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Ketamine for Chronic Pain

Ketamine infusion Therapy is a Highly Effective Treatment for patients who have chronic pain. this includes fibromyalgia, complex regional pain syndrome (CRPS), reflex sympathetic dystrophy (RSD), migraines and more.

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Ketamine Infusions for chronic Pain

Ketamine Infusion therapy has been shown to be effective in the treatment of Chronic pain conditions such as fibromyalgia, complex regional pain syndrome (CRPS), reflex sympathetic dystrophy (rsd), migraine headaches and more.

Introduction to Ketamine for Chronic Pain

Chronic pain can be debilitating as well as demoralizing.  Understanding and treating patients with chronic pain is complicated, by a variety of different pain syndromes, causes, medications and medical conditions.  When first and second-line drugs such as opioids, anticonvulsants, or antidepressants fail to provide satisfactory pain relief, third-line drugs such as ketamine, has been shown to help. Ketamine can help in treatment of many pain syndromes.  Pain relief rates depend on the pain condition, but approximately two thirds of patients have a meaningful response.

HOW DOES KETAMINE FOR CHRONIC PAIN WORK?

As a noncompetitive antagonist of the N-methyl-d- aspartic acid receptor, ketamine produces profound regulatory effects on ascending nociceptive pain transmission.  As is the case with many neuropathic pain agents, transient antagonism at the receptor level may not fully explain the mechanism of neuropathic pain relief observed. Ketamine also modifies descending inhibitory pathways through activation of areas involved in regulation of pain, including the anterior cingulate cortex, orbitofrontal cortex, insula and brainstem, in healthy volunteers, receiving low-dose ketamine infusions.

What does this mean?

Ketamine blocks the pain receptors, producing significant pain relief.

WHAT SHOULD I EXPECT FROM MY KETAMINE INFUSIONS FOR CHRONIC PAIN?

Our mission at Virginia Infusion Therapies is to provide our patients with sustained relief from chronic pain, in a caring and comfortable environment.  While not all of our patients will find Ketamine or our other infusions to be the miracle cure. Two thirds of patients report significant improvement of their chronic pain condition.

KETAMINE FOR CHRONIC PAIN | WHAT TO EXPECT

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Free Consultation

Your ketamine infusion experience will begin with a complimentary telephone interview. If we agree that you are a good candidate, you will be invited to make an infusion appointment.

First Week

Our protocol is to perform three infusions over a one week period. Each of these infusions is approximately 4-hours in length. This allows us to deliver a dose of medication that will help with your pain, while minimizing any adverse side effects. You will find that we make every effort to make your experience at Virginia Infusion Therapies safe, soothing, and comfortable.

After Your Infusion

Following your treatment, we will have you relax, in the office for approximately 1-hour before leaving. This will allow your body to recover from the ketamine effects. Virginia Infusion Therapies is committed to your safety, thus it is imperative you meet our stringent criteria for release to home or your hotel.

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How Will You Know It's Working?

While the success rate of ketamine is notably high, it doesn’t work for everyone. Fortunately, in most circumstances, it only takes three infusions to determine whether or not you will benefit from this therapy. If there is not an adequate response after three infusions, we typically recommend discontinuing ketamine therapy.

What pain conditions can Ketamine be used for?

  • Complex Regional Pain Syndrome (CRPS) also known as (Reflex Sympathetic Dystrophy (RSD).
  • Chronic back and neck pain
  • Migraine headaches
  • Fibromyalgia
  • More uses are under investigation

Is Ketamine Safe?

When used by appropriately trained physicians, in the proper clinical setting, the answer is YES. However, Ketamine has a potential for adverse side effects, such an nausea, vomiting, rapid heart rate, transiently elevated blood pressure and temporary “out of body experience”. In the safe hand of an appropriately trained physician, these side effects can easily be managed.

Virginia Infusion Therapies’ Board Certified Emergency Physicians have the qualifications and training to administer Ketamine in a quiet, comfortable and safe environment. And, we are committed to your comfort and safety.

What are side effects of ketamine?

Most people feel temporary drowsiness, dizziness, blurry vision, coordination and cognition difficulties (clouded thinking), illusions and a dreamlike state. In addition, you may experience some, nausea and double vision. You will be given medication as needed, to alleviate any uncomfortable experiences.  You may also have a mild elevation of heart rate and blood pressure.  The side effects usually develop within 20 minutes of the start of the infusion and subside after infusion ends.  Some studies report minimal continued effects up to 4 hours after Ketamine infusions.

With the longer (4hour) infusions, you may feel need to empty your bladder.  We will have in-room accommodations for your needs.

 

Should I stop or lower doses of my current medications?

Absolutely NOT. You may find in time, with the help of your pain management, psychiatrist or other managing physician, a decreased need for some of your medications, but this is not the norm. We do not encourage you to change any medications for pain until you get on maintenance Ketamine therapy and in direct consultation with your pain management, psychiatrist or other managing physician. Failure to continue your current medication regimen, could compromise your Ketamine response and potentially put you in danger of worsening your condition. We will need to correspond with your provider before you make any medication changes.

Should I stop seeing my Pain Management Physician, Psychiatrist or Managing Physician?

Absolutely NOT.

You may find in time, with the help of your pain management, psychiatrist or other managing physician, a decreased need for some of your medications, but this is not the norm. We do not encourage you to change any medications for pain until you get on maintenance Ketamine therapy and in direct consultation with your pain management, psychiatrist or other managing physician. Failure to continue your current medication regimen, could compromise your Ketamine response and potentially put you in danger of worsening your condition. We will need to correspond with your provider before you make any medication changes.

What to expect during ketamine infusion and how to minimize side effects?

Shortly after you arrive here at Virginia Infusion Therapies, you will be escorted back to our infusion room. You will be with seated in a comfortable reclining chair with soft lighting.  Prior to this, you will be asked to empty your bladder before the infusion starts.  You will not be able to get up and walk to bathroom during the infusion. A bedside commode for women and a bedside urinal for men will be provided if necessary.

The physician will answer all the questions you have. Next, a small IV will be placed for the ketamine infusion.  We will monitor your heart rate, blood pressure, and oxygen, using a state-of-the-art monitor and you will be observed for any signs of adverse side effects. During the infusion you will be able to communicate with the physician and family, but may have difficulty with any conversations. We do not encourage conversations, as your experience will be enhanced in a quiet environment.  You are strongly urged to bring soothing music and your headphones to make the experience even more enjoyable.

Shortly after the infusion starts, you may start feeling strange and possibly have an “out of body” experience.  You may also experience some blurred vision, double vision, decreased coordination, and mild dizziness.   You can still talk and communicate your needs.  These effects are the normal and expected response to the dissociative effect of ketamine.  Having the music helps you stay connected to reality and decreases any fears you may have.  During the infusion, the physician or nurse will try to minimize stimuli in the room and give you your space, but will be immediately available for any questions or concerns.

Ketamine will heighten your senses and make you feel like you are in a dreamlike or illusionary state.  Please note that during the infusion you will not process information in the usual way.  Therefore, you may patient feel anxious. Medication is available to help during the infusion, if it is necessary.

Near the end of the infusion you may feel nauseous, due to the blurry and double vision associated with the infusion.  Closing your eyes may help stop or diminish the nausea feeling.  Medication is available if this occurs. Remember, you are being treated by Board Certified Emergency Medicine Physicians and we are trained to deal with any complications that may occur.

After the infusion we will monitor you for approximately 1 to 1.5 hours or until we feel you are safe to be able to get up and walk around safely. Even though the majority of the side effects of ketamine resolve at the end of the treatment, some studies have shown minimal effects lasting up to 4 hours after infusions.

We ask that  you don’t eat any solids or non clear liquids for 4 hours or drink clear liquids for 2 hours before appointment as you are getting a sedative medication.  Failure to comply with this requirement could potentially require us to cancel you infusion for the day and reschedule you for another day.  There will be a $100 cancelation fee if this happens.  Please setup a ride back home or to your hotel room.  You may not drive or use heavy machinery for 24 hours after the infusion. 

How long are the ketamine infusions For chronic pain?

Infusion for pain syndromes are approximately 4 hours plus 60 to 90 minutes after infusion, for in-office recovery.

What is the response rate to ketamine infusion for chronic pain, and how do you determine maintenance schedule?

Patients will need three, approximately 4-hour infusions in the first week. Depending on your response after the third infusion, a maintenance plan will be customized individually for you. Maintenance Ketamine infusions for pain syndromes, are every 1-3 months, depending on your response to therapy.   Data is limited on immediate response and duration across all pain syndromes.  Pain relief rates depends on the pain condition being treated. However about ⅔ of patients have meaningful benefits.  Some patients may have significant pain relief and can even be pain free for 6 months or more.

 

How many sessions should be done to determine if I will respond to pain infusions?

If you do not respond significantly after 3 ketamine infusions, you will be considered a non-responder. In this case it is unlikely further doses will be of benefit to you.

Ketamine for chronic pain: What to Expect

There are 4 steps to your ketamine infusion therapy.  The first step is a phone consultation to determine if you are a good candidate for ketamine therapy.  This is followed shortly by your first treatment.  Many patients will see immediate improvement after only one treatment.  Initial symptom improvement may only be temporary and requires a full loading dose followed by intermittent maintenance, as with traditional medications.

Consultation

Your initial phone consultation will be with one of our doctors.  You will be asked about your clinical history, medications, and appropriateness for ketamine infusion therapy

First Treatment

Your first treatment will be scheduled, after the phone consultation. Infusion will generally take about 4 hours, plus approximately 90minutes for recovery.

Initiation

You will be evaluated over the course of the first week to assess your response to Ketamine.  This will help determine how often you will need maintenance therapy.

Maintenance

After the first week,  most patients need a single infusion approximately every 1-3 months to sustain the benefits of ketamine therapy.

FAQs about your Ketamine Appointment

How long prior to my appointment should I arrive?
30 minutes before first session to get paperwork done, answer any further questions and get setup for procedure.

15 minutes prior to subsequent sessions to answer any questions and set up for procedure.

Do I need to have someone accompany me to my appointment?
Yes.  Will need a ride home as cannot drive or operate heavy machinery for 24 hours after infusion.
Can I eat or drink prior to my appointment?
You need to stop eating and drinking prior to your visit.  Stop all solid foods and non-clear liquids 4 hours prior to your procedure; stop all clear liquids 2 hours before your appointment.
What can I expect during my Ketamine Infusion Session?
We will review you chart, answer any further questions, place IV and monitor your vital signs.  Please make sure to use restroom prior to the infusion, as will not be able to get up and use bathroom, during the infusion, due to decreased coordination.  A urinal for men and a bedside commode for women will be available if necessary.
How do I know if I am going to respond well to Ketamine?
If you do not respond significantly after 4 sessions, for the 1 hour infusion protocol or after 3 sessions for the 4-hour infusion protocol, you will be considered a likely non-responder.  According to literature it is not recommended to continue infusions in patients that are considered non-responders.
How long will I feel better if the ketamine works for me?
Approximately 70% of patients will have improvement of their symptoms.  And, 10-30% can develop remission of their symptoms with continued treatment.  

**IT IS EXTREMELY IMPORTANT TO UNDERSTAND THAT KETAMINE INFUSION IS NOT A CURE FOR DEPRESSION, ANXIETY, CHRONIC PAIN OR OTHER CONDITIONS, BUT IS A PART OF A COMPREHENSIVE TREATMENT PLAN.  THIS  INCLUDES CONTINUING YOU CURRENT MEDICATION AND THERAPIES.

Will my insurance pay for Ketamine infusions?
At this time, most insurance plans DO NOT cover Ketamine infusion therapy.  However, we will be happy to provide documentation of your visits, if you think your plan will cover this therapy. Virginia Infusion Therapies does not participate or bill insurance plans.
Do I continue to continue my other medications if I start Ketamine Infusions? How about my other doctors?
Yes.  Please continue with all of you current therapies and treatments while receiving Ketamine infusions.  Virginia Infusion Therapies provides only the infusion therapies you need for you condition.  Your primary care doctor, mental health provider, or other specialist will need to determine if your medications should be changed or discontinued.  Making changes without consulting primary care doctor, mental health provider, or other specialist will make it more difficult to control your symptoms and may disqualify you from further treatment at Virginia Infusion Therapies. We would be happy to correspond with your providers and coordinate your care.

FAQs about Ketamine

What other conditions can be treated with Ketamine?
Ketamine infusion therapy has been found to helpful in treating a variety of medical and mental health conditions including major depression, postpartum depression, anxiety, PTSD, migraine headaches, cluster headaches and fibromyalgia.
How did researchers discover that ketamine could be used to treat depression?

Ketamine was initially noticed in anecdotal reports from anesthesia cases. They noticed anxiety, depression and pain improvement for some of their patient who underwent anesthesia for other reasons.  Some patients with severe anxiety, depression or intractable pain would report they had, at least temporary relief, of their symptoms.  John Krystal, MD in the 1990s, now the chair of psychiatry at Yale, as well as other investigators began to study how Ketamine could affect the neurotransmitters in the brain.  They discovered that ketamine’s interactions with glutamate produced a rapid antidepressant effect in patients with major depressive disorders.  Prior to these studies, most efforts in the treatment of anxiety and depression focused on medications that controlled serotonin and norepinephrine. These medications continue to be used and are helpful in conjunction with Ketamine therapy.

Is Ketamine safe?
When used by appropriately trained physicians, in the proper clinical setting, the answer is YES. However, Ketamine has a potential for adverse side effects, such an nausea, vomiting, rapid heart rate, transiently elevated blood pressure and temporary “out of body experience.” In the safe hand of an appropriately trained physician, these side effects can easily be managed.

Virginia Infusion Therapies’ Board Certified Emergency Physicians have the qualifications and training to administer Ketamine in a quiet, comfortable and safe environment. We are committed to you and your well being.

Is Ketamine a recreational drug?
Ketamine is not designed to be a recreational drug, but like other medications used to treat diseases, has been abused as a recreational drug.  As a street drug, it has been used in doses much higher than those administered for therapeutic treatment of depression, other mental health diseases, and chronic pain.  

When abused chronically and at high doses, Ketamine can become psychologically addictive. It has not been shown to be physically addictive.

However, when used at therapeutic doses, current data suggests that Ketamine to treat depression, other mental health conditions, and chronic pain may be used without any long term negative effects.  This makes it a viable treatment option for patients concerned about addiction, especially from chronic use of opiates, benzodiazepines, and other medications. In addition, there are no known long term negative side effects as with other medication used to treat these illnesses.

Can Ketamine only be given by Intravenously (IV)?
No. but, this is how we suggest it is given. Ketamine can also be given by sublingual, intramuscular, intranasal, and oral routes.  Any method other than IV has been found to be less effective and predictable than the IV route.

Our Story

Virginia Infusions Therapies was founded by four physicians with a combined 50 years of experience using Ketamine to sedate patients for procedures, in the emergency room. Over the years, they have treated severely depressed patients, PTSD, post postpartum depression, chronic or intractable pain and a myriad of other chronic conditions. Many had no great alternatives except pain and depression medications that they know has long term side effects and addictive properties. Some patients would even have to be admitted to the hospital for temporary relief of their symptoms. 

Virginia Infusion Therapies came to being when it was discovered that Ketamine, a drug that they were very familiar with for sedating their patients, was also an extremely effective option in the treatment of patients that suffer from certain mental and physical conditions such as depression, chronic pain, migraine headaches, and PTSD amongst other conditions.

Contact Infusion Therapies

Our Virginia ketamine clinic and infusion center is happy to answer any questions you have, address your concerns, and point you in the direction of health and wellbeing. To contact us, just complete the brief form below and a member of our clinical team will reach out shortly.

Referral Program

If you've had an excellent experience with Virginia Infusion Therapies, then your friends and family members may benefit also. Let them know about our ketamine infusion center, and if they schedule an appointment, you'll receive $25 off your next visit.