An estimated 51.6 million U.S. adults experienced chronic pain in 2021, and for many people, standard treatments such as opioids, anticonvulsants, physical therapy, and nerve blocks may provide incomplete or short-lived relief (Rikard et al., 2023). At our clinic in Marietta, Georgia, we offer IV ketamine infusion therapy as an off-label option for patients with chronic pain conditions including complex regional pain syndrome (CRPS), fibromyalgia, neuropathic pain, and refractory migraines who have not found adequate relief through conventional approaches. If you have been told there is nothing more to try, we would respectfully disagree. There may still be treatment options worth exploring.
When Chronic Pain Becomes Treatment-Resistant
Chronic pain is commonly understood as pain that persists or recurs for longer than three months. When it continues despite multiple therapeutic trials, including medications, injections, procedures, and behavioral interventions, it may be described as refractory or treatment-resistant chronic pain.
Conditions such as CRPS, fibromyalgia, neuropathic pain syndromes, and chronic migraine can be particularly difficult to manage. Part of the reason is central sensitization, a state in which the central nervous system becomes persistently amplified in its pain response and continues to generate pain signals even when the original injury or stimulus has resolved.
How Ketamine Targets Chronic Pain: The NMDA Mechanism
The reason IV ketamine may help where other treatments have not comes down to its mechanism of action in the pain system. Ketamine is an NMDA receptor antagonist. It temporarily blocks N-methyl-D-aspartate receptors in the central nervous system, which are involved in central sensitization.
In plain terms, NMDA receptors can act like amplifier knobs for pain signals in the spinal cord and brain. When the nervous system becomes chronically sensitized, those amplifiers may remain turned up. Ketamine may help interrupt that cycle of amplification (Niesters et al., 2014).
Beyond its NMDA receptor activity, ketamine has effects on several neuromodulatory systems. This broader activity is one reason it has been studied in chronic pain conditions that have not responded adequately to more targeted approaches (Niesters et al., 2014). To better understand ketamine for chronic pain treatment, including how different protocols are applied, our dedicated resource covers the key considerations.
Conditions We Evaluate for IV Ketamine for Pain
At our clinic, IV ketamine pain protocols are used off-label for several chronic pain conditions.
Complex Regional Pain Syndrome
CRPS can involve burning pain, changes in skin color or temperature, swelling, and extreme sensitivity to touch. IV ketamine has been studied in patients with CRPS, including in a placebo-controlled outpatient trial. Evidence varies by protocol and patient, but consensus guidelines identify CRPS as one of the chronic pain conditions with evidence supporting IV ketamine use in appropriately selected patients (Cohen et al., 2018; Schwartzman et al., 2009).
Fibromyalgia
Fibromyalgia is associated with widespread musculoskeletal pain, fatigue, sleep disruption, and cognitive symptoms. Because central sensitization can play a role in fibromyalgia, ketamine’s NMDA-blocking mechanism has been studied as a possible option. The evidence remains limited and is primarily focused on short-term outcomes, so a comprehensive evaluation is essential before treatment is considered (Pastrak et al., 2021).
Neuropathic Pain
Neuropathic pain can result from nerve damage associated with conditions such as diabetic peripheral neuropathy, postherpetic neuralgia, or chemotherapy-related neuropathy. Ketamine may affect abnormal pain signaling through NMDA receptor activity, although evidence and expected response vary by diagnosis and protocol (Cohen et al., 2018; Niesters et al., 2014).
Refractory Migraines
For patients with refractory migraines that have not responded to standard preventive and acute treatments, IV ketamine has been studied in specialized settings. Available evidence includes small case series and observational studies, so this approach requires careful individual assessment rather than assumptions about likely response (Lauritsen et al., 2016).
Results vary by individual, and not every patient with these conditions will experience meaningful pain relief from ketamine infusions. Please discuss with your provider whether IV ketamine is appropriate given your diagnosis, history, and prior treatment trials.
Addressing Fear: Is IV Ketamine for Pain Safe?
We hear this concern frequently, and we take it seriously. Common questions involve the temporary dissociative experience and the potential for misuse.
At subanesthetic doses, ketamine may cause temporary changes in perception, dizziness, nausea, or a mildly altered state. Responsible administration includes appropriate screening, individualized dosing, ongoing monitoring, and readiness to manage adverse effects. Consensus guidelines emphasize that risk and benefit must be considered carefully, especially when higher doses or more frequent infusions are involved (Cohen et al., 2018).
Our clinical team monitors patients throughout treatment and discusses potential risks, side effects, and expectations before an infusion begins. We also review your medical history, medications, and any substance-use concerns as part of the intake process. For more guidance before beginning treatment, read what to look for in a ketamine clinic.
Addressing Cost: What Ketamine Pain Infusions Cost in Atlanta
Ketamine for chronic pain is used off-label, and payment options can vary by protocol and may change over time. We encourage prospective patients to discuss current pricing, financing options, and potential out-of-network reimbursement directly with our team during consultation.
Cost should not be the reason someone stops searching for relief.
What to Expect: The Pain Infusion Protocol
Ketamine infusion protocols for chronic pain may involve longer treatment sessions than psychiatric protocols. The recommended session length, number of infusions, and follow-up schedule depend on your diagnosis, medical history, prior treatment response, and safety considerations.
Many patients ask whether treatment involves a series of infusions and whether maintenance care may be appropriate. These decisions are individualized. We will explain the recommended protocol, monitoring plan, transportation requirements, and realistic goals before treatment begins. If you are weighing your options, exploring the psychiatric aspects of chronic pain can help you understand the full picture of how chronic pain and mental health intersect.
Frequently Asked Questions
How is a ketamine pain infusion different from a psychiatric ketamine infusion?
Pain protocols may involve different dosing and session lengths than psychiatric protocols. The specific approach is tailored to your condition and adjusted based on your response, safety considerations, and treatment goals. Results vary by individual.
How long does pain relief from ketamine last?
Relief duration varies widely. Some patients experience meaningful pain reduction after an initial series, while others may require additional care or maintenance treatment. There is currently no reliable way to predict duration of response in advance.
Will IV ketamine help with my fibromyalgia?
Fibromyalgia may involve central sensitization, which is one reason ketamine has been studied in this condition. Some research suggests possible short-term pain benefits, but response rates and duration vary, and long-term evidence remains limited (Pastrak et al., 2021). A comprehensive evaluation is required before treatment.
Can I combine ketamine infusions with my existing pain medications?
Whether you can continue current medications depends on your individual regimen. We conduct a full medication review during intake and will discuss any safety considerations with you before treatment. Do not stop or adjust prescribed medication without guidance from the clinician managing your care.
Does insurance cover ketamine infusions for chronic pain?
IV ketamine for chronic pain is an off-label treatment, and coverage can vary. Please discuss current cost, financing, and possible out-of-network reimbursement questions with our team before beginning treatment.
Key Takeaways
- Chronic pain conditions including CRPS, fibromyalgia, neuropathic pain, and refractory migraines may involve central sensitization, a state in which pain signaling remains persistently amplified.
- IV ketamine’s NMDA receptor antagonism may help interrupt central sensitization and alter pain signaling pathways (Niesters et al., 2014).
- IV ketamine for chronic pain is used off-label. Evidence varies by condition, dose, protocol, and individual patient factors (Cohen et al., 2018).
- Pain protocols may involve longer sessions than psychiatric protocols, but treatment plans should always be individualized.
- Results vary by individual, and a comprehensive evaluation is required before treatment to confirm candidacy.
Chronic pain should not define your life. At our clinic in Marietta, we work with patients across the Atlanta metro area who have tried multiple approaches and are still searching for relief. Call us at 770-580-1042 to schedule a consultation and discuss whether IV ketamine may be appropriate for you.
References
Cohen, S. P., Bhatia, A., Buvanendran, A., Schwenk, E. S., Wasan, A. D., Hurley, R. W., Viscusi, E. R., Narouze, S., Davis, F. N., Ritchie, E. C., Lubenow, T. R., Hooten, W. M., & Strichartz, G. R. (2018). Consensus guidelines on the use of intravenous ketamine infusions for chronic pain from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Regional Anesthesia and Pain Medicine, 43(5), 521–546. DOI: 10.1097/AAP.0000000000000808. https://pubmed.ncbi.nlm.nih.gov/29870458/
Lauritsen, C., Mazuera, S., Lipton, R. B., Ashina, S., & Schwenk, E. S. (2016). Intravenous ketamine for subacute treatment of refractory chronic migraine: A case series. The Journal of Headache and Pain, 17, 106. DOI: 10.1186/s10194-016-0700-3. https://pubmed.ncbi.nlm.nih.gov/27878523/
Niesters, M., Martini, C., & Dahan, A. (2014). Ketamine for chronic pain: Risks and benefits. British Journal of Clinical Pharmacology, 77(2), 357–367. DOI: 10.1111/bcp.12094. https://pubmed.ncbi.nlm.nih.gov/23432384/
Pastrak, M., Abd-Elsayed, A., Ma, F., Vrooman, B., & Visnjevac, O. (2021). Systematic review of the use of intravenous ketamine for fibromyalgia. Ochsner Journal, 21(4), 387–394. https://pubmed.ncbi.nlm.nih.gov/34984054/
Rikard, S. M., Strahan, A. E., Schmit, K. M., Guy, G. P., Jr., & Zelaya, C. E. (2023). Chronic pain among adults: United States, 2019–2021. Morbidity and Mortality Weekly Report, 72(15), 379–385. DOI: 10.15585/mmwr.mm7215a1. https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm
Schwartzman, R. J., Alexander, G. M., Grothusen, J. R., Paylor, T., Reichenberger, E., & Perreault, M. (2009). Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo controlled study. Pain, 147(1–3), 107–115. DOI: 10.1016/j.pain.2009.08.015. https://pubmed.ncbi.nlm.nih.gov/19783371/
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. IV ketamine infusion therapy for chronic pain should only be pursued under the supervision of a licensed provider familiar with your full medical history. Ketamine is FDA-approved as an anesthetic; IV use for chronic pain is off-label. Individual results vary. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room.
