Ketamine Infusions – Can They Relieve Your Chronic Pain?

Intravenous Ketamine Infusion – Would it Relieve Your Chronic Pain?

by Andrew Germanovich, DO
Restore Orthopedics and Spine Center, Orange County

Ketamine is a drug normally used in anesthesia to create a state of unconsciousness, dissociation or sedation. The effects depend on the dose. It has been used throughout the world since the 1960’s.

Recently, it has been used to treat many chronic pain syndromes like CRPS, treatment-resistant fibromyalgia, post-herpetic neuralgia and severe depression.

There are over 1,000 publications promoting use of Ketamine for reasons other than anesthesia.

Low dose Ketamine infusion for nerve pain:

Benefits include reduced pain in the short term (during the infusion) and in the long term (up to two weeks after the infusion). 

Physiology:

The mechanism is thought to work by inhibiting an N-Methyl-D-Aspartate receptor. Without inhibition, inflammatory molecules in the spinal cord activate this receptor, which dials up pain intensity inside the central nervous system as it travels to the brain.   

Procedure:

The patient is brought to the post-operative recovery area at Restore Surgery center, where he or she will change into a gown and be placed in a hospital-type bed. We monitor the patient’s heart rate, rhythm and oxygen saturation.

A nurse will place a small gauge IV catheter and a saline solution will be delivered at a low rate. We deliver the ketamine through a special syringe pump. The rate is between 10mg-50mg per hour depending on patient needs and the treatment algorithm. Prior to the start of the infusion, the patient may receive Versed (Midazolam) for mild sedation. The entire infusion lasts 4 hours.

We recommend a close friend or a family member to accompany the patient during their infusion to ensure comfort. However, a nurse will always be available to assist during the infusion.

The infusions can be spaced out weekly or monthly depending on individual patient needs.

Side Effects:

At higher doses (for sedation and anesthesia) Ketamine can produce unpleasant side effects like hallucinations and panic attacks, drooling and fast heart rate. To manage unpleasant experiences we supplement our infusions with small dose of Versed (Midazolam) to relax the patient and decrease the likelihood of remembering these side effects if they were to occur.

Insurance Coverage:

Typically these are cash procedures, since many insurance companies deem these to be “investigational treatments”, despite the plethora of evidence in favor of ketamine in the literature. Prices range $700 – $1200 per infusion depending on individualized treatment plan.

Contact:

Contact the office of Dr. Germanovich at 714-598-1745 and ask for Rachel to schedule a consultation.

About Dr. Germanovich

With the philosophy that a thorough physical exam is crucial for successful treatment, Dr. Germanovich takes a hands-on approach to the diagnosis and treatment of pain conditions.  He uses a multi-modal treatment approach for every patient starting with therapeutic exercises, manual manipulation, heel lifts, aqua therapy and medications. If basic treatments fail, Dr. Germanovich utilizes precise spine, joint, tissue and nerve injections using ultrasound, fluoroscopy and CT guidance. For complex clinical pain syndromes he may implant spinal cord stimulation and intrathecal drug delivery systems.  Dr. Germanovich’s particular areas of interest are postural biomechanics and musculoskeletal pain due spinal and pelvic misalignment in conditions such short leg syndrome or psoas syndrome.  He is an expert on chest wall pain due to slipped rib syndrome. In addition to his traditional medical education, Dr. Germanovich utilizes osteopathic manual techniques for an accurate diagnosis and effective treatment.  Dr. Germanovich is an active member of many professional Pain Medicine and Anesthesiology societies.

Citation: 

Niesters et al. Ketamine for chronic pain: risks and benefits. British Journal of Clinical Pharmacology. 2014 Feb; 77 357-67