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Ketamine for Chronic pains
Ketamine Therapy: Success for Chronic Pains
Ketamine Therapy has seen exponential growth in the last several years in the treatment of chronic pain
simply because it is very fast acting and effective.
There is an abundance of literature supporting Ketamine effectiveness for chronic severe pains.
The Cost of Ketamine therapy as it is not covered by most Insurances is a deterrent for many patients.
Our clinics have therefore kept this Cost more affordable than other clinics.
Dr. Tilak and his dedicated Team are ready to offer this novel therapy at either of our 2 locations:
one near Avenues Mall in Jacksonville and the other at Middleburg/Orange park location.
Conditions where Ketamine Therapy is successful:
- Fibromyalgia
- Neuropathic pain
- Chronic spine (back, neck and thoracic region) pain due to degenerative arthritis
- Chronic pains from Rheumatological conditions
- Complex regional pain syndrome
- Reflex sympathetic dystrophy
- Acute and chronic migraines
- Postherpetic neuralgia
- Ketamine also relieves cancer pain in patients who are opioid resistant or who can’t tolerate opioids.
What is Ketamine?
Ketamine was first approved by the FDA in 1970 to be used as Anesthetic. Yale School of Medicine first published a trial in 2000 showing its effectiveness against Depression. Many institutions then conducted several other trials showing similar results. Hundreds of clinics in various countries including the US are currently offering Ketamine for above indications with good success for a variety of conditions as above. Ketamine discussions have taken place in multiple TV shows and media. with physicians and patients presenting their success stories.
Separate tab on Ketamine in the news is included on this website for those interested.
Mechanism of Action of Ketamine
Ketamine interacts with multiple receptors in the brain. The main receptor is the NMDA receptor. Its interaction with this releases Glutamate which explains some of its effect on mood disorders, as Glutamate release uplifts the mood and causes happiness. Ketamine's effect on AMPA receptors also causes glutamate release.
Another important action is on brain structure which probably explains its longer term effects. Studies pioneered at Yale by Neuroimaging showed that Ketamine creates new neural connections in various parts of the brain (anterior cingulate cortex, prefrontal cortex, limbic system) which were found suppressed by chronic stresses be it Mood disorders or Drug abuse or chronic pain. This is called Neuroplasticity: brain adaptability by changing its structure.Studies show that it probably does this by release of Neuronal vascular endothelial growth factor. Ketamine is also an opioid receptor agonist which explains its effect on pain conditions.
Benefits of Ketamine Therapy
* relief of sadness, stress, anxiety, and restoring mental balance and wellness and happiness
*Very quick results in hours or upto a day
* Ketamine therapy can be used in conjunction with prescription medications and psychotherapy
* With relief of fatigue and stress, patients feel energetic and blissful
*Ketamine enables the brain to develop new neural connections (synapses), a new treatment
* Excellent option for Treatment resistant conditions as above
* Longer term results over weeks to months with multiple infusions
What to Expect with Ketamine Infusion
Many patients notice distinct improvement within a few hours or upto a day of IM infusion. Some patients start to feel better with improvement in day to day functioning, before distinct improvement in pain relief. The duration of these positive effects from the first infusion typically depends on the severity of the underlying condition but may last from a few days to a few weeks. For longer lasting relief, weekly treatments for 6 to 8 weeks is recommended. Booster injections may be given on a monthly basis or longer as needed. Patients on chronic Opioid medications have been able to decrease the dose and later may be able to stop these medications without feeling significant pain. Ketamine will also treat Depression and Anxiety and substance use disorders which are not uncommon in chronic pain patients. Ketamine also helps with opiate withdrawal symptoms that are mild to moderate.
Why IM Ketamine Infusion Therapy?
IV route is cumbersome. Many patients find it uncomfortable, and require more intense monitoring. It is associated with risk of fluid extravasation and infection.
Many studies have demonstrated no significant difference in results of IM and IV therapy, both short term and long term as bioavailability of IM route is about 95%. Thus minor dose adjustment will give the same amount of Ketamine as IV route.
IM Ketamine is more cost effective, more convenient thus patients can afford more treatments for long term results. IM therapy doses can be spaced out at 15-30 minute intervals depending on patient preference. We can also give a small dose of Benzodiazepine or anti nausea medication if needed.
Safety of Ketamine
Ketamine has been used as Anesthetic since 1970 and has a proven track record of being very safe even when it is given at much higher dose when used as Anesthetic for children and adults . You will also be closely monitored for about an hour after the Ketamine Infusion. Dr. Tilak is board certified in both Internal Medicine and Interventional Pain management with added training in taking care of patients undergoing complex procedures with moderate sedation. He has been practicing for over 30 years as a physician with a proven safety record.
Success rate of IM Ketamine therapy
With proper patient selection, many studies have reported success rates of about 70%. Success rate is mainly calculated by patients feeling significantly better in many ways and not just pain relief than before the treatment. Ketamine relief will be less if there is a higher degree of anatomic destruction. Dr. Tilak, being board certified in Interventional pain management and Internal Medicine is well suited to predict the degree of improvement before and during Ketamine therapy.