When you hear the word “ketamine” your mind may instantly go to one of its many monikers as a commonly used street drug: “special K,” “vitamin K,” or “Super K.” This drug, however, has been used in medicine for more than 50 years, most commonly for its role as an anesthetic during surgery. Recently, however, there has been much interest in the role of ketamine as a treatment for chronic pain management, and doctors have begun to prescribe low doses of this medication to patients with chronic pain conditions such as complex regional pain syndrome (CRPS).
Ketamine is a drug with sedative (sleep-producing) and analgesic (pain-relieving) effects. It combats pain by acting against a specific chemical receptor known as N-methyl-D-aspartate, or NMDA, which is found in the nervous system and, in part, modulates pain. However, ketamine interacts with other receptors as well, broadening its clinical uses.
Generally, two types of patients with chronic pain may benefit from ketamine: patients with chronic pain that have not had much success with other pain medications or treatments, and/or patients with chronic pain who plan to undergo surgery.
“I think ketamine has the potential to be a very effective pain medicine for patients: In general, patients who have been taking opioids for pain and found them to be ineffective,” said Sunavo Dasgupta, MD, founding partner at Premier Pain & Spine.
Several conditions, including cancer, CRPS, fibromyalgia, neuropathic pain, phantom pain, postherpetic neuralgia, sickle cell disease, and spinal injury, may result in chronic pain. Ketamine has been used to manage pain in all of these conditions.
As Dr. Dasgupta notes, “Its use in pain medicine is because of a very specific action in the spinal cord on a very specific set of receptors.” Due to this, doctors who prescribe ketamine do so with care, especially in patients with poorly controlled cardiovascular disease, severe liver disease, poorly controlled psychosis, substance abuse problems, elevated intracranial pressure, and glaucoma.
Ketamine can be administered through many different routes. Most commonly, ketamine is delivered through an intravenous (IV) pump. Sometimes, patients will ingest ketamine orally as a pill. Ketamine can also be applied directly to the skin as a topical gel or cream, inhaled through the nose, or injected into a muscle or bone. These available routes of administration make ketamine highly adaptable to several clinical scenarios. Regardless of the route chosen, the medication must be dosed adequately and cautiously to be effective and safe.
If you experience chronic pain and you think ketamine infusion therapy might be right for you, reach out to schedule your consultation today.