Use of Ketamine to Treat Chronic Pain (Podcast)

Approximately 20% of U.S. adults experience chronic pain, according to the Centers for Disease Control and Prevention. During the past two decades, intravenous ketamine infusion has gained popularity as a treatment option for patients with the most refractory cases.

“If a patient has tried conventional treatments — such as medications, injections, surgery, pain psychology, pain rehabilitation programs — and their pain persists, then ketamine may be a good option,” says Pavan Tankha, DO, an anesthesiologist and pain management physician who serves as Medical Director of the Center for Comprehensive Pain Recovery in Cleveland Clinic’s Neurological Institute.

In the most recent episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Tankha talks about the use of ketamine to manage refractory chronic pain. He delves into:

• The history of ketamine and how it became a pain management treatment
• Patient selection and administration of ketamine infusion
• Contraindications and potential side effects
• The risk of addiction to ketamine
• What constitutes a positive response to treatment

Click the podcast player above to listen to the 25-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the episode

Podcast host Glen Stevens, DO, PhD: Are there certain chronic pain conditions for which ketamine works better than for others?

Dr. Tankha: Very good question. So, the literature for ketamine and pain is somewhat limited. Because of that, if you go based on simply the literature, the most extensively studied pain state is complex regional pain syndrome, where ketamine has been shown to have a modest benefit. Other neuropathic pain states, such as phantom limb and spinal cord injury, have some data to suggest it may work. Nociceptive pain pathways, such as osteoarthritis and rheumatoid arthritis, have limited to no data.

Anecdotally, based on my own experience, I’ve found that ketamine can potentially help with these conditions, but because we don’t really understand how it works, we can’t choose the appropriate candidates all the time. But given its good safety profile, I recommend giving it a try if you have exhausted other methods.

Dr. Stevens: When you give ketamine, where do you do it? What is the administration like?

Dr. Tankha: We are fortunate to have the capabilities on Cleveland Clinic’s main campus [in an infusion suite]. … It is done over a five-day period, Monday through Friday. You come in, we start an IV and we run the ketamine through your bloodstream for approximately 40 minutes. At the end of the infusion, we give you some fluids just to wash it out of your system. And then you can go home. Because ketamine is a general anesthetic, you need someone to take you back home. Some patients get a little loopy, some patients don’t feel anything. But just to be on the safe side, we ask that someone take the patient home.