INITIALLY A BATTLEFIELD ANESTHETIC, KETAMINE IS A BURGEONING TREATMENT FOR NEUROPATHIC PAIN

“Horse tranquilizer,” “Special K,” and other misnomers. For much of its known existence, ketamine has been maligned and misunderstood. Discovered in the ’60s and used as a surgical anesthetic during the Vietnam War, ketamine is now garnering attention for its therapeutic properties when used to treat post-traumatic stress disorder (PTSD), depression, and neuropathic pain.

Steven Richeimer, MD, Chief, Division of Pain Medicine at University of South California, began working as a psychiatrist in the late ’80s and has practiced pain medicine since 1994. He has found ketamine to be an effective tool in treating neuropathic pain.

A complex pain to treat

Neuropathic pain is tricky to treat, because it is associated with the neurological system. Richeimer began using ketamine in treatments in 2014. His practice is one of a small handful in the United States that bills ketamine treatments through insurance; most other treatment centers require cash payments, with infusions costing anywhere from a couple hundred dollars to a few thousand. Because of this, there is a year-and-a-half waitlist for individuals wanting to use ketamine through Richeimer’s practice.

“[Ketamine] was used as a battlefield anesthetic, so there were already hints that it was useful to treat pain, but we really didn’t understand if it could do anything for chronic pain,” states Richeimer. Research has found that ketamine interacts with receptors associated with neuropathic pain.

How it works

Ketamine as a treatment modality can take many forms, including topical creams, oral capsules or lozenges, and nasal sprays. The most powerful treatment is done via IV infusions. If a person’s needs call for infusion therapy—be it ketamine or the newer lidocaine infusion therapy, which Richeimer says also has a promising outlook—they must pass cardiology and psychology health screens. Due to ketamine’s hallucinogenic properties, patients are heavily sedated during the infusions.

Richeimer says response to the treatment and the degree of pain relief varies from patient to patient. Some report immediate improvement during the infusion (but pain may return quickly); others see a gradual improvement that lasts for weeks and eventually months or years. Treatment regimens are determined on a case-by-case basis.

Infusions take four hours at a time, and patients are not allowed to drive themselves for 48 hours following a treatment. They are required to have someone they know drive them home, rather than using a ride-sharing service.

“For patients who are interested in the ketamine treatment, they need to understand the logistics of it are an impediment,” Richeimer says. “The IV infusions are much more potent and powerful, but also take over one’s life at least for chunks of time. It is a much more involved treatment, whereas topical and oral routes are fairly easy to integrate into a normal routine.”

“[Ketamine] was used as a battlefield anesthetic, so there were already hints that it was useful to treat pain, but we really didn’t understand if it could do anything for chronic pain.”