This Could Be Big: Intravenous Ketamine for Fibromyalgia

This Could Be Big: Intravenous Ketamine for Fibromyalgia

By Ginevra Liptan, MD

Ginevra Liptan, MD

Ginevra Liptan, MD

Editor’s Note: Ginevra Liptan, MD is both a fibromyalgia patient and physician specialist. Her new book The FibroManual: A Complete Fibromyalgia Treatment Guide for You…And Your Doctor releases May 3, 2016.

A recent CBS news segment featured a doctor in Florida talking about his success treating fibromyalgia with intravenous (IV) ketamine, a medication usually used for surgical anesthesia. One of his patients described that her fibromyalgia pain was “virtually eliminated” by this treatment.

I wasn’t surprised to hear this. A few years back, several of my fibromyalgia patients reported mysterious pain reduction that lasted for several weeks after they underwent seemingly unrelated surgeries. In each case, I found the only consistent feature was not the type of surgery they had, but that that they had all received IV ketamine as part of their anesthesia during surgery.

The fascinating—and exciting part—is that although IV ketamine is used in anesthesia to block pain signals only temporarily, for some fibromyalgia patients it seemed to trigger a more long-lasting “cool down” of the pain signals, allowing for a period of sustained pain relief without any further medication. We don’t understand exactly how ketamine might trigger sustained pain relief. We do know that ketamine’s primary action is to block certain receptors (NMDA) that act to transmit pain signals. These NMDA receptors are massively overstimulated in fibromyalgia.

So it’s possible that a large IV dose may act to reset the system; like rebooting a computer (Have you tried turning it on and off again, the magic words any IT service person will tell you!). However, ketamine also activates opiate receptors and boosts levels of other pain lowering chemicals like serotonin, norepinephrine, and dopamine. It may be a combination of these actions that results in a pain “reboot.”

Ketamine’s medical usage has largely been curtailed because it can also be a drug of abuse. As a street drug it is known as Special K. However, resistance to medical usage is slowly changing, as more and more studies show benefit for illnesses that don’t have many treatment options. IV Ketamine has been most well studied as a treatment for resistant depression. A Washington Post article called ketamine for depression “the most significant advance in mental health in more than half a century.”

IV ketamine is slowly becoming more accepted and available for severe depression. In fact, several academic medical centers, including Yale University, the University of California at San Diego, the Mayo Clinic and the Cleveland Clinic, have begun offering IV ketamine treatments off-label for severe depression. This treatment has also shown great promise in complex regional pain syndrome, characterized by severe pain, swelling, and skin changes usually occurring after an injury.

Ketamine given intravenously is a more potent pain reliever than morphine for fibromyalgia. http://www.ncbi.nlm.nih.gov/pubmed/8610220

In one study, more than half of the patients who were treated with IV ketamine reported at least a 50% decrease in their pain levels. http://www.ncbi.nlm.nih.gov/pubmed/10781923 But these two studies only looked at immediate reduction of pain.

To assess for long-term benefits, other researchers gave one dose of IV ketamine and then tracked fibromyalgia pain levels after two weeks and then again at eight weeks. At two weeks, some residual pain benefits remained, but these had disappeared by week eight. http://www.ncbi.nlm.nih.gov/pubmed/21482474 There may be dosage or timing issues at play here, as extrapolating from research on CRPS sustained pain benefit was seen only after subjects received a series of several IV ketamine infusions over several weeks. http://www.ncbi.nlm.nih.gov/pubmed/23703410

For now, IV ketamine for fibromyalgia remains very much an experimental treatment. This means it is usually not covered by insurance and can be expensive. But as research progresses, this is slowly changing and more pain clinics are starting to offer this treatment.

For more information and a list of providers: http://www.ketamineadvocacynetwork.org

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Authored by: Ginevra Liptan, MD

There are 18 comments for this article
  1. Dr Nick Penney PhD at 8:18 pm

    Wow! at a time when the prescription of opiates is being tightened its interesting that even more potent drugs are being advocated for the treatment of fibromyalgia(FM)! Fibromyalgia is a truly Biopsychosocial pain problem and we need to consider the pain, distress, fatigue, stress, previous or current depression to name a few of the variables that may impact on the individual
    A recent article in the Journal of The American Medical Association suggested that as opiate prescription is tightened Mindfulness may be a mind/body solution worth trying, and no side effects!! Integrating pain education with mindfulness is an empowering way to help patients help themselves.

  2. Amy at 7:17 pm

    There is no way I would take horse tranquilizer for pain, unless my case was terminal. Some people might think this is great but I think it’s continuing down the wrong road and it’s going to make people worse in the end. I know it’s just my opinion, but I have read just a couple of stories here about it ruining people’s lives. I tried the Fentanyl patch years ago and it almost ruined my life. I feel like this is just another way to turn chronic pain sufferers into drug addicts. There must be a better way.

  3. Cindy May at 10:13 am

    I am very excited and hopeful at the thought of this miracle drug being made available to patients suffering these terrible diseases. I have been diagnosed with Adhesive Arachnoiditis, Fibromyalgia, Rheumatoid Arthritis, and Lupus. The pain I live with on a daily basis is not just physical but so mentally taxing on your body. I live in the Richmond area. I would greatly appreciate any info on clinics and Drs that are accepting patients such as myself so that I may be able to try this medication with hopes of living a somewhat normal life again. Thank you, Cindy May

  4. veronique at 3:17 am

    I was on Ketamine for 1 year, I received 70mg by intravenous for 6 days /week. Nurses were coming in my home to change the tube and to do the mixte.
    I had 2 heart attack symptoms I was rush to hospital twice. I lost 1 year of my life, I lost friend, jobs and memories.
    I never going to try this again.

  5. Amy at 8:33 pm

    The story doesn’t mention that ketamine is a animal traquilizer/sedative. Why?

  6. Anne at 1:06 pm

    Perhaps in another 10 years this will be mainstream if, and that’s a big “if” the alphabet groups change their pain relief prohibition stance by then. I’ve been waiting 18 years for relief, since I was 40 years old and I’m 58 years old now so I won’t hold my breath. Yes, I’m realistically and negatively biased. Is it any wonder why?

  7. Anne Cho at 5:30 am

    While this may not be appropriate for long term use I was thinking it could be used to calm down or break a prolonged flair up that many of us get into from time to time.

    I know whenever I have an outpatient procedure done under conscious sedation or deep sedation my Fibro pain and fatigue are gone for several weeks to several months. Wonder if it just might be related to being able to go into a deep sleep as well?

  8. Sue Ross at 3:31 pm

    I am interested. I have Psa, fibro, COPD, central sleep apnea, depression. I am from Pa. There are no administration sites that are close by.

  9. Will at 11:11 am

    Long term Ketamine use causes bladder problems that are very serious and taking it for 16 years i highly doubt as they would have no bladder left. I have taken it for a year roughly at 5ml every 4 hrs 24/7 and it caused me bladder problems. The drug at the start was promising with relief but that soon passed and had to be topped up with Fentanyl patches 50 changed every 3 days. Ketamine is not a long term solution at all.

  10. Beth at 10:13 am

    Perhaps Ketamine will one day prove to be very effective in treating CRPS, Fibro, Depression, and any number of other chronic pain related diseases/syndromes.
    BUT –as we’re seeing currently with Opiates– as long as the CDC, FDA and other consulting agencies have the following *control/availability attitude*, we may never know for sure:

    “Ketamine’s medical usage has largely been curtailed because it can also be a drug of abuse.”

    Using such an absurd *control/availability guideline* is, to my mind, not only Medically Irresponsible, but fundamentally illogical! This premise is a clear-cut example of a *Logical Fallacy*!

    A Logical Fallacy with Far-Reaching and *Dangerous* Repercussions!

    With the recently released CDC and FDA *Suggestions*/RULINGS(!) In Mind, I am thoroughly shocked, deeply disappointed, AND –as a CRPS-RSD/Fibro/IC/CPPS Patient– I’M TRULY, UTTERLY TERRIFIED(!!!) that the mental capabilities of the people within the CDC and FDA –the very same people who are legally making final decisions about MY healthcare– are so deficient in Intellectual Rationale, Logical Reasoning, and GOOD OLD COMMON SENSE!

    …smsh!

  11. Ed Stines at 7:59 am

    Kathy,

    I am so happy to hear of your relief from this horrid pain, there are some day where I can not function and even wondered what the end result will be. How can anyone live like this is a question which often enters my mind, more so these days than before. I know I was told in the beginning that this is progressive but damn, it is easy to forget pain when you are feeling well. Do you know what the additive for reducing the anxiety was? I am most interested.

    Thank you so much and I sincerely hope that the relief lasts forever.

    Ed

  12. Velvet at 5:59 am

    In the last 2 months I have read over a dozen articles of supposed miracle treatments or doctor’s that have finally found out how to treat or even “cure” fibromylgia. That they have finally found a way to test a person to see if they actually have fibromylgia or something else.
    You know what I think, I think no one has a clue! They took away the drugs that most fibromylgia patients found the most relief from because the DEA and the government can’t control the boarders good enough to keep the illegal drugs from being smuggled in so they punish the people who need it the most.
    And doctor’s and scientists aren’t anywhere close to figiring out what causes or the best way to treat fibromylgia. It’s just like depression, it’s different for every individual, it can only be treated case by case. Not as a whole.

  13. Linda at 2:09 am

    My sister had this to control her pain. It worked for a time but then stopped. I guess she became amuned to it.

  14. Kathy Jamison at 3:50 pm

    I had Iv ketamine treatments done in Phoenix, Amazing results! I have crps in my right foot all the way to my hip, right side of my neck and in my right arm. For three years I had pain 24/7 some days so severe I was bed ridden. 4 days of ketamine and I have been symptom free for 17 days, no muscle relaxers,no opiates, and no feeling of severe depression. I was in a room with monitors and a nurse the whole time. I can’t tell you how much I wish every Dr or pain clinic would offer this treatment. They added an anti anxiety medication so that I did not have hallucinations. The ketamine wellness center in Phoenix is awesome. I have my life back because of this treatment.

  15. Gail christmas at 1:43 pm

    I found the same thing when on chemo. Took a lot of the fibromyalgia pain away.

  16. Ed Stines at 10:23 am

    Richard, I completely agree with you however, I had surgery six weeks ago and I told my Anesthesiologist that I had CRPS and she was very aware of the condition and she suggested using a bit of ketamine in my IV. I mentioned the known hallucinatory effects which I would rather not have so she suggested adding something else to the IV to prevent that. I asked my regular Pain doc what he mystery substance could be and she suggested that it may have been propanolol (sp). After the surgery, I had no indications of CRPS for about 6 days, the longest period I had gone without symptoms and the most normal I had felt since dx. I know a lot of people in my support group who have had IV ketamine and they only have positive reactions. I am still out on this since I have had so many surgeries, implants and procedures, however this may be the way to go in the long run.

  17. Richard A. Lawhern, Ph.D. at 5:43 am

    One footnote to this interesting article: patients should be made aware that administration of Ketamine by IV can be accompanied by very vivid hallucinations (one of the reasons the drug is abused). I have heard from a couple of doctors that such a procedure is considered unsafe unless the patient is hospitalized for some period of time. So this is NOT a trivial concern, or one that should be used outside of a medically controlled environment.