Ketamine and Esketamine (Spravato) for Chronic Pain: An Overview - COPE

Ketamine and Esketamine (Spravato) for Chronic Pain: An Overview

Ketamine and Esketamine (Spravato) may be useful in a medical condition called chronic pain. This article explains what is chronic pain and discusses ketamine for chronic pain to help manage the condition. 

What is Chronic Pain?

Chronic pain is defined as any pain lasting more than 3 months. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain persists—often for months or even longer, outlasting the usual healing process.

Chronic pain may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. However, there may also be no clear cause. Other health problems, such as fatigue and sleep disturbance, often accompany chronic pain. The difficulty in carrying out important and enjoyable activities can lead to disability and depression.

How common is chronic pain?

Chronic pain is a frequent condition, affecting an estimated 20 percent of people worldwide and accounting for 15 to 20 percent of doctors’ visits in the United States. Nearly 50 million American adults have significant chronic pain, according to a study supported by the National Institute of Health. The annual cost of chronic pain in the United States is as high as $635 billion a year, which is more than the yearly costs for cancer, heart disease and diabetes.

What are the different types of chronic pain?

Common chronic pain conditions include the following:

  • Fibromyalgia syndrome
  • Chronic back pain / chronic pelvic pain
  • Chronic pain after surgeries and injures
  • Chronic neuropathic pain (e.g. diabetic neuropathy, post-herpes neuralgia, Complex Regional Pain Syndrome)
  • Chronic headaches and orofacial pain
  • Chronic musculoskeletal pain (e.g. osteoarthritis)
  • Chronic cancer pain

Chronic Pain Treatment Options

With chronic pain, the goal of treatment is to reduce pain and improve function, so the person can resume day-to-day activities. It is important to remember that chronic pain usually cannot be cured, but it can be managed.

Medications, electrical stimulation, biofeedback, nerve blocks, surgery, massage, relaxation, and cognitive behavioral therapy are some of the treatments used for chronic pain. Medications include Acetaminophen (Tylenol), Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g. Advil), Antidepressants (e.g. Cymbalta), and Anticonvulsants (e.g. Lyrica). Opioid pain relievers (e.g. Vicodin, Percocet) have been used when other medicines do not help. Recently there have been concerns that opioid medications can have a variety of adverse effects including physical dependence, and risk of overdose.

Unmet needs

A large number of patients with chronic pain have poor quality of life due to continuing pain, limitation of activities, and adverse effects of opioid medications. Studies have found that 30-35 percent of patients with chronic pain have clinically meaningful depression and patients with depression are three times more likely to develop chronic pain. Ketamine and Esketamine (Spravato), administered in low doses, may be of value in chronic pain patients.

Ketamine and Esketamine (Spravato) for chronic pain

Low dose intravenous infusion of ketamine improved post-operative and post-traumatic pain control and reduces opioid dosage requirements by 30 – 50 percent in published studies. Ketamine and Esketamine (Spravato) can be helpful for patients who have developed opioid tolerance and require higher doses of opioid medications. In such cases, the addition of low doses of ketamine called ‘burst therapy’ has been found to improve pain management without additional adverse effects.

Scientific literature has shown ketamine infusions to be effective in chronic neuropathic pain. In a few studies, pain relief was found to persist for weeks after ketamine treatment. Randomized controlled trials in fibromyalgia showed that ketamine increased endurance and reduced pain intensity, tenderness at trigger points, and muscular hyperalgesia (increased pain and muscle pain at rest). 

Take home message

Chronic pain for ketamine has proved to be effective without serious side effects, although more systematic research is needed. A trial of intravenous ketamine can be considered for patients with chronic pain that is incapacitating and has not responded to routine medications or in patients who cannot tolerate opioid pain medications or those with significant depression. Patients and clinicians should consult knowledgeable experts for recommendations for ketamine in chronic pain.

Learn More About Ketamine and Esketamine (Spravato) for Chronic Pain

If you or someone you love is suffering from chronic pain, we encourage you to reach out to COPE to learn more about our innovative, effective, evidence-based treatments. Please call our office at COPE to schedule an appointment.