A patient participating in guided physical therapy as part of a comprehensive approach to Complex Regional Pain Syndrome (CRPS) care.
When is ketamine considered for chronic pain?
Ketamine may be considered for chronic pain when standard, multimodal treatments have not provided adequate relief and when central sensitization is suspected to play a significant role. It is not a first-line therapy and is evaluated as part of a broader, physician-guided care plan.
Chronic pain is one of the most complex clinical challenges providers manage. While many patients improve with medications, physical therapy, interventional procedures, and behavioral support, others continue to experience persistent pain that interferes with function and quality of life.
For referring providers, understanding where ketamine fits, which patients may be appropriate, and how care is coordinated is essential to responsible referral and continuity of care.
How does chronic pain become treatment-resistant?
Chronic pain differs fundamentally from prolonged acute pain. Persistent nociceptive input—repeated pain signaling from tissue injury—can drive changes in central pain processing within the brain and spinal cord.
This process, often described as central sensitization, results in amplified pain signaling even when peripheral injury has healed or is no longer the primary driver. Patients may experience pain that is disproportionate to objective findings, along with decreased function, sleep disruption, and mood changes.
As these factors interact, pain becomes increasingly difficult to manage with conventional approaches alone.
Why is ketamine evaluated in select chronic pain cases?
Ketamine’s role in chronic pain management is related to its effects on how the brain and spinal cord process pain, rather than acting primarily at the site of injury like traditional peripheral pain relief.
Ketamine is an NMDA receptor antagonist—a medication that dampens activity at key receptors involved in amplifying pain signals and reinforcing pain pathways within the brain and spinal cord.
As an NMDA receptor antagonist, ketamine acts on nervous system signaling rather than directly on joints, muscles, or peripheral nerves. In select patients, this can help reduce pain amplification that develops when the brain and spinal cord remain sensitized after injury or surgery.
Ketamine is not intended to replace comprehensive pain care. Instead, it may support symptom reduction and improve a patient’s ability to engage in rehabilitation and adjunctive therapies when other treatments have not been sufficient.
Which patients may be appropriate for referral?
Referral for physician-guided ketamine therapy may be considered when patients demonstrate:
- Persistent pain despite appropriate multimodal treatment
- Clinical features suggestive of central sensitization
- Significant functional impairment related to pain
- Pain conditions involving complex nervous system dysregulation
- Capacity to participate in coordinated follow-up care
Referral decisions should be individualized and grounded in clinical judgment rather than diagnosis alone.
What outcomes should providers and patients expect?
Ketamine does not cure chronic pain or reverse underlying structural or neurological disease.
Its role is to support pain modulation, functional improvement, and engagement with ongoing care. Patient response varies, and benefit is not universal. Clear expectation-setting is essential to avoid overinterpretation of results or reliance on ketamine as a standalone solution.
Ongoing assessment helps determine whether continued treatment aligns with clinical goals.
How are safety and appropriateness evaluated?
Ketamine therapy requires careful screening and physician oversight.
Before treatment, patients undergo medical and psychiatric evaluation to assess appropriateness, medication interactions, and risk factors. During treatment, monitoring focuses on safety, physiological response, and tolerance.
Responsible care emphasizes individualized evaluation, conservative decision-making, and clear communication between treating and referring clinicians.
How does coordination with referring providers work?
Ketamine therapy is most effective when integrated into an existing care framework rather than delivered in isolation.
At Vitalitas, care emphasizes collaboration with referring providers to support continuity before, during, and after treatment. This coordination helps align expectations, reinforce follow-up care, and integrate any symptom improvement into longer-term management strategies.
Key takeaways for referring providers
- Ketamine is considered only after standard treatments have been insufficient
- Central sensitization is a common factor in appropriate referrals
- Ketamine supports, but does not replace, comprehensive pain management
- Screening, safety, and coordination are essential
- Collaborative care improves continuity and clinical alignment
For providers evaluating whether a patient may be appropriate for referral, clinical discussion and shared decision-making are encouraged. Providers are welcome to schedule a brief diagnostic consultation with Dr. Eve Langston or reach out to our team with questions.
