Pain Management Procedures
Ketamine Infusion for Chronic Pain
Ketamine Infusion for Chronic Pain
What is ketamine infusion therapy?
Ketamine is an anesthetic medicine that also affects NMDA receptors involved in pain processing. At carefully controlled doses, intravenous ketamine may be considered for selected severe chronic pain conditions. The strongest chronic-pain support is for short-term relief in some patients with CRPS; evidence for chronic headache, generalized pain, low-back pain, and many other conditions is weaker or inconsistent.
What about depression, anxiety, OCD, PTSD, and POTS?
IV ketamine is not FDA-approved to treat any psychiatric disorder. Esketamine nasal spray is a different FDA-approved product with specific indications and a restricted monitoring program. Ketamine is used off-label by some medical programs for treatment-resistant depression and other psychiatric conditions, but it requires appropriate mental-health evaluation, informed consent, monitoring, and coordination. Evidence for anxiety, OCD, PTSD, POTS, and headache varies and should not be summarized as one established indication list.
What happens during an infusion?
An IV is placed, and vital signs are monitored while ketamine is given over a defined period. The protocol depends on the diagnosis, dose, medical history, and treatment setting. Staff must be able to monitor and manage blood-pressure changes, sedation, dissociation, nausea, breathing problems, and other reactions. A responsible adult must drive you home.
What should I expect?
During treatment, you may feel detached, dreamlike, dizzy, nauseated, or sensitive to light and sound. Thinking and coordination can remain impaired after the infusion. Benefit, when it occurs, may be temporary and often requires a planned series or maintenance strategy.
Important risks and safeguards
Risks include increased blood pressure and heart rate, sedation, dissociation, hallucinations, nausea, urinary problems with repeated exposure, liver injury, breathing problems, and misuse or dependence. Certain uncontrolled heart, liver, psychotic, pregnancy, or substance-use conditions may make treatment inappropriate. APG should publish separate pain and psychiatric pathways only after confirming protocols, prescriber roles, emergency capability, and follow-up.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.