Ketamine has demonstrated its effectiveness in treating chronic pain, mainly when a neuropathic component is involved. The prolonged activation and upregulation of dorsal horn NMDA receptors in chronic pain lead to central sensitization, resulting in increased pain signals being sent to the brain. Ketamine’s potent analgesic properties are attributed to its inhibiting descending pathways and main anti-inflammatory effects.
Indications for Infusion and Treatment Guidelines
Ketamine has shown positive outcomes in the induction and maintenance of anesthesia, as well as analgesia and mood disorders. In the treatment of severe, chronic pain, ketamine plays a role in reversing central sensitization, reducing opioid-induced hyperalgesia, and addressing conditions such as phantom limb pain, migraine headaches, complex regional pain syndrome (CRPS), fibromyalgia, and traumatic spinal cord injuries.
For moderate CRPS improvement, researchers have used different methods, including a protocol involving an infusion of 22 mg/h or 0.35 mg/kg/h repeated over four hours. Another approach utilized a total dose of 80 mg infused over five hours.
Immediate pain relief evidence is limited for conditions such as mixed neuropathy, phantom pain, fibromyalgia, and migraine headaches.
Establishing a standardized protocol has been challenging due to discrepancies in the literature. However, despite the heterogeneity of the evidence, practice guidelines recommend initiating therapy with an 80 mg ketamine infusion over a minimum of two hours. Subsequent dosing will be determined based on the patient’s clinical response.
This article was written by a medical professional at Florida Medical Pain Management. Florida Medical Pain Management is proud to offer comprehensive pain management St Petersburg FL to a diverse group of patients. Patients at Florida Medical Pain Management can get help managing hip, knee, leg, and neck pain. The practice also offers comprehensive arthritis management, along with treatments for auto accidents, sports, and work injuries.
