The Effectiveness of Ketamine Infusion for Chronic Pain
Patients with chronic pain often present a challenging treatment scenario for health care practitioners. This has historically been the case, and the opioid crisis has served to create additional challenges by discouraging the use of opioids which have traditionally been the mainstays of pain therapy. Because of the opioid epidemic, treatment guidelines have emerged which encourage non-opioid therapy as an alternative to the use of opioids. Ketamine infusion has surfaced as one of the non-opioid therapies utilized for various types of chronic pain syndromes. Ketamine is not FDA approved for the treatment of pain but may nonetheless be Medicare-covered if the medical literature supports the effectiveness of ketamine for the treatment of pain. A review of medical literature suggests that ketamine infusion is a viable option for certain types of pain conditions, namely chronic regional pain syndrome or CRPS. This is consistent with what we have experienced with CMS, as we have often observed at least minimal ketamine infusion treatments being included within the WCMSA upon review and approval of a submitted WCMSA.
In July 2019, the International Anesthesia Research Society published the results of a systematic literature review which compiled the results from seven randomized controlled trials evaluating the long-term effectiveness of ketamine infusion for the treatment of pain. In total, the seven trials that were evaluated included 211 patients with three types of pain: neuropathic, mixed and nonneuropathic. Three of the seven studies reported significant analgesic benefit with ketamine, with a small analgesic effect that persisted for up to two weeks post-infusion. There was no difference in pain relief based on pain classification. The results suggested but did not establish, enhanced pain relief with higher doses of ketamine and in patients with CRPS. The analysis also concluded that additional studies enrolling a larger population of patients are needed in order to determine the efficacy of ketamine for chronic pain syndrome.
In 2018, guidelines for the use of ketamine infusion for the treatment of chronic pain were published by a consensus panel of experts in pain management. The panel included the Boards of Directors at both the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the American Academy of Pain Medicine (AAPM), in addition to the American Society of Anesthesiologists’ (ASA) Committees on Pain Medicine and Standards and Practice Parameters. Panel members noted a recent swell in the utilization of ketamine infusion for the treatment of pain and felt that the establishment of guidelines for ketamine utilization was necessary and appropriate. The panelists noted weak evidence for the use of ketamine in various pain conditions with the exception of CRPS. For CRPS, the guidelines recommend ketamine infusion dosing of 22mg per hour for 4 days or 0.35mg per kilogram of body weight per hour over 4 hours daily for 10 days. For breakthrough pain that may exist in between infusions, the guidelines recommend the use of oral ketamine, dextromethorphan or ketamine nasal spray as needed. The committee of pain management experts echoed the need for larger clinical trials to evaluate a broader range of pain conditions in order to fully delineate ketamine’s place in the overall management of pain. As additional clinical trials are conducted with ketamine, the guidelines regarding ketamine may change, and will be sure to update our readers.
While Ketamine infusion treatment is on the rise, it
is important to understand that the costs of this treatment can range up
to $2,750 per infusion or more depending upon the length of the treatment and
location of where treatment will be received. Because pricing can vary so greatly it is
extremely beneficial to obtain a clinical assessment of these costs. For questions concerning ketamine, please
reach out to our team at firstname.lastname@example.org.
 Orhurhu, Vwaire MD et al. Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesthesia & Analgesia: July 2019 – Volume 129 – Issue 1 – p 241-254.