Ketamine: Offering Solutions To Pain
Intravenous (IV) ketamine infusion therapy has emerged as a treatment option for a variety of chronic pain conditions including fibromyalgia, small fiber neuropathy, complex regional pain syndrome (CRPS), reflex sympathetic dystrophy (RSD) and psychiatric conditions including depression, post-traumatic stress disorder (PTSD), suicidal ideation, and obsessive-compulsive disorder (OCD).
History of Ketamine
Ketamine is not a new drug. It has been used for five decades in human and veterinary medicine. Ketamine is an anesthetic drug that was introduced into clinical practice in 1970.1 At 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 is thought that Ketamine affects multiple receptors to include opiate receptors,, its NMDA receptor antagonism at subanesthetic doses is thought to be much more important in the treatment of chronic pain and psychiatric disorders. Blocking the NMDA receptor and preventing the passage of ions through the channel interrupts pain signal transduction, giving central pain centers a chance to “reboot”. This often requires that a patient undergo a series of low dose ketamine infusions for dramatic or complete elimination of their chronic pain. Ketamine infusions have been most often used when other treatment modalities have failed. Certain types of pain considered to be “neuropathic” in origin have been most studied and are considered to be most responsive to ketamine therapy.
Ketamine infusion therapy is generally well tolerated and, as such, very few patients need to terminate treatment due 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. Patients undergoing infusions are given a benzodiazepine to control this dysphoria. Although rare, other possible side effects include nausea and rarely a headache. These side effects can also be managed and often eliminated during the infusion therapy. Following the completion of a daily infusion regimen, patients are usually tired for several hours and need to be accompanied home by a responsible adult. We have yet to observe any long-term negative side effects that can be attributed to repeated intravenous ketamine therapy. Furthermore, ketamine is not highly addictive like more common FDA approved analgesics like opioids, making it an ideal medication to study to determine how to best treat chronic pain, depression, and PTSD effectively. Dr Alvarado accepts new patients from all over the country into his treatment center to help alleviate these debilitating symptoms and regain life.