Ketamine Therapy for Neuropathic Pain

What the Evidence Says About Ketamine for Neuropathic Pain

Neuropathic pain — pain from nerve damage or dysfunction — is one of the conditions covered by the 2018 ASRA/AAPM/ASA consensus guidelines on IV ketamine for chronic pain (Cohen et al.). The guideline's overall conclusion frames the state of play: "evidence supports the use of ketamine for chronic pain, but the level of evidence varies by condition and dose range," with support across neuropathic conditions drawn largely from small trials showing short-term relief.

The pharmacologic rationale is direct — ketamine blocks NMDA receptors involved in central sensitization, the process that amplifies nerve pain — but durable benefit beyond the infusion period is not well established. Neuropathic pain protocols are usually run by anesthesiology- or pain-medicine-led practices alongside standard treatments such as SNRIs, gabapentinoids, and topical agents, not as a replacement for them.

FDA status: No form of ketamine is FDA-approved for neuropathic pain. 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?
• Ketamine Side Effects: Is Ketamine Therapy Safe?