Ketamine Infusion TherapyThere is a growing body of pain therapists and modalities to help alleviate and in many cases eliminate chronic pain. Pain results from tissue injury, and treatment is aimed at targeting the tissue involved and the nature of the injury. All pain has commonalities with other types of pain in terms of pain pathways, neuroreceptors, neurotransmitters and central brain chemistry changes in response to chronic pain. Scientists and pain specialists continue to increase their understanding of the complexity of the pain mystery. This enables them to make treatment plans to help manage your specific pain with greater success.
The NMDA Receptor
The dorsal horn of the spinal cord is important for the transmission and modulation of pain signals arising in the periphery. An important receptor in the dorsal horn is the NMDA receptor. Peripheral pain causes the release of glutamate which binds to this receptor. This results in an opening of the NMDA receptor channel allowing the influx of ions which leads to a cascade of neurochemical events ending with pain perception by the brain. With prolonged stimulation of these receptors, a central sensitization occurs. Ketamine blocks the NMDA receptor and stops the transmission of peripheral pain signals to the brain. With prolonged blockage during Ketamine Infusion Therapy, the brain “reboots” and stops interpreting peripheral stimulation as pain.
Ketamine is not a new drug. It has been used for five decades in human and veterinarian medicine. Most commonly it has been used as a general anesthetic agent. In anesthetic doses it results in a complete loss of consciousness while preserving certain protective reflexes. That has made it attractive to anesthesiologists in selective patients. While it does stimulate opiate receptors, much like morphine, its action in subanesthetic doses as an NMDA receptor antagonist is much more important in the treatment of chronic pain. By blocking the receptor and closing the channel to ion transport, pain signal transmission is interrupted giving central pain centers a chance to “reboot”. One or a series of low dose ketamine infusions in awake patients can dramatically alter or even eliminate their chronic pain. Ketamine infusions have been most often used when other treatment modalities have been less effective. Certain types of pain considered to be “neuropathic” in origin have been most studied and are considered to be most responsive to ketamine therapy. However, other types of chronic pain such as chronic temporal mandibular joint (TMJ) pain, some headaches, and musculoskeletal pain may also benefit from ketamine infusions. The list of chronic pain syndromes that benefit from ketamine therapy continues to grow.
Who are Ketamine Infusions Likely to Help?
- Persons with neuropathic pain that is not well controlled with injections, nerve blocks, or prescription pain medication. Examples of this kind of pain are trigeminal neuralgia, complex regional pain syndrome (CRPS), or reflex sympathetic dystrophy (RSD), phantom limb pain, diabetic and other neuropathies, post-herpetic neuralgia, and some headaches.
- Persons with chronic back and neck pain no longer responsive to any form of treatment.
- Persons with debilitating fibromyalgia.
- Persons with other debilitating musculoskeletal and joint pain.
Ketamine Side Effects
Ketamine infusions are generally well tolerated, and few patients need to terminate treatment because of side effects. Still, ketamine is a derivative of phencyclidine (PCP) a known psychedelic and if not combined with sedation can cause hallucinations in many patients. You will be given a benzodiazepine to control this dysphoria. Other possible side effects include nausea and rarely a headache. These side effects also can be treated during the infusion. Following treatment patients will be tired for several hours and need to be accompanied home by a responsible adult. There are no long term side effects associated with Ketamine in the relatively low doses used to treat chronic pain. There is no chance of addiction to Ketamine.
Treatment protocols are individually planned depending on the nature of your pain and your response. In some cases a series of treatments will be recommended, often daily for a period of a week or more. The duration of pain relief following one or more ketamine infusions can not be predicted. The goal is to achieve lasting relief as measured in weeks or months following the last treatment. Most patients who enjoy prolonged pain relief will need to return on occasion for a booster infusion.
There is no guarantee that ketamine infusions will improve your chronic pain. 80% of patients will have some significant reduction in pain, approximately 15-20% of patients may not experience relief. After the first two infusions together we will decide whether the continuation of ketamine therapy is right for you. If it does provide relief, we suggest a minimum series of 5 infusions initially and can extend up to 10 infusions if needed.
Because we can not predict your response, the first two ketamine infusions will be at lower doses and of shorter duration. Starting with the third dose and thereafter, the duration of the infusions will be longer if tolerated. The Ketamine dosage will be determined individually according to your pain response.
The Cost of Treatment
The initial consultation will be billed to your medical insurance (if we are participating providers, otherwise this evaluation will be billed at time of visit). You will need a recent EKG completed before ketamine infusions can be performed, so please have this done or we will order this at your consultation. However the first 2 infusion treatments are billed together and all additional infusions will be billed per session due at time of visit.
Our cost in providing ketamine infusions is not covered by any insurance companies to the extent necessary to meet expenses. Therefore, we do not participate in any insurance plans and will not bill them on your behalf. We will provide you the necessary forms for you to submit to your insurance company after treatment for reimbursement to the extent that they will cover this service.
We accept cash, cashier checks and all major credit cards. Please contact us for cost and to schedule your appointments.