Ketamine Therapy for Chronic Pain

What the Evidence Says About Ketamine for Chronic Pain

Chronic pain has its own formal guidance: in 2018, the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists published joint consensus guidelines on IV ketamine infusions for chronic pain (Cohen et al., Regional Anesthesia & Pain Medicine). Their summary conclusion: "evidence supports the use of ketamine for chronic pain, but the level of evidence varies by condition and dose range."

The guidelines found the strongest support in complex regional pain syndrome (moderate evidence for pain relief lasting up to 12 weeks with multi-day infusion protocols), with weaker, shorter-term evidence for most other chronic pain conditions. Pain protocols use longer infusions and often higher dosing than mood protocols, which is why they cost more and are offered by a narrower set of clinics — often anesthesiology-led practices.

FDA status: No form of ketamine is FDA-approved for chronic pain conditions. Generic (racemic) ketamine is FDA-approved as an anesthetic; its use for this condition is off-label, prescribed at a clinician's discretion.

Sources:

• Cohen et al., Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain (ASRA/AAPM/ASA, Reg Anesth Pain Med 2018)

Related Reading

• How Long Does Ketamine Last?
• How Much Does Ketamine Therapy Cost?