Ketamine and Pain Management
Ketamine and Treatment of Pain Management
Post traumatic Stress Disorder (PTSD) is a trauma related disorder that may occur in individuals who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, rape, or war. While PTSD is prevalent in veterans, it can affect anyone at any age. Individuals with PTSD may have disturbing thoughts and feelings related to their experience that lasts long after the traumatic event has ended. Individuals may relive the event through flashbacks or nightmares, feel sadness, fear, or anger, and may feel detached or numb when with others.
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Individuals with PTSD may find they avoid situations or people that remind them of the traumatic event. They may also have strong negative reactions too loud noises or other stimuli.
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Post traumatic Stress Disorder (PTSD) is a complex disorder that requires treatment tailored to the specific needs and symptoms of the client. Therapy for clients with PTSD focuses on rebuilding hope for the future, teaching healthy and sustainable coping skills, and improving symptoms such as: nightmares, agitation, flashbacks, anxiety, and depression. Our counselors are trained in Positive Psychology, Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT) and ready to assist clients in healing.
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Integrated Ketamine Assisted Psychotherapy (IKAP) is also a treatment option for client’s struggling with PTSD. 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 trauma, embrace change, and focus on hope for the future.
Resources and Relevant Studies - Ketamine Facts
Ketamine for pain management
Key Points
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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.
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Despite limited evidence, a trial of low-dose intravenous or subcutaneous ketamine adjuvant to morphine may be warranted in refractory cancer pain.
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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.
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Ketamine has dose-dependent adverse effects, and there are good arguments for avoiding high doses.
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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.
https://www.frontiersin.org/articles/10.3389/fphar.2020.599721/full