The Renaissance of Ketamine for the Treatment of Chronic Pain

The Renaissance of Ketamine for the Treatment of Chronic Pain

By Ed Coghlan.

Dr. Adam C. Young, MD is the Director, Acute Pain Service and Assistant Professor for Anesthesiology & Interventional Pain Medicine at Rush University Medical Center. Recently he agreed to share his thoughts with the National Pain Report on the use of ketamine for the treatment of chronic pain.

National Pain Report: “Ketamine has been around for a long time, and yet it seems to have a new momentum in helping treat some elements of chronic pain. What’s new in 2018?”

Adam C. Young, MD

Dr. Young: “Indeed, ketamine is an old drug that has seemed to found new meaning in the past 2 decades.  One of the reasons is published evidence of the utility of ketamine in the operative setting has shown to have promising results in reducing acute (short-term) and chronic (long-term) pain.  Another is the current crisis known as the ‘opioid epidemic.’  Ketamine is known to possess properties that reduce tolerance to opioid medications, provide pain relief via other mechanisms, and provide effects that can be long-lasting.  As the dangers of chronic opioid use have become better understood, physicians are suggesting ketamine to patients for these reasons.”

National Pain Report: “Obviously, every patient case is a little different.  What do you recommend a patient who hasn’t tried ketamine do, in terms of educating one’s self, talking with a physician, how often to have the treatments etc.?”

Dr. Young: “Discussing the nature of a ketamine treatment with your physician is essential.  Ketamine is administered typically as an intravenous infusion.  Beyond that the duration of treatment, dose of treatment, and number or treatments can vary from one physician to another.  Talk to your physician regarding the dose- how they determine it and if there are changes to it throughout treatment.  Ask about how long infusions last and how often they are performed.  Repeat infusions are fairly common and there may be a benefit to doing so at short intervals as a series.  You should ask your physician about other medications that are given during the infusion.  In my practice we administer medications to blunt some of the side effects of ketamine in order to make the infusion better tolerated and provide the patient with a better experience overall.”

National Pain Report: “What are the side effects you warn patients of when discussing ketamine treatment with them?”

Dr. Young: “Ketamine is a good drug, despite some of the aforementioned benefits it does have side effects which can be particularly bothersome.  Common side effects include nausea, vomiting, increased saliva production, and vivid dreams.  Ketamine is also known as a dissociative anesthetic, meaning it induces a trance-like state where patients can maintain consciousness but have an inability to move.  There have been cases where patients can hallucinate or experience dysphoria, an unpleasant state of consciousness.”

National Pain Report: “How much does a treatment cost?”

Dr. Young: “Costs vary from office to office and have a wide range.  I can only share what my office charges, which is roughly $1000 per treatment.  I administer ketamine in a series of 3 infusions, on consecutive days.  If a patient proceeds with all three it is roughly $3000 for the entire series.”

National Pain Report: “Looking forward to 2018, what do you think should occur regarding the use of ketamine for chronic pain?”

Dr. Young: “I wholeheartedly believe in the utility of ketamine as an adjunct in the treatment of chronic pain.  The United States’ opioid epidemic has underscored the need to treat pain without opioids- ketamine gives us a viable option to do so.  Pain physicians have embraced the use of ketamine given its spectrum of benefits with tolerable side effects.  We have seen chronic pain patient improve, wean or stop stronger oral pain medications, and see improvements in mood.  The medical literature is catching up with our clinical experience; I hope this will encourage insurance carriers to cover this treatment in the future.”

National Pain Report: “Thanks, Dr. Young.”

To learn more about ketamine and for a list of international providers, click here.

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Authored by: Ed Coghlan

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17 Comments on "The Renaissance of Ketamine for the Treatment of Chronic Pain"

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I have not had ketamine infusions, but I was kept under a Ketamine induced coma for 48 hrs and my brother was given ketamine for anesthesia even though his record clearly said he was not to get it. He died. I had terrible hallucinations and continuing nightmares. On the other hand, as a chronic pain patient I have been on a low dose opioid for several years and could not have any quality of life without it. In my experience ketamine, first developed to euthanize horses and then a street drug called “Special K” ( the date rape drug), is a dangerous medication. It is now given for acute pain in ERs which is, to my mind, both frightening and irresponsible. Opioids, properly prescribed and used have helped thousands of people in chronic, debilitating pain. The so called opioid epidemic may be real for those who use it to get high, but does not apply to those of us suffering from daily, ongoing unremitting pain.

I’m not sure what you mean by renaissance of use but I stand witness to the fact that it can be a lethal, and misused drug. At the same time, opioids are being denied, ketamine is being lauded? I question this.

I’ve done initial five day continuous ICU infusion, followed by three 6-8 hour booster infusions, originally for severe, chronic neck pain resulting from a high speed rear end crash 15 years ago. I had c-2,3 &4 fusion in 2007, which reduced pain level by about 20%, still hard to live with. I then developed trigeminal neuralgia type one and two. Ketamine helps for both problems. I got about three months of good relief following the five day and I get about six good weeks following boosters. From that point, relief tapers down slowly. I’m not sure if there is a cumulative effect of multiple treatments, I think so.
For those who would like to try this, call a teaching hospital. I’m on A Medicare plan and these hospitals do accept my insurance. For the five day, I paid $1200 out of pocket, for boosters,$250-300( price went up from 2016 to 2017).
I have high blood pressure and it does go up during infusions. So far, I have used clodidine from home to control, but next time I’m going to ask the hospital to provide it with IV, I have read that some doctors do this.
I am a guinea pig, but grateful for reduced pain and ability to be more productive. The treatments allow me to reduce other medications, including Oxycodone.
By the way, in my 15 years of using opiates, and during my last taper ( over 16 horrible months, last two the worst) I notice that pain level went down as I went down in dose.
Over time, opioids make pain levels much worse, most doctors don’t know this. Responsible doctors use “drug holidays” to keep this and severe withdrawal symptoms down, IMO. My first pain management doctor was trained by big Pharma, believing that there is no upper limit in dosage. I was up to 420 mg Oxycodone and he believe, as taught by these legal drug pushers-thanks OxyContin.
What looks like drug tolerance can also be the drug itself making pain worse.

If I correctly understand ketamine infusions, the person also receives a benzodiazepine during the infusion process. So that means the person receiving the infusion receives at least 2 highly addictive drugs. Also, if this works so well, why do the majority of chronic pain patients who receive ketamine infusions still on a daily medication regimen?!

It seems like this just a money making opportunity for some doctors I have also heard about this drug being used for depression in the same manner. I don’t understand why by now they haven’t figured out that by taking opiates away from those who truly need them and use them responsibly only harms them the bad apples should be weened out by now we have prescription monitoring programs drug screens pill counts and yet when still compliment with all that we are forced to have our dose lowered and forced to have these new treatments that are either ineffective or unaffordable leading to a life of agony misery anger depression and my final plan if I don’t get pain relief like I had with 40mgs of methadone suicide I literally can’t take the pain anymore

Many more insurance companies cover Ketamine each day. I fought for coverage and failed for years, then one day magically received a letter stating that it was covered. It varies from plan to plan and state to state. You need to call your own insurance plan and ask. You also need to vet your potential provider. They are not all created equally! Clinics seem to be popping up wherever anyone has an empty closet and an IV pole. Be an empowered patient and do your research. We only get one body. Ketamine is a very valuable tool, when used by skillful hands!

This article is a great one. Great explaining the downside of ketamines. It is a high profit, low efficacy and dangerous treatment. It is clear there will be no renaissance of “Special K”. But like Suboxone a la Kolodny, some doctors will prosper whilst a patient’s pain and pain costs skyrocket. And yes animals are put down with it in horrible fashion.

I greatly appreciate hearing about alternatives to opioids for chronic pain. There can be no down side to increasing our knowledge in the quest to better address pain. As to who can afford such a treatment… if it were to work, I would find a way to come up with the money, as I am sure many others would. It would pay for itself in the long run.

Thanks so much for sharing this article, and please continue to share information about alternative treatments for chronic pain.

Now, time for a deep dive on Ketamine ; ^ )

Do insurance companies cover these treatments? Do the side effects only last while you are getting the infusion or carry on?

Having had both first and second hand experience with ketamine, I am compelled to caution readers regarding the potential and very real down sides of ketamine which the authors mentions but downplays.and to recount a bit of the history of ketamine. The beginning use of ketamine began in two places in the last quarter of the 20 th century. It was de eloped legitimately in veterinary medicine as a horse tranquilizer and used both to sedate and put down horses. During that same period of time it had another name, “Special-K”. otherwise known as the date rape drug, was sold on the street and Likley still is. I am a person whose varied medical conditions make me a chronic pain sufferer. Dealing every day with intractable pain I most often speak up or write about the current “ War on Opioids” really being a War on Chronic Pain Patients” and fight to have the other side of the story told…..the one that acknowledges intractable pain as real and the benefits opioids for some patients as legitimate, appropriate, and necessary. I do believe that Dr. Young’s intention in this article is to legitimize our pain and seek ways to provide enough relief so that people like me can get out of bed in the morning. However, I find myself this time asking that the “ other side” of ketamine be acknowledged also. I was given Ketamine to keep me “ under” for 48 hrs between two cervical kyphosis surgeries. I can tell you it was a terrifying experience. dr, Young says it can cause “ vivid dreams”. If by that he meant intricate, brutal and horrifying hallucinations, then say it. Those surgeries were 6 years ago and I can still vividly recall not only the 48 hours between surgeries, but the weeks after. I awoke from surgery combatant, abusive, in terrible pain. I was mistrustful of everyone, cried all the time and continued to hallucinate. I was not given ketamine following surgery but the effects were with me for weeks. That was my first hand experience with ketamine. My second hand experience was when ketamine was used as an anesthetic when my brother was being operated on for a subdural hematoma. The use of Ketamine, though contraindicated for a patient on beta blockers whose record clearly states that, was determined to be medically appropriate by the attending anesthesiologist. My brother awoke from the surgeries combatant, abusive and then non- responsive. His death was the end result. I am a strong advocate for the use of medications that will allow patients with chronic pain to have some semblance of a life. Patients and their physicians should be the ones to determine what medications. But all information should be available and full. Ketamine may well help some patients, but the risks are far greater than this article suggests. Yes, I want insurance to help pay for pain medications and even more I want the FDA Opioid Policy Committee to include Physicians who treat… Read more »

I personally would be reluctant. Given the side effects and the fact that it causes vivid dreams and inability to move can only give me great concern as to the damaged it can do neurologically and damage it could cause brain tissue leading to a increase for risk of dementia, etc. We must be careful especially not knowing long term effects of this drug over the course of a decade or longer. There are so many class action and multi district litigation suits over damage from drugs that have been on the market for sometime. Everyone must do what’s best for themselves with as much information as possible and as always shouldn’t it be the patients choice of treatment and we are supposed to be a free society that can choose for ourselves what’s best for our given situation and including the treatment of Opiod’s.

I have talked with my pain management doc. He tells me ketamine infusion is not covered by insurance. I want to try it but dont have thousands of dollars to spend out of pocket.

The fact remains that most chronic pain patients who take opioids do not have complications & therefore there is no need for alternative treatment. When will doctors, pharmacists, the media & others understand that the epidemic is a heroin & fetanyl problem & all these restrictions will not change that. We need to keep shouting the truth! The most natural of medications, such as marijuana & the poppy, are less harmful when taken as directed than anything else. The chronic pain community is not the problem! Why are we punished?

I wonder about this. I was seeing a patient who had placed on a nasal spray. It was a heck of a lot cheaper than this crazy $1,000/visit charge! I would have a lot bigger disability payment if I was able to charge, and collect, that type of payment from my patients, during my limited career. But, in the, rural, US that does not appear to be a very compassionate billing practice! This type of practice ignores the typical patient. It also drains the insurance pool and drives up the $500+/month insurance bill for my wife, alone, on Obamacare. We also notice that this man seems to be poorly informed, when it comes to responsible patient care!

I’ve read that ,these treatments should always have an anesthesiologist present. Can you elaborate on that?

How many pain patients can afford $1,000-3,000 out of pocket for this type of treatment? I have used ketamine in a compounded lotion and it did reduce my pain. However, I could not afford several grand for treatments!

OK. That’s great!!! If that’s you are worried about overdosing with chronic pain patients, then have them count every so often their pain medication. You are looking in the wrong direction. And again some patients have been taking their meds for years and years. Doctors have been trying different types of meds and at the end of the day what works for one person does not work for another. Just stop this!!!! You are hurting us not helping us!!

I’ve been a pain management patient for 10yrs, the past 6yrs I’ve been seeing a very qualified pain dr. I have had a conversation about ketamine with him but was told I was not a good candidate because of my blood pressure. I was wondering if there is a way to try a really low dose to see how my body would react.I do want to atleast try.