Neuropathic pain is defined as pain resulting from damage to the peripheral or central nervous system. It can occur as a result of a number of conditions such as surgery, head trauma, stroke, spinal cord injury, neuropathy, and complex regional pain syndrome. Other disorders, such as fibromyalgia, cause hypersensitivity of the central nervous system, resulting in widespread pain. Intravenous (IV) Lidocaine, a local anesthetic, has been used for years and lately there has been renewed interest in this treatment for neuropathic pain. IV Ketamine, a dissociative anesthetic used for general anesthesia, has also been used for neuropathic pain and medically-resistant depression. Published study results indicate that they are generally very safe and effective in various conditions. We often combine both lidocaine and ketamine for dual benefit, but at times will start with one agent.
What is Ketamine?
Ketamine is a non-opioid, potent drug that has sedative, pain-relieving and psychedelic properties. It is an emerging treatment option for pain and mood disorders.
How does Ketamine work?
Ketamine helps to reduce pain suffering by acting against a chemical receptor known as N-methyl-D-aspartate (NMDA), which is found in the nervous system. This NMDA receptor is an important pain modulator. Ketamine infusions provide longer-lasting relief, leading to elimination or reduction of opioid and other medications along with alleviating symptoms of depression caused by chronic pain and reduced function.
Who may benefit from Ketamine?
Ketamine infusion therapy is used to reduce or eliminate pain for patients diagnosed with conditions such as:
- Chronic Diabetic Neuropathy
- Cluster Headaches/Migraines
- Complex Regional Pain Syndrome (CRPS)
- Severe Anxiety
- Widespread Pain
What to expect if receiving a ketamine infusion?
Other than improvement in pain severity, Ketamine infusion therapy may help alleviate additional symptoms such as anxiety, decreased self-esteem, irritability, lack of sleep and reduced sexual interest/activity. Ketamine infusion is fast acting and patients have experienced improvements within days of the treatment.
How it is done
Your ketamine infusion therapy will be approximately 4 to 5 hours from beginning to end, and therefore a protective undergarment will be required to avoid the need of transfer to the washroom. The doctor will determine dosage and duration of treatment. All infusions are delivered in a safe and comfortable environment. During the infusion process, your vital signs will be monitored by a nurse. You will usually feel relaxed and, in some cases, will be asleep because of the medications. This effect will wear off within approximately 30 minutes after infusion. Other medications you may receive include sedatives, and those used to prevent and treat side effects. You will continue to be monitored by the medical staff for approximately 45-60 minutes. You must be picked up by a responsible adult and have someone with you overnight. All patients who will be receiving a Ketamine infusion are asked not to eat or drink for 8 hours prior to the treatment.
Unless instructed otherwise, take all routine medications. If you are an insulin-dependent diabetic, take half of your morning insulin and hold your oral diabetic pills. You must be picked up by a responsible adult (i.e. independent taxi or public transit is not acceptable) and have someone with you for a few hours. All patients who will be receiving Ketamine infusions are asked not to eat heavy food (i.e. fat, protein) for 9 hours prior to treatment, but you may have a light snack (e.g. toast, fruit) up to 6 hours prior and clear fluids (e.g. black coffee/tea, water, Gatorade) up to 2 hours prior.
Due to privacy regulations, patients are not permitted to take calls, pictures or videos during the infusions. You will be asked to place your devices on Airplane Mode. Bring music/headphones or earplugs to help relax, and avoid speaking loudly, which can disturb other patients.
Although your scheduled infusions may differ in timing, the first five infusions are often scheduled every 1-4 weeks. After completion of the initial course, your doctor will advise whether to continue the infusions or to stop. If your symptoms return in a few months, you and your pain physician may decide to book a ‘booster’ infusion.
As ketamine is an anesthetic, patients may experience the following side effects:
- Hallucinations or strange thoughts
- Increased urge for urination
Very rare complications of Ketamine (like all anesthetics) include allergic reaction and death. Large-dose, long-term use of ketamine can lead to chronic cystitis which is a sensation of a bladder infection that does not go away. Ketamine also has abuse potential and can profoundly affect mood. These are NOT realistic risks of Ketamine used for medical purpose in a controlled fashion.
What is Lidocaine?
Lidocaine is a local anesthetic that is often used in combination with Ketamine for the management of neuropathic pain. Lidocaine has no cognitive side effects but can sometimes cause short-lived nausea, dizziness or tingling around the mouth. Very rare complications include seizure, cardiac arrhythmia, allergic reaction, or extremely rare death. If you are recommended Lidocaine infusions, you will likely receive both medications, but the infusions run for only 45 minutes with a 15-minute planned recovery period. A responsible adult is still required to accompany you.
Fees and OHIP Coverage:
OHIP will pay for your medical care, but not for the medications used. Therefore, patients are responsible for a medication fee for the facility that will be due prior to treatment on each visit. Due to government regulations around intravenous drugs, you cannot bring your own medications. Please refer to the clinic fee schedule for uninsured services or speak to the front desk staff for details about cost and accepted payment methods. Your physician may also provide you with a prescription for additional