Ketamine is a hallucinogenic and anesthetic drug discovered in the early 1960s and used widely in the surgical treatment of soldiers during the Vietnam War. Since then, it has played a role as an analgesic and anesthetic agent in both veterinary and human medicine and has been researched for well over 50 years.
Ketamine’s benefits and side effects are well-known and understood by medical experts, which is why it retains FDA-approved uses, alongside its off-label potential as an experimental trauma treatment, anti-convulsant, and antidepressant. Because of its hallucinogenic and dissociative effects, it is also a popular recreational, or “street” drug.
As such, ketamine is both listed by the WHO as an Essential Medicine and remains strongly regulated by the DEA. While ketamine has a list of potential beneficial uses, it is not a drug to be underestimated or misused. Applied correctly, it can, however, prove an effective alternative to opioids and other classes of drugs.
What Is Ketamine Infusion?
Like other psychoactive substances, from caffeine to heroin, ketamine’s mechanism of action begins once it hits the bloodstream and interacts with a variety of receptors in the cells of our body. Its interactions with these different receptors elicit a variety of effects depending on ketamine’s dosage, and its interactions with other drugs in a patient’s system.
For example, ketamine’s pain management role may be amplified by a low dose of opioids, minimizing both the risk of opioid addiction and hallucinogenic side effects from high-dose ketamine. Ketamine’s antidepressant effects are yet to be fully understood, but its dissociative and anesthetic effects are primarily associated with ketamine’s interaction with NMDA receptors.
However, these receptors are involved in a great number of physiological functions, which is partly why high enough doses of ketamine can elicit side effects such as (but not limited to):
- Increased heart rate
- Increased blood pressure
- Nausea (in about a quarter of patients)
- Double vision
- Amnesia and dissociation
It’s generally not recommended to consider ketamine for its analgesic/painkilling effects while suffering from any condition that would be worsened by a significant uptick in blood pressure or heart rate, as well as psychiatric conditions (especially a history of psychosis or schizophrenic symptoms).
How Effective Is Ketamine Infusion in the Treatment of Pain?
Ketamine is used in both surgery and post-surgery, as well as long-term chronic pain treatment, but for a small number of patients. There are times when a patient may present with circumstances that make ketamine infusion a viable pain management option, but it is critical to discuss the topic thoroughly with your physician.
Ketamine’s analgesic effects are largely due to its interactions with our cell receptors, but whether these are the same receptors related to the patient’s pain may play a role in whether the drug will be effective. Ketamine infusion has been used to successfully to manage pain in cases of:
Some doctors recommend ketamine infusions in cases where opioids do not or have stopped working or are not a viable treatment option due to other issues, such as intolerance or addiction. Ketamine may also play a vital role in treating intractable pain. Clinical studies on the general effectiveness of ketamine have brought mixed results. Hence, its limited and specific use in patients who fit the criteria.
This is further complicated by the fact that heart and liver problems, as well as substance use and psychosis, tend to be contraindications for its use. Ketamine is administered intravenously when used for pain, typically in the form of a pain pump. This is an internal or external device that automatically delivers a dose of ketamine into the patient’s bloodstream.
Ketamine is also prescribed in pill form, as a topical gel, and via inhalants. Topical ketamine has also been effectively used to treat certain kinds of chronic pain. Being precise about when and how ketamine is administered is important, because of its hallucinogenic and dissociative side effects.
Ketamine as an Adjunct to Opioids for Chronic Pain
One of the issues with the use of opioids after an operation is that they are sometimes linked to greater postoperative pain, and their continued use diminishes their effectiveness. Sometimes, ketamine can be combined with opioid pain treatment to reduce the dosage needed to elicit a painkilling effect. Ketamine can also reduce a patient’s post-operative morphine use.
Other Therapeutic Uses of Ketamine
Ketamine is currently approved for use as an anesthetic, an analgesic, and a prescription antidepressant in nasal spray form. While it has a sedative effect, it is not used as a sedative due to the availability of better and safer alternatives. That said, it is used in emergency departments as a sedative for asthma patients, due to its bronchodilation effect.
Off-label uses for ketamine are varied and include neuroprotective use, anticonvulsive use, treatment for alcohol use disorder, and various different kinds of pain – not just acute, chronic, and neuropathic pain, but also headaches, chronic migraines, and phantom pain.
Is Ketamine Infusion Right for Me?
Before considering ketamine infusion, be sure to thoroughly discuss the treatment with your doctor. Ketamine’s potential may be vast, but because it touches on several different receptors in the brain and body, it also comes with its fair share of drawbacks. Modern pharmacology is working on finding safer ways to mimic ketamine’s effects without the side effects, such as hallucinations and high blood pressure.
However, if your pain doctor/specialist feels that ketamine may be an applicable treatment option for you, then understand that it is far more than just a recreational drug. Its analgesic and anesthetic effects have been the subject of research and medical use for half a century.