• First synthesized in the 1960s

• It is a dissociative anesthetic that causes a decrease in pain. It’s described as dissociative because people who use it often describe it as an out of body experience. This drugs is known for its psychedelic effects which are most common known as a “K-Hole”.

• It is used recreationally (illegally) and in medical practices. It commonly used as anesthesia for procedures.

• Research is being done to see if ketamine can effectively treat psychiatric conditions, acute pain, and chronic pain (Niesters et al., 2014)

• It works by inhibiting the N-methyl-D-aspartate receptor. It may also have anti-inflammatory benefits.

• There is some evidence that ketamine inhibits sensory pathways and blocks the input of pain (Niesters et al., 2014)

• It may be a safe alternative to opioids, but both ketamine and opioids have the potential for abuse.

Can it decrease chronic pain?

• The official answer is yes. But the length of time that the pain relief varies depending on the chronic pain condition, dosage of ketamine, the number of ketamine administrations, and several other factors.

• Ketamine can also be used to treat mental health conditions such as depression, post-traumatic stress disorder, obsessive compulsive disorder, and generalized anxiety disorder (Drozdz et al., 2022).

• Ketamine has been used to treat various types of pain conditions, but it seems to be most effective for neuropathic pain (Niesters et al., 2014)

• Neuropathic pain can be defined as changes or damage within the nervous system that lead to alterations in structure and function and increase the perception of pain.

• The success rate of ketamine for reducing pain varies in each study. Some studies show that there is only pain relief during administration while other studies show that their is pain relief for up to 3 months (Niesters et al., 2014)

• The duration of pain relief may depend on the duration of the infusion.

• Ketamine has been used on a variety of conditions including complex regional pain syndrome, post-herpetic neuralgia, peripheral nerve damage, migraine headaches, pain related to spinal cord injuries, and phantom limb pain (Cohen et al., 2018).

• It is most commonly used to treat complex regional pain syndrome (Cohen et al., 2018)

• A 2005 study showed that ketamine decreases opioid use (Niesters et al., 2014).

• Ketamine can decrease depression which a large majority of people with chronic pain suffer from (Niesters et al., 2014)

• Guidelines recommend that ketamine should be reserved for those with neuropathic pain that is not responding to other treatments (Niesters et al., 2014)

How does it work?

• Ketamine has been described as a way to reset the central nervous system (Cohen et al., 2018).

• It is theorized to increase neuroplasticity within the brain and reverse a process known as pain centralization (Cohen et al., 2018).

• This process is not fully understood.

What are the side effects?

• Psychedelic effects can occur depending on the dose. This may result in one’s perception of reality being impacted. Someone may experience auditory hallucinations, paranoid ideas, anxious feelings, inability to control thoughts, and increased awareness of sound and color. (Niesters et al., 2014)

• Giving ketamine with a benzodiazepine can reduce psychedelic effects.

• Tachycardia and hypertension

• Elevated liver enzymes

• Ketamine is usually safe and well tolerated in the clinical setting.

• The benefits outweigh the risks for the majority of people with chronic pain.

Ketamine and Psychotherapy

• Research is showing that psychotherapy can prolong the effects of ketamine. This means long term results in the reduction of chronic pain and mental health conditions.

• Psychotherapy can be defined as the treatment of psychological disorders or symptoms through the promotion of personal growth, symptom management, and well-being through therapeutic techniques (Drozdz et al., 2022)

• We don’t fully understand why ketamine assisted psychotherapy works, but we believe it is related to increased neuroplasticity within the brain, reduction of pain-related fear, enhanced treatment engagement, and the restructuring of traumatic memories (Drozdz et al., 2022).

• Ketamine assisted psychotherapy involves providing education on why and how this strategy works, supervised dosing of ketamine in a safe environment, and followed-up by psychotherapy.

• Psychotherapy can be done before, during, and after ketamine administration (Drozdz et al., 2022)

• Long-term psychotherapy may be more beneficial than short-term.

• Further research is needed on ketamine assisted psychotherapy.

Sources:

Cohen SP, Bhatia A, Buvanendran A, et al. 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. Reg Anesth Pain Med. 2018;43(5):521-546. doi:10.1097/AAP.0000000000000808

Drozdz SJ, Goel A, McGarr MW, Katz J, Ritvo P, Mattina GF, Bhat V, Diep C, Ladha KS. Ketamine Assisted Psychotherapy: A Systematic Narrative Review of the Literature. J Pain Res. 2022;15:1691-1706

https://doi.org/10.2147/JPR.S360733

Niesters M, Martini C, Dahan A. Ketamine for chronic pain: risks and benefits. Br J Clin Pharmacol. 2014;77(2):357-367. doi:10.1111/bcp.12094