Ketamine Infusion Frequently Asked Questions

What is Ketamine?
Please read http://www.nationalpain.com/introduction-to-ketamine.

What Conditions Can Ketamine Infusions Help?
Ketamine infusions can help with conditions under the central sensitization umbrella. We have successfully performed over 1200 ketamine infusions for patients with central sensitization including, but not limited to:
•  Anxiety
•  Chronic Pain (In general)
•  CRPS/RSD
•  Depression
•  Fibromyalgia
•  Headaches
•  Opioid Induced Hyperalgesia
•  Phantom Limb Pain
•  PTSD

You can read more at http://www.nationalpain.com/central-sensitization.

Can Ketamine Infusions Really Help in Severe Depression, Suicidal Ideations, and PTSD?
The simple answer is yes. We have successfully saved countless lives with ketamine infusions. It has been one of the best tools we have had, period. There have been a plethora of research publications demonstrating and supporting ketamine infusions in the management and treatment of depression and suicidal ideations. In fact, a very large pharmaceutical company is in Phase 3 trials on humans using ketamine to treat patients with depression. We have also treated numerous veterans and patients in the military with PTSD. We have also treated patients who have suffered horrible traumatic experiences, such as sexual assault and rape, who then became controlled by PTSD. We were able to allow them to control the PTSD with ketamine infusions. Dr. Joshi has been the first in the world to describe mechanism of action and treatments for PTSD. Ketamine infusions are one of the best tools known to mankind for the immediate treatment of PTSD.

Are Ketamine Infusions Safe?
When ketamine infusions are administered in a controlled medical setting by a properly trained anesthesiologist and fellowship trained interventional pain physician using custom tailored protocols for the patient, ketamine infusions are very safe. In fact, they are arguably safer than many of the medications that patients are prescribed for pain and depression! Ketamine is the only anesthetic that does not suppress the body’s cardiovascular and respiratory systems. Ketamine has a long safety record dating back almost 50 years. When administered appropriately, we have seen NO long term side effects on any part of the body, including the liver, in the 1200+ infusions we have performed. We have one of the largest ketamine infusion databases and are one of the most experienced providers of ketamine infusions so observations are more meaningful than a small study on rats (usually cited by ignorant physicians and lay people when discussing safety).

Ketamine Infusions Sound “To Good To Be True”. Is This Real?
Anyone who understands the science does not find the results of ketamine infusions to be surprising. For those of us who can integrate higher level science with clinical art, we actually are more surprised when ketamine infusions do not work. It is really simple actually. There are pathologic receptors in the central nervous system. Ketamine binds and inhibits those pathological receptors. They reset, like a computer when it is rebooted. Patients notice an immediate change that can last for days to weeks to months typically. However, for ketamine infusions to be “real”, the provider has to be “real”. Do not expect the same results if you have a ketamine infusion from a counterfeit anesthesiologist/pain specialist! In other words, if the provider is not legitimate anesthesiologist with a legitimate, accredited interventional pain fellowship with a legitimate pain practice with legitimate customized and individualized protocols for the patient, the provider is not a legitimate ketamine infusion specialist by our standards. Do you want to trust your life to a counterfeit?

In addition to all of our research and outcomes, the National Institutes of Health and pharmaceutical companies have been studying ketamine for more than ten years. There are literally hundreds of articles and publications in highly regarded scholarly journals outlining ketamine’s mechanism of action and clinical effects for decades. Dozens of these studies and publications have been conducted at Yale and other major academic institutions, NIH, the VA, Harvard, Johns Hopkins, Mt. Sinai Medical School, Oxford University, and many more around the world. A recent study from University of California, San Diego looked at over 41,000 patients with depression. They found that the incidence of depression symptoms in patients who took ketamine in addition to other pain therapeutics dropped by 50 percent compared to the patients who took any other drug or drug combination for pain. Patients who took ketamine also less frequently reported pain and opioid-associated side effects, such as constipation, as compared to patients who received other pain medications. If those patients had received ketamine infusions, the success rate would have been even higher.

Anyone who has not seen these articles, refutes the findings, or makes general blanket statements that ketamine infusions do not help with central sensitization is either ignorant, biased, been paid to make those statements, and some type of bigoted agenda, or is flat out stupid.

How Much Does a Ketamine Infusion Cost?
Please read http://www.nationalpain.com/ketamine-infusion-cost.

What is the Ketamine Infusion Like?
Please read http://www.nationalpain.com/about-the-ketamine-infusion-experience.

Why Have I Not Heard About Ketamine Infusions Before or More Often?
There are many reasons why ketamine infusions are not more widely known or offered.

One reason is education. Proper pain management is still not taught in medical schools and residency programs throughout America. If a physician has not completed an accredited pain management fellowship, it is likely that the physician does not know proper pain management. This has led to many of the problems we see on the news today.

The second reason is reimbursements. Some insurance companies do cover ketamine infusions and they have specific billing codes for ketamine infusions. Their reimbursement rates are typically not very high and that is probably one of the reasons why ketamine infusions are not done more frequently. For example, there are 30 minute procedures that we perform that yield us the same reimbursement as spending 4 hours with a patient during a ketamine infusion. The unfortunate reality is that most physicians, hospitals, and large medical groups are run like a business…it’s all about profit. What is even more unfortunate is that some of these providers and groups know how effective ketamine infusions are so the specifically do not perform them and do not refer their patients for infusions. They don’t make money if the patient gets better. We do not subscribe to that theory. We cannot subscribe to that theory. We have seen too many patients benefit from ketamine infusions. We have literally saved lives by preventing suicides with our infusions.

The third reason is arrogance. At the end of the day, all physicians, providers, hospitals, insurance companies, employers, media, politicians, and everyone else that is part of our society are people. Many people think they know everything and if they come across something they do not know, they will criticize it instead of understand it. They have this sense that if they did not discover it, then it must not be true. In many cases, those are the same people who live their lives with stereotypes. Yes, good old fashioned not-politically correct bigotry. We have seen that anger directed to our patients and to us directly as providers and as a business that employs people from ethnic minorities. It is disgusting but it occurs very commonly, as almost all patients with central sensitization will affirm!

Why is it Called a Horse Tranquilizer and a Party Drug?
Ketamine was originally developed for human use about over 50 years ago. Since then, it has been safely used on humans and on animals (remember, humans are animals as well). Veterinarians use ketamine for surgical anesthesia because of its safety profile. The term “horse tranquilizer” is used by people, in some cases physicians, because of their ignorance about ketamine and the field of anesthesiology in general. Ketamine is no more a “horse tranquilizer” than water is a “horse beverage”.

Ketamine can be abused and that is the reason why we do NOT advocate for ketamine via intranasal, sublingual, IM, oral, and suppository routes. Those routes of administration are NOT the same as a ketamine infusion because those routes are usually not under monitored conditions, steady plasma state is not achieved, peak plasma levels can be dangerously high, side effects are higher, efficacy is lower, and addiction potential is higher. It is through those routes that ketamine, like every other medication out there, can be abused. Therefore, we do not recommend these routes in the management and treatment of central pain conditions. The IV route allows for great control by the physician administering the infusion (assuming the physician is knowledgeable and experienced, such as a pain fellowship trained anesthesiologist).

You can read more at http://www.nationalpain.com/routes-of-administration.