Ketamine Infusions

What Are Ketamine Infusions?

Ketamine infusions, also known as intravenous ketamine therapy, involve the administration of ketamine directly into the bloodstream via an intravenous (IV) line. This therapy is primarily used in the management of chronic pain conditions that have not responded well to other conventional treatments.

Ketamine, a medication primarily used for anaesthesia and pain management, works as an NMDA receptor antagonist, which can help modulate pain pathways and provide relief in these chronic pain conditions. 

By doing so, ketamine can help reduce the perception of pain and provide relief for individuals suffering from various types of chronic pain, including CPRS or complex regional pain syndrome, neuropathic pain, central pain syndromes, and certain types of cancer-related pain.

During a ketamine infusion session, patients typically receive a carefully calculated dose of ketamine solution, which is infused slowly over a set period of time under close medical supervision. 

The infusion rate and duration may vary depending on the specific condition being treated, the patient’s individual response to the treatment, and other factors such as overall health and tolerance to the medication.

Ketamine infusions are often administered in a clinical setting, such as a pain management clinic or hospital, where healthcare providers can monitor the patient’s vital signs and adjust the infusion rate as needed to ensure safety and effectiveness. 

Overall, ketamine infusions offer a potential therapeutic option for individuals suffering from chronic pain conditions that have not adequately responded to other treatments. However, like any medical intervention, ketamine infusion therapy carries certain risks and potential side effects, which should be carefully considered and discussed with your pain management doctor and entire healthcare team before undergoing treatment.

What Do Ketamine Infusions Treat?

Ketamine infusions primarily target chronic pain conditions, particularly those involving neuropathic pain, central pain syndromes, complex regional pain syndrome, and certain types of cancer-related pain. 

Neuropathic pain arises from damage or dysfunction of the nervous system, leading to abnormal signalling and perception of pain. 

Central pain syndromes involve pain that originates from the central nervous system, such as the brain or spinal cord, often resulting from conditions like stroke, multiple sclerosis, or spinal cord injury. 

Cancer-related pain can arise from the tumour itself, nerve compression, or as a side effect of cancer treatments.

Ketamine infusions can also be used to wean use of high dose opioids since it reduces hyperalgesia, manages pain, and manages symptoms of withdrawal during opioid reduction. 

How Do Ketamine Infusions Alleviate Chronic Pain?

Ketamine infusions work to treat chronic pain through several mechanisms:

• NMDA Receptor Antagonism. Ketamine blocks N-methyl-D-aspartate (NMDA) receptors in the brain and spinal cord. These receptors are involved in pain transmission and central sensitization, a process that amplifies pain signals. By inhibiting NMDA receptors, ketamine can reduce the intensity of pain signals and prevent the brain from becoming overly sensitive to pain.
• Modulation of Glutamate. Ketamine affects the neurotransmitter glutamate, which plays a key role in excitatory signalling in the nervous system. By modulating glutamate release and reuptake, ketamine can alter pain pathways and reduce chronic pain perception.
• Anti-inflammatory Effects. Ketamine has anti-inflammatory properties that can help reduce pain associated with inflammation. It inhibits pro-inflammatory cytokines and other inflammatory mediators, contributing to pain relief.
• Neuroplasticity. Chronic pain can alter brain structure and function through a process called maladaptive neuroplasticity. Ketamine can promote neuroplasticity, potentially reversing these changes and restoring more normal pain processing.
• Opioid Receptor Interaction. While ketamine primarily targets NMDA receptors, it also interacts with opioid receptors, which are involved in pain relief. This interaction can enhance the analgesic effects of ketamine and may reduce the need for opioid medications.
• Psychological Effects. Chronic pain often has a significant psychological component, including anxiety and depression. Ketamine’s dissociative and antidepressant effects can help alleviate these symptoms, indirectly reducing the perception of pain.

Why Would You Get Ketamine Infusions for Chronic Pain?

Ketamine infusions may be considered for chronic pain management for patients in situations where other treatments have been ineffective or are not well tolerated. 

Here are some reasons why someone might receive ketamine infusions for chronic pain:

• Neuropathic Pain. Ketamine infusions are often used for neuropathic pain, which arises from damage or dysfunction of the nerves. Conditions such as diabetic neuropathy, postherpetic neuralgia (shingles), and complex regional pain syndrome (CRPS) may benefit from this treatment.
• Central Pain Syndromes. Conditions like fibromyalgia, multiple sclerosis, and spinal cord injury can lead to central pain syndromes, where pain originates from the central nervous system. Ketamine infusions may help alleviate this type of pain.
• Cancer Pain. Ketamine infusions might be used to manage cancer-related pain, either as a direct result of tumour growth or as a side effect of cancer treatments like chemotherapy or radiation therapy.
• Treatment Resistance. In cases where chronic pain does not respond well to other treatments such as medications, physical therapy, or nerve blocks, ketamine infusions may be considered as an alternative or adjunctive therapy..
• Targeted Pain Relief. Ketamine infusions allow for targeted pain relief by directly acting on the nervous system, providing localised pain relief.
• Reduction of opioids. Ketamine infusions can be used to reduce high dose opioids that patients may be on due to chronic pain.

Ultimately, the decision to undergo ketamine infusion therapy for chronic pain should be made in consultation with your pain management doctor. You need to consider factors such as the specific type and severity of pain, overall health, and potential risks and benefits of the treatment.

Risks of Ketamine Infusions

Ketamine infusions, while generally considered safe and effective for managing chronic pain, do carry certain risks. Here are some potential risks associated with ketamine infusions:

• Psychological Effects. Hallucinations, vivid dreams, or other dissociative experiences, along with feelings of detachment from reality or depersonalization can occur in rare circumstances. 
• Cognitive Effects. Short-term confusion, memory issues, and difficulties with attention and concentration.
• Nausea and Vomiting. These can occur during or after the infusion.
• Dizziness and Lightheadedness. Patients may feel unsteady or faint, especially when standing up.
• Cardiovascular Effects. Increased blood pressure and heart rate. Potential for arrhythmias or other cardiac issues, particularly in patients with pre-existing heart conditions.

• Respiratory Depression. Although less common with ketamine than with other anaesthetics, there is still a risk of depressed breathing.
• Urinary Issues. Long-term or high-dose use of ketamine has been associated with urinary tract symptoms, including cystitis (inflammation of the bladder) and other bladder problems.
• Liver Dysfunction. Prolonged use of ketamine can affect liver function, though this is relatively rare.
• Dependence and Abuse. There is potential for psychological dependence and misuse, particularly if ketamine is not used under medical supervision.

• Tolerance. Over time, patients may develop a tolerance to ketamine, requiring higher doses for the same effect, which increases the risk of side effects.
• Interaction with Other Medications. Ketamine can interact with other medications, potentially leading to adverse effects. A comprehensive review of a patient’s medications is necessary before starting ketamine infusions.
• Mental Health. Patients with a history of psychiatric conditions such as schizophrenia or severe anxiety may experience worsening symptoms with ketamine.
• Monitoring Requirements. Because of the potential for serious side effects, ketamine infusions must be administered in a controlled medical setting with appropriate monitoring.

It is important that your healthcare providers thoroughly evaluate your medical history, monitor vital signs during the infusion, and adjust the infusion rate or dose as necessary to minimise the risk of adverse effects. You should also be informed about the potential risks and benefits of ketamine infusion therapy and encouraged to report any unusual symptoms or reactions during or after the infusion.

The Process of Getting Ketamine Infusions

The process of getting ketamine infusions typically involves several steps, beginning with consultation and assessment by a healthcare provider specialising in pain management. Here is a general rundown:

1. Consultation and Assessment. The first step is to schedule a consultation with a pain management specialist or healthcare provider experienced in administering ketamine infusions. During this consultation, your physician will review your medical history, conduct a physical examination, and assess your current pain condition to determine if ketamine infusion therapy is appropriate for you.
2. Discussion of Treatment Plan. If ketamine infusion therapy is deemed suitable for your condition, your pain management doctor will discuss the treatment plan with you. This includes explaining the goals of the treatment, discussing potential risks and benefits, and addressing any questions or concerns you may have.
3. Preparation. Before the infusion, you may also be advised to continue taking any prescribed medications as usual, unless instructed otherwise by your healthcare team. The infusion is performed in a hospital setting and can run between 3-5 days depending on the individual circumstances. You may also be required to be assessed by a psychologist or psychiatrist if there is a pre-existing history of mental health disorder.
4. Placement of IV Line. On the day of the infusion, you will be admitted to a ward where a healthcare provider will insert an intravenous (IV) line into a vein, usually in your arm or hand. The IV line allows for the controlled administration of the ketamine solution directly into your bloodstream.
5. Ketamine Infusion. Once the IV line is in place, the ketamine infusion will begin. The ketamine solution is typically administered slowly over a set period of time (generally less than an hour), and gradually titrated or adjusted, depending on the specific treatment protocol prescribed by your healthcare provider. Throughout the infusion, your vital signs, such as blood pressure, heart rate, and oxygen saturation, will be closely monitored by healthcare staff to ensure your safety and comfort.
6. Monitoring and Observation. During the infusion, you will be closely monitored for any signs of adverse reactions or side effects, such as changes in heart rhythm, blood pressure, or neurological symptoms. If any concerning symptoms arise, the infusion may be adjusted or temporarily halted until the symptoms are addressed.
7. Post-Infusion Care. After the infusion is complete, you will be observed for a period of time to ensure that you are stable and free from immediate adverse effects. Your pain specialist may provide instructions for post-infusion care, including any medications to take or activities to avoid.
8. Follow-Up. Depending on your response to the ketamine infusion therapy, your physician may schedule follow-up appointments to assess your progress, adjust your treatment plan if necessary, and discuss any further recommendations for pain management.

It is important to follow all pre- and post-procedure instructions provided by your healthcare provider to ensure the safety and effectiveness of the ketamine infusion therapy. Additionally, communicate openly with your pain management team about any concerns or changes in your condition throughout the treatment process.

Preparing for Ketamine Infusions

Please refrain from undergoing any additional medical procedures, such as dental treatments or colonoscopies, within 48 hours before or after getting ketamine infusions. 

Prior to your appointment, please inform us if:

• You are currently taking antibiotics.
• You have a pacemaker or defibrillator.
• You have any allergies.
• You have diabetes.
• You are feeling unwell, as we may need to reschedule your procedure.

You will need to arrange transportation to and from your appointment, as driving yourself is not advised within the 24-hour period following the procedure.

After Getting Ketamine Infusions (Follow-Up)

You can usually return home shortly after completion of a ketamine infusion. There are no specific restrictions on your day-to-day activities. However, it is advisable to prioritise rest and keep your activity level mild during the initial 24 hours post-procedure, and avoid driving or operating heavy machinery.

Occasionally, you may experience some discomfort or bruising at the injection site. Relief typically begins within 48 hours as the medication takes effect.

The effectiveness of a ketamine infusion can last anywhere from several days to weeks to months following the procedure. Please reach out to Persistent Pain Solutions with any questions or concerns during your recovery period.

Finding a Doctor Who Performs Ketamine Infusions Near You

If you are suffering from complex regional pain syndrome, neuropathic pain, fibromyalgia, chronic migraines, chronic back pain, or postamputation pain, or are dealing with central pain syndromes or cancer pain unresponsive to other treatments, then intravenous ketamine infusions may be the right treatment for you. 

Finding a pain specialist or pain management doctor who offers ketamine infusions may be a source of some relief. 

If you are suffering from one of the aforementioned conditions, ask your general practitioner for a referral to a pain management physician who can provide access to a ketamine infusion or similar procedures for neuropathic pain. You can also research pain management clinics online or speak to family members, friends, or support groups (both online and in real life) for recommendations; those who have dealt with similar chronic pain issues or other problems may have valuable advice to offer. 

Ketamine infusions can alleviate some types of pain, providing a higher quality of life for patients dealing with chronic pain conditions that have not responded well to other treatments.

Please note that Dr Mittal does not directly offer this treatment but will refer you to her collaborative associates to provide access to this treatment.