Common Questions

Ketamine can be administered through many different routes. Most commonly, ketamine is delivered through an intravenous (IV) pump. Sometimes, patients will take ketamine orally as a pill. Ketamine can also be applied directly to the skin as a topical gel or cream, inhaled through the nose, or injected into a muscle or bone. These available routes of administration make ketamine highly adaptable to several clinical scenarios. Regardless of the route chosen, the medication must be dosed adequately and cautiously to be effective and safe. We have excellent outcomes with IV ketamine infusions the treatment we provide at Infusion Therapeutix.

Generally, two types of patients with chronic pain may benefit from ketamine: patients with chronic pain that have not had much success with other pain medications or treatments, and pain that affects the central nervous system. Complex regional pain syndrome (CRPS) responds the best to ketamine infusion therapy. Patients with neuropathic and nerve pain also do well. Some patients are rapid responders to ketamine infusions and report long-term pain relief.

For chronic pain, we recommend a 5-day or an 8 to 10-day protocol depending on the type of pain, location of the pain as well as other factors. We schedule infusions Monday through Friday, early morning, or early afternoon appointments, currently no weekends. Patients may have to return for a day or two for maintenance infusions if needed to maintain good pain control.

For the last two decades, researchers at Yale have led ketamine research by experimenting with using sub-anesthetic doses of ketamine delivered intravenously in controlled settings for patients with severe depression who have not improved with standard antidepressant treatments. The results have been dramatic. In several studies, participants showed a significant decrease in depression after just 24 hours. These are patients who felt no meaningful improvement on other antidepressant medications. Treatments may be scheduled over a 2-3-week period. Two to three infusions per week over 2-3 weeks. Many patients may not need any repeat infusions for months.

Because migraine headaches are challenging to treat, specialists are paying close attention to ketamine for migraine headache pain management. Ketamine is widely known as a pain medication as well as being used for depression. It’s also used as anesthesia in higher doses. However, specialists are turning to lower doses of ketamine as a treatment option for migraine headaches as well.

Ketamine is an excellent option for patients who experience migraines and haven’t responded to other therapies. Under most circumstances, patients who respond the best to these treatments are experiencing severe migraines. These patients tend to rate their pain level between three on the 0/10 pain scale when they discharge. That’s in comparison to having a pain level of over seven when they arrive for treatment. After experiencing pain levels that are high for several days, patients want relief.

Ketamine infusion therapy is an excellent treatment for anxiety. A growing body of evidence points to the role of glutamate, a widely distributed excitatory neurotransmitter, in mediating response to stress and the formation of traumatic. Its antidepressant and anti-anxiety effects are presumed to occur through activating synaptic plasticity by increasing brain-derived neurotrophic factor translation.

Patients treated for mental health conditions will need a letter of referral from their treating mental health provider and must continue ongoing mental health treatment. Some chronic pain patients may need a referral from a pain management provider as well as a mental health evaluation if not currently being treated.

All treatments are performed in private, quiet, rooms with guest chairs. Patents relax in comfortable reclining chairs and are encouraged to bring anything that provides comfort, including eye masks and sound reducing headphones. Many patients bring their own music devices to listen to.

For chronic pain we like to see a response of pain relief by the 3rd or 4th day of treatment. Mental health usually in 2-3 days patients feel positive mood changes.

We will not treat patients who have any of the following medical issues:

• Active substance abuse (alcohol, non-prescribed medications, etc.).
• History of psychosis
• Undiagnosed mental health condition, not seeing a mental health provider
• History of increased intracranial pressure
• Uncontrolled hypertension
• Acute or unstable cardiovascular disease
• Previous negative response to ketamine
• History of ketamine abuse disorder
• Pregnancy (current)

Patients are instructed to continue to take their medications as usual except for Lamictal. We will consult with their Lamictal prescriber to make suggested adjustments to dosing during the infusion process.

While ketamine has been an FDA approved medication for anesthesia and pain since 1970, at this time, ketamine is considered an off-label treatment when administered as an IV infusion for both chronic pain and mental health conditions. The off-label use of ketamine for the treatment of mood disorders and chronic pain is supported by a growing body of research. Ketamine, as with other medications, may be administered for conditions outside its FDA-approved indications, consistent with medical standards and regulations. Although widely used throughout the world for the last 2 decades, these treatments are not covered by Medicare, Medicaid, or most private insurance carriers. We are hopeful this will change soon. If you would like to seek reimbursement as some insurance carriers may pay for a portion of the treatment, we can furnish paperwork for you to submit on your own.