Utah Ketamine Authority

Ketamine and Pain Management

Ketamine and Treatment of Pain Management

Pain management is a series of approaches taken to alleviate chronic pain. Chronic pain conditions include: back pain, headaches, arthritis, cancer pain, or nerve and muscle pain. A pain management provider will create a plan that may include medications, therapy, injections, and exercise to assist individuals in feeling better and improving their quality of life.

Mental illness and Chronic Pain are often intertwined, and many clients benefit from learning therapeutic interventions to better cope with life’s challenges. Using Positive Psychology, Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT) clients can learn to manage anxious and depressive symptoms that trigger pain. Therapy may not be limited to the individual, but may also include family members. Loved ones can be both a source of support and conflict, however, including them in treatment can help them understand, gain coping skills, and improve communication. With support from our counselors, clients can change unhelpful ways of coping and embrace hope for the future.

Integrated Ketamine Assisted Psychotherapy (IKAP) is also a treatment option for client’s struggling with chronic pain. IKAP is the combination of psychotherapy and an IV ketamine infusion. This process invites neuroplasticity (the ability to change and grow) within the brain's neural connections. This allows clients the ability to process, embrace change, and focus on hope for the future.

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Resources and Relevant Studies

Ketamine for pain management

Key Points

There is good evidence that perioperative ketamine decreases postoperative pain scores and opioid requirements, but there is a lack of consensus on dose, for both bolus and infusion.
Despite limited evidence, a trial of low-dose intravenous or subcutaneous ketamine adjuvant to morphine may be warranted in refractory cancer pain.
There is only very limited evidence for the use of ketamine in chronic noncancer pain and concerns and a lack of safety data concerning long-term or repeated treatment. Importantly, there is no strong evidence to support the current practice of treating chronic noncancer pain with repeated intravenous infusions.
Ketamine has dose-dependent adverse effects, and there are good arguments for avoiding high doses.
Spinal administration is associated with neurotoxicity, whereas oral ketamine has low bioavailability and is associated with adverse effects.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181464/

Ketamine Use for Cancer and Chronic Pain Management

Ketamine’s analgesic effects are believed to be an effect of NMDA-receptor blockade which decreases central neuronal excitability and therefore conduction of pain impulses. However, ketamine may also have other beneficial mechanisms of action when used to treat neuropathic pain such as the inhibition of microglial activation and neuronal inflammation as discussed above and demonstrated in several animal studies.

Ketamine has repetitively been shown to reduce pain scores and subjective measures of pain. While the use of topical ketamine alone does not have strong supporting evidence, its use in multi-agent creams has been effective in some pain conditions.

Use of ketamine has classically been associated with dissociative effects, however several recent studies have demonstrated that at sub-anesthetic dosages the occurrence of psychomimetic effects in the general population is minimal. Furthermore, the risk of these adverse events can be further reduced with pre-medication of benzodiazepines.

A unique aspect of ketamine treatment in chronic pain patients is that it seems to counteract opioid-induce hyperalgesia and not therefore not only improves pain management but does so while simultaneously reducing a patient’s required total daily morphine equivalent. In some instances, this has been reported to improve quality of life while in others it serves to improve respiratory and hemodynamic stability.

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