Page Updated on Jan 27, 2020 by Dr. Reyfman (Pain Management Specialist) of Pain Physicians NY

Pain Physicians NY (Brooklyn, Queens, Manhattan, Bronx) is the leading provider of ketamine infusion in NYC. All treatments are provided by our top rated pain relief specialists and pain management doctors in an established, professional ketamine clinic. Ketamine infusions have many possible applications which include the prevention of chronic postoperative pain as well as the treatment of neuropathic pain. 

Completely new therapeutic areas for ketamine use include ketamine treatment of refractory depression. In addition to mental illnesses such as depression, ketamine therapy in NYC can be a good solution for regular physical complaints and pain.

We can determine whether a ketamine infusion therapy is suitable for you from a comprehensive medical history, your previous medical history and a discussion with you. Ketamine treatment in NYC is always accompanied by ongoing care from your family doctor.

What Is Ketamine?

Ketamine is a chiral derivative of cyclohexanone and belongs to the family of arylcyclohexylamines. It is structurally related to numerous other anesthetics and psychoactive substances such as methoxetamine or phencyclidine. Ketamine was introduced in 1962 and is considered to be a “dissociative anesthetic” due to the combination of psychotropic and analgesic effects.

What Is Ketamine Therapy?

Ketamine Infusion Therapy in NYC | Top Depression and Pain DoctorsKetamine therapy was introduced in 1999 and in the past couple of years, the number of US pain clinics has increased at which ketamine infusions are used for the treatment of chronic pain due to fibromyalgia, but also against eating disorders, obsessive-compulsive disorder, etc. Ketamine infusion therapy involves the administration of a single infusion or a series of infusions.

Researchers believe that ketamine works like other antidepressants and regulates the activity of certain electrochemical cells in the brain. The difference is that while other antidepressants respond to monoamines like serotonin, norepinephrine, or dopamine, which together make up only 15 percent of the brain’s neurotransmitters, ketamine works on glutamate, an amino acid that regulates 50 percent of the nervous system.

Indications of Ketamine Therapy

Ketamine combines analgesia and rapid sedation in one substance, with analgesia in the foreground at low doses. In low doses, ketamine has an antihyperalgesic, antiallodynic and tolerance-protective effect. Additional, potentially desired effects include anticonvulsant, antidepressant, anti-inflammatory, and neuroprotective effects. Ketamine thus has a wide range of potential areas of application. It affects hemodynamic stability just as little as the intestinal motor function and does not cause respiratory depression even in higher doses.

Ketamine can be used in emergency medicine, as well as intraoperatively and postoperatively to prevent chronic postoperative pain. Other possible areas of application are the therapy of chronic pain and seduction/analgesia in the intensive care unit, whereby one also makes use of its neuroprotective effect.

Call ketamine doctor Leon Reyfman, MD of Pain Physicians NY with locations in Brooklyn, Queens, Manhattan, and Bronx NYC to help you determine if ketamine therapy is the right treatment for your pain or depression.

Scientific research shows that ketamine can be a useful and highly effective drug for the treatment of certain diseases such as:

  • Depression, especially resistant depression
  • Major depressive disorder
  • Anxiety
  • Post-Traumatic Stress Disorder (PTSD)
  • Depressive phases of bipolar disorder
  • Chronic neuropathic pain
  • Fibromyalgia
  • Diabetic neuropathy
  • Oncology pain
  • Prevention of postoperative pain
  • Opioid-induced hyperalgesia

Ketamine Treatment for CRPS or RSD

There is currently no cure for complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy (RSD). The primary goal of CRPS treatment is to provide relief from persistent pain and discomfort. Ketamine therapy is a great alternative to conventional treatment options and offers promising results for relieving pain. Ketamine provides relief by resetting the central nervous system’s sensitization to pain.

During treatment, ketamine calms your brain and helps it restore normal processing of pain, resulting in long-term pain relief. This is quite different when compared to opiates which actually make the patients more pain-sensitive over time. Studies have shown that ketamine infusions are both completely safe and effective when used to manage CRPS and are a great choice when other options fail to provide results.

Ketamine Infusion Therapy for Chronic Pain

Another specialty of ketamine is its effectiveness against neuropathic pain. This is attributed to the importance of the NMDA receptor in the genesis of neuropathic pain. However, there are also indications that ketamine influences descending pain relief and has anti-inflammatory effects.

Long-term pain relief was seen in several studies when the ketamine infusion was extended over a period of several days and improvement in pain symptoms have lasted up to three months. However, the review emphasizes that no reliable long-term data are available on the use of ketamine in chronic pain and that further research is still needed though.

How Is Ketamine Administered?

There are various ways how ketamine therapy in NYC can be administered like intravenous administration, intramuscular administration, oral administration, sublingual administration, nasal administration, and rectal administration. However, it is most effective when administered intravenously. The infusion can last for a few hours and is sometimes spread over several days.

Ketamine can be administered in the following ways when used for analgesic purposes:

  • Intravenous administration – both racemic ketamine and S-ketamine are in use. However,  according to recent reviews, S-ketamine should be more titratable since it has a higher clearance and a steeper increase in the effect with the concentration. In analgesic use, the bolus doses of 0.1-0.25 mg/kg are recommended, followed by continuous infusion at 0.2-1.0 mg/kg/h.
    When using racemic ketamine, these doses should be doubled though. After intravenous administration of ketamine, there is initial flooding with a half-life of 10 to 15 minutes and a total duration of approximately 45 minutes.
  • Oral administration – the bioavailability of oral ketamine is poor due to its pronounced first-pass metabolism. Only about 17-24% of oral racemic ketamine and 8-11% of oral S-ketamine reach the systemic circulation. Due to the metabolism in the liver, much more S-norketamine than ketamine enters the circulation after the oral intake of S-ketamine. A steady-state of oral S-ketamine is achieved after the third dose, and there is no accumulation of S-ketamine or its metabolites if S-ketamine is taken orally twice a day.
  • Intramuscular administration – ketamine can also be injected intramuscularly, resulting in rapid absorption with a bioavailability of 93%. Ketamine is detectable in the plasma after only four minutes, peak concentrations are reached after 5 to 30 minutes. The effects begin 1 to 5 minutes after the injection. Due to the rapid onset of action, intramuscular injection is an alternative to intravenous administration if no suitable intravenous access is available.
  • Sublingual administration – sublingual formulations of ketamine are developing as user-friendly options for third-line therapy for pain patients. Bioavailability is no better than when taken orally. However, the metabolism to norketamine is less pronounced and the maximum plasma level is reached more quickly. The sublingual administration can be advantageous if a quick effect is sought, which is the case with acute pain or breakthrough pain.
  • Intranasal administration – of ketamine bypasses the first-pass metabolism in the liver. This means that metabolism to norketamine remains low. At around 45%, the bioavailability of nasal ketamine is somewhat better than when taken orally. The maximum plasma level is achieved with ketamine nasal spray only 10 to 17 minutes after application.
    This leads to faster onset of action than with oral, sublingual or rectal administration. The rapid onset of action makes nasal ketamine an option in the treatment of breakthrough pain, but the exact dosage is difficult to control though.
  • Rectal administration – with the rectal application of ketamine, similar bioavailability of norketamine is achieved as with sublingual ketamine. Rectal administration may be an option for patients who are unable to swallow.

Complications and Side Effects of Ketamine Therapy

Like every other medication, ketamine infusion therapy in NYC can have side effects and lead to complications. Possible side effects and complications of ketamine therapy are:

  • High blood pressure or low blood pressure
  • Fast heartbeat or slow heartbeat
  • Decreased lung function
  • Apnea
  • Muscle tremors
  • Hallucinations
  • Confusion
  • Delirium
  • Nausea and vomiting
  • Laryngeal spasms
  • Bladder inflammation
  • Bloody urine
  • Hydronephrosis
  • Difficult and painful urination
  • Skin rash
  • Decreased appetite
  • Double vision
  • Nystagmus

Ketamine side effects are usually dose-dependent and spontaneously reversible.

Is Ketamine Infusion Therapy Suitable for Everyone?

Living with chronic pain has a significant impact on a person’s quality of life. Those suffering from pain on a daily basis are ready to try almost anything which would help them relieve the pain even for just a couple of hours, not to mention days or weeks. When it comes to ketamine infusion therapy, even though it is a new therapy used for depression and chronic pain treatment, the number of those who have tried it or would like to try this kind of therapy is increasing.

However, not everyone who lives with chronic pain on a daily basis is suitable for this kind of treatment. Ketamine infusion therapy is not recommended in the following cases:

  • Pregnant and breastfeeding women
  • Acute cardiovascular diseases
  • Uncontrolled blood pressure
  • History of psychosis
  • History of increased intracranial pressure
  • A negative response to previous treatment with ketamine infusions

Even though ketamine therapy is a relatively new method of treatment for chronic pain, it has resulted to be very successful, especially when other treatment methods have failed. The number of pain clinics that are offering this kind of treatment is increasing every day throughout the US.

However, a great precaution and certain medical examinations are necessary before and after ketamine treatment is applied. For those who live with chronic pain daily for months or years, it is well worth a try when nothing else has managed to relieve their pain.

If you are considering ketamine infusion therapy in NYC as an option for chronic pain or depression, don’t hesitate to contact us and speak to our ketamine specialist. After a thorough examination by our top rated pain management doctors, we can determine whether an NYC ketamine infusion therapy is suitable for you.