Ketamine Therapy for Chronic Pain in Asheville
Ketamine has been used in pain medicine for over fifty years. For patients whose chronic pain has not responded adequately to standard treatments, ketamine infusion therapy is a clinically established option.
Chronic Pain and the Glutamate System
Chronic pain is not just acute pain that lasts longer. The longer pain persists, the more the nervous system changes. Central sensitization is the clinical term for this: a state where the pain signaling system becomes amplified and dysregulated. The volume gets turned up on signals that should not be painful, and the brain’s interpretation of pain becomes resistant to standard interventions.
Ketamine acts as an NMDA receptor antagonist on the glutamate system. The glutamate system is centrally involved in pain signaling and central sensitization. In short, ketamine can interrupt the amplification loop that perpetuates chronic pain.
This mechanism is why ketamine has a long history in pain medicine and why it remains a relevant option for patients whose pain has not responded to standard treatments.
What the Research Shows
The evidence base for ketamine in chronic pain is one of the longer-established in ketamine medicine.
- CRPS (Complex Regional Pain Syndrome). Ketamine infusion therapy for CRPS has the strongest evidence base of any chronic pain indication. Multiple studies report significant pain reduction lasting weeks to months following infusion protocols.
- Fibromyalgia. Smaller studies and clinical experience suggest ketamine infusions can reduce pain intensity and improve function in patients with treatment-resistant fibromyalgia.
- Neuropathic pain. Including post-herpetic neuralgia, diabetic neuropathy, and certain post-surgical pain syndromes. Evidence supports ketamine as a useful tool when standard neuropathic pain medications have failed.
- Refractory headache and migraine. Some clinics offer ketamine for refractory migraine. Our current protocols focus on CRPS, fibromyalgia, and neuropathic pain.
Conditions We Evaluate
- Complex regional pain syndrome (CRPS), Type I and Type II
- Fibromyalgia (when first-line treatments have not produced adequate response)
- Neuropathic pain syndromes, including post-herpetic neuralgia and diabetic neuropathy
- Post-surgical chronic pain with neuropathic features
- Phantom limb pain
We do not currently offer ketamine for acute pain, cancer pain, or pain primarily managed by an interventional pain specialist (epidural injections, nerve blocks, implantable devices). For those conditions, work with a board-certified pain medicine physician.
Who May Be a Good Candidate
Ketamine therapy may be considered for adults with:
- Chronic pain (3+ months) in one of the indications above
- Inadequate response to first-line treatments (NSAIDs, anticonvulsants, antidepressants used for pain, physical therapy, interventional procedures where indicated)
- Significant functional impairment from pain
- A history of failed multidisciplinary pain management
You may not be a candidate if you have:
- Uncontrolled hypertension or cardiovascular disease
- Active substance use disorder (case-by-case review; some chronic pain patients have opioid use complications)
- Pain that is better managed by a different intervention (your evaluation may include this recommendation)
- Other conditions identified during medical evaluation
For chronic pain patients, the evaluation includes coordination with your existing pain management team where appropriate.
What Treatment Looks Like
Phone Consult
Free, about 15 minutes. We answer your questions, confirm whether ketamine is a likely fit for your specific pain condition, and schedule your evaluation if appropriate.
Medical Evaluation
A licensed clinician reviews your pain history, prior treatments, current medications, and treatment goals. Pain-focused evaluation includes specific questions about pain quality, distribution, triggers, and functional impact.
Infusion Protocol
Pain-focused protocols typically use different dosing than depression or anxiety. Sessions may run longer (60 to 240 minutes depending on protocol). For some chronic pain conditions, a multi-day series is recommended (3 to 5 consecutive days of infusions), followed by maintenance dosing.
Maintenance and Coordination
Pain protocols typically include maintenance dosing tailored to symptom recurrence. We coordinate with your existing pain management physician, primary care provider, or specialist when you give written consent.
Costs
Ketamine therapy for chronic pain is typically not covered by insurance and is paid out of pocket. Pricing varies based on infusion duration and protocol. HSA and FSA accepted where eligible.
Frequently Asked Questions
How long until I notice pain reduction?
Many patients report pain reduction during or immediately after the first infusion. Durable improvement typically develops over the initial series. Response varies by condition: CRPS often shows the most rapid and substantial response, fibromyalgia and neuropathic pain may require longer protocols.
How does ketamine compare to opioids for chronic pain?
The two work through different mechanisms. Opioids act on opioid receptors and produce immediate but short-lasting pain relief with substantial dependence and tolerance risk. Ketamine acts on the glutamate system, can interrupt central sensitization, and produces longer-lasting effects from a smaller number of sessions. Ketamine is not addictive in the same way opioids are when used in monitored clinical settings. For most chronic pain patients, the goal is reduction in opioid burden through alternative mechanisms.
Will I have to stop my current pain medications?
That decision is made in coordination with your prescribing physician. Most patients continue their pain medications during ketamine therapy. Some are able to taper after a positive response under their physician’s supervision.
How is ketamine for pain different from ketamine for depression?
The mechanism is related but the protocols differ. Pain-focused dosing is typically higher and longer than depression dosing. Pain treatment plans more often involve consecutive-day series for established conditions like CRPS, while depression treatment often uses shorter, spaced sessions.
Can ketamine help with my fibromyalgia?
For patients with fibromyalgia that has not responded to first-line treatments (gabapentin, pregabalin, SNRIs like duloxetine, physical therapy, exercise), ketamine may produce meaningful response. Evidence is smaller than for CRPS but clinical experience is supportive. Discuss with our clinical team during evaluation.
What about CRPS Type I?
CRPS Type I (formerly called RSD) has the strongest evidence base for ketamine therapy among chronic pain conditions. Multiple studies and decades of clinical use support ketamine infusion protocols for CRPS. We tailor the protocol to your specific case during evaluation.
Ready to Talk?
Book a free 15-minute phone consult. We answer your questions, review your case, and let you decide.
Visit: Hydrate Medical Asheville, 190 Hendersonville Rd Suite 30, Asheville, NC 28803
Ketamine therapy is not appropriate for every patient. A medical evaluation by a licensed clinician is required prior to treatment. Individual results vary. This page is educational and is not a substitute for medical advice. Hydrate Medical does not promise outcomes.
Sources
- Schwartzman RJ, et al. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study. Pain, 2009.
- Sigtermans MJ, et al. Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1. Pain, 2009.
- Cohen SP, et al. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain. Regional Anesthesia and Pain Medicine, 2018.