, and many people are relatively healthy. Thus, for them, constant pain is quite a depressing experience. Even more upsetting is that doctors may not help sufficiently. For many such individuals, ketamine infusion offers hope. In many cases, it may be a life-changing treatment.
Take the example of Berkley Jones, a tough lady and nurse in the US Air Force. The kind of person who never thought she could suffer from intractable pain. She has been physically active and worked hard. However, her life changed due to an allergic reaction leading to hospitalization. After that, she would constantly feel tired and have body aches. Doctors diagnosed her with fibromyalgia.
But things kept getting worse for her when she got injured during a training exercise. As a result, she severely injured her arm. She required surgical treatment. But, when she woke up, she found that her arm was swollen more than expected, and she experienced unbearable pain, something unexpected. This was when doctors diagnosed her with Complex Regional Pain Syndrome (CRPS).
From then onwards, her life changed for the worse. She had to leave her job, and she became wheelchair-bound. She stayed in bed for long hours and became depressed. But then she heard about ketamine therapy and decided to give it a try. She stayed at the hospital for treatment which included five days of ketamine infusions, and the results were life-changing. She was back on her feet and walking with a cane. As a medic, she was amazed by the results and even wrote a book “Ketamine Infusion: A Patient’s Guide.”
Is Ketamine Approved for Chronic Pain, and How Does It Work?
Ketamine is a new trend in pain and depression treatment. However, it is quite an old medicine that has been around since the mid-20th century. For decades, it was mainly used as an anesthetic. It is a US FDA-approved anesthetic and is quite effective for post-surgical pain. Later, the US FDA also approved it to treat depression, a condition in which it may significantly alter the course of the disease.
When it comes to pain management, it is still only approved for post-surgical pains but not for chronic or intractable pains. Thus, its use in managing chronic pains is still an off-label use. Ketamine is not an opioid, and this is good about it. It means ketamine does not cause side effects characteristic of opioids and has a better safety profile. For example, it does not suppress respiration or cause severe constipation.
Nonetheless, ketamine does alter the state of mind, causing unpleasant feelings, dissociation, and even hallucinations. Thus, its use is highly regulated. As it can alter the state of mind, it has also found an illegal use in underground parties. What is unique about this drug is that it can reboot the brain. Now researchers think that it can even help rewire the brain. This may explain how it can help in conditions like depression and chronic pain. Moreover, unlike other painkillers and antidepressants, its effects are long-lasting. Thus after ketamine infusion therapy, one does not need to take medications daily or need them in much smaller dosages. It appears to help manage the root cause of many of these disorders.
Hospitals use high-dose ketamine infusions. However, doctors are now also using low-dose ketamine in pain clinics. It has a less intense effect at lower dosages, but it also causes fewer unpleasant effects. Thus, the person can go back home after the therapy. In addition, low-dose treatment makes ketamine use much safer.
Generally, clinics would give low-dose infusions for over an hour. This is because a low dose would not cause psychosis and thus is safer for use in clinical settings. However, a low-dose infusion is sufficient to help with chronic or intractable pains. It can still help rewire the brain, reduce pain sensation, help overcome pain-related distress, and even positively influence mood.
Frequently asked questions
Is ketamine an opioid?
No. Ketamine is not an opioid, and that works in its favor. It does not cause the side effects typical of opioids: it does not suppress breathing and does not cause severe constipation, so its safety profile is better. It does alter the state of mind, which is why its use is tightly regulated and why it is given under medical supervision.
How does ketamine help chronic pain?
Ketamine suppresses pain sensation, and researchers now think it helps rewire the brain. That may explain why it helps both chronic pain and depression, and why its effects last longer than those of regular painkillers and antidepressants. After ketamine infusion therapy, many people no longer need daily medication, or need it in much smaller doses.
What are the side effects of a ketamine infusion for pain?
Because ketamine alters the state of mind, it can cause unpleasant feelings, dissociation (feeling detached from your body or surroundings) and even hallucinations. Low doses have a milder effect and cause fewer of these unpleasant effects. That is why pain clinics use low-dose infusions: they are safer, and the person can go home after the therapy.
How long does a ketamine infusion for chronic pain take?
In a pain clinic, a low-dose ketamine infusion usually runs for a little over an hour, and you go home the same day. Hospitals use higher-dose infusions and may keep a patient for several days. In the story above, a nurse with CRPS stayed in the hospital for five days of ketamine infusions and was back on her feet, walking with a cane.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
