Ketamine is a drug with several FDA-approved and off-label uses, including as a surgical anesthetic (sedative), veterinary anesthetic, anti-depressive, and analgesic (painkilling) drug. With many headlines surrounding it, media coverage on ketamine has led to some notable confusion.
While it does have a reputation as a street drug, ketamine is also a valuable tool in treating major depressive disorder, post-traumatic stress disorder, several different forms of chronic pain, and as an anesthetic agent in diagnostic and surgical cases. Its versatility is owed in part to the variety of effects it causes depending on dosage and method of administration, from injection into the muscle or bone to inhalation through a nasal spray.
As an analgesic drug, ketamine’s role is as an off-label alternative to opioids for cases where opioid drugs are minimally effective. Including cases of opioid tolerance, opioid addiction, and certain forms of chronic pain.
How Does Ketamine Work?
Ketamine primarily works by blocking N-Methyl-D-aspartic acid (NMDA). Although it has a complex mechanism of action that has not been fully researched. Current research has thus far revealed a litany of agonist and antagonist actions, making it an incredibly complicated pharmacological tool. Its dissociative and sedative qualities are the most well-known. And the two most notable off-label uses include its antidepressant effects and analgesic potential.
While ketamine’s potential use as an antidepressant was first uncovered in 2000, one of its enantiomers (esketamine) was approved as an antidepressant in 2019 in the form of a nasal spray, specifically for treatment-resistant depression (cases of major depressive disorder where typical treatments prove ineffective after several weeks). Studies to determine ketamine’s usefulness as a painkiller range from studying its use in non-cancer pain, to general chronic pain and complex regional pain syndrome (CRPS).
Overall, ketamine infusions can be beneficial. The rate of adverse effects was similar to placebo. The efficacy of the treatment ranged from low to substantial. The criteria for a positive response sitting at a 20 percent reduction in opioid use. With pain relief, it’s 30 percent or more.
How to Administer, Monitor Ketamine Infusion for Pain
Ketamine infusion is a slow release of ketamine via a needle under the skin, allowing the body to slowly absorb it subcutaneously. A pump feeds ketamine into the body through a butterfly needle. The dosage adjusts on how the patient responds. Dosages depend on bodyweight, the type of pain, and more.
This method allows doctors to continuously review and adjust your medication. As well as, ensuring that any side effects – should they occur – can be immediately controlled and managed completely. The device pumping the drug into the body is typically small and worn on your person. Which allows you to normally go on with your day. This is similar to a morphine pump/pain pump.
During the process, some pain clinics also supplement the patient’s body with a few other medications and nutrients to bolster the immune system. This prevents hallucinations, and support the nervous system.
Ketamine Infusion for Pain as an Alternative to Opioids
The opioid crisis provides continuing motivation to find alternatives for opioid drugs. While opioids make for a poor solution to chronic pain, their analgesic qualities are largely unparalleled for acute pain. Nevertheless, there is an ongoing opioid crisis and the continuing risks associated with opioids. From tolerance to addiction, it’s clear that many who suffer from conditions that typically warrant long-term opioid prescription . For instance, fibromyalgia, chronic migraines, and chronic non-cancer pain need an effective alternative.
Ketamine infusion for pain can be an effective medicine to curb the excessive and/or illicit use of opioids, in select cases. Ketamine is still a powerful anesthetic drug, and its use is strictly followed by the DEA. As other alternatives continue to be identified and researched, ketamine plays an important role as a drug with lots of existing and continuing research behind it.
It’s also important to note that ketamine is not officially approved for pain management. The FDA has not approved ketamine for CRPS, chronic pain, or the replacement of opioids. So far, ketamine is officially use is in depression treatment (as nasal esketamine) and as an anesthetic. Particularly in pediatric medicine and veterinary medicine. However, its off-label use as a pain management tool has helped many wean off opioids or find an alternative in cases where opioids were no longer an option.
In the future, we may identify a substance or technique that more effectively targets neuropathic and nociceptive pain. Both in the short-term and the long-term. But for now, ketamine infusion for pain is an alternative that can help patients who cannot rely on opioids for one reason or another.
Is Ketamine an Illegal Drug?
Ketamine has developed a street reputation as a recreational drug, due to the fact that it is a sedative. Among other things, some of the effects of taking ketamine recreationally include hallucination, immobility, difficulty speaking, a floating feeling, and euphoria. Excessive use can trigger psychosis and seizures and links to amnesic symptoms. Ketamine’s history as a recreational drug goes back to the 1980’s. It’s still common to refer to it as a party drug.
Understandably, this gives some people cause for concern. Swapping one addictive drug for another seems like a terrible strategy. However, ketamine addiction is much rarer and less likely than opioid addiction. And both tolerance and withdrawal issues are far less pronounced in ketamine use.
Like with opioids, the vast majority of ketamine addiction cases occur when the drug is used without any prescription. Unlike ketamine infusions, which require strict dosage control and an IV, recreational ketamine use typically involves ingestion or inhalation of the drug.
Futhermore, medical professionals are not proposing ketamine as a widespread alternative to opioids in every single case of acute and chronic pain. Medical ketamine use is and continues to be limited. Most notably for cases of CRPS and select other diagnoses of chronic pain.
In the cases where ketamine infusion for pain is the best possible alternative, the drug can lead to lasting relief. It helps patients manage their symptoms and continue seeking other, more long-term pain management solutions.