Dr. Adam C. Young, MD is the Director, Acute Pain Service and Assistant Professor for Anesthesiology & Interventional Pain Medicine at Rush University Medical Center. Recently he agreed to share his thoughts with the National Pain Report on the use of ketamine for the treatment of chronic pain.
National Pain Report: “Ketamine has been around for a long time, and yet it seems to have a new momentum in helping treat some elements of chronic pain. What’s new in 2018?”
Dr. Young: “Indeed, ketamine is an old drug that has seemed to found new meaning in the past 2 decades. One of the reasons is published evidence of the utility of ketamine in the operative setting has shown to have promising results in reducing acute (short-term) and chronic (long-term) pain. Another is the current crisis known as the ‘opioid epidemic.’ Ketamine is known to possess properties that reduce tolerance to opioid medications, provide pain relief via other mechanisms, and provide effects that can be long-lasting. As the dangers of chronic opioid use have become better understood, physicians are suggesting ketamine to patients for these reasons.”
National Pain Report: “Obviously, every patient case is a little different. What do you recommend a patient who hasn’t tried ketamine do, in terms of educating one’s self, talking with a physician, how often to have the treatments etc.?”
Dr. Young: “Discussing the nature of a ketamine infusion with your physician is essential. Ketamine is administered typically as an intravenous infusion. Beyond that the duration of treatment, dose of treatment, and number or treatments can vary from one physician to another. Talk to your physician regarding the dose- how they determine it and if there are changes to it throughout treatment. Ask about how long infusions last and how often they are performed. Repeat infusions are fairly common and there may be a benefit to doing so at short intervals as a series. You should ask your physician about other medications that are given during the infusion. In my practice we administer medications to blunt some of the side effects of ketamine in order to make the infusion better tolerated and provide the patient with a better experience overall.”
National Pain Report: “What are the side effects you warn patients of when discussing ketamine treatment with them?”
Dr. Young: “Ketamine is a good drug, despite some of the aforementioned benefits it does have side effects which can be particularly bothersome. Common side effects include nausea, vomiting, increased saliva production, and vivid dreams. Ketamine is also known as a dissociative anesthetic, meaning it induces a trance-like state where patients can maintain consciousness but have an inability to move. There have been cases where patients can hallucinate or experience dysphoria, an unpleasant state of consciousness.”
National Pain Report: “Looking forward to 2018, what do you think should occur regarding the use of ketamine for chronic pain?”
Dr. Young: “I wholeheartedly believe in the utility of ketamine as an adjunct in the treatment of chronic pain. The United States’ opioid epidemic has underscored the need to treat pain without opioids- ketamine gives us a viable option to do so. Pain physicians have embraced the use of ketamine given its spectrum of benefits with tolerable side effects. We have seen chronic pain patient improve, wean or stop stronger oral pain medications, and see improvements in mood. The medical literature is catching up with our clinical experience; I hope this will encourage insurance carriers to cover this treatment in the future.”
To learn more about ketamine, click here.