Over the past decade, the utilization of intravenous (IV) ketamine infusions for the management of chronic pain has significantly increased, as indicated by lead author Steven Paul Cohen, MD, director of Medical Education, Pain Medicine Division, at Johns Hopkins Medicine in Baltimore, MD. Given that ketamine is a generic pharmacological agent lacking FDA approval for chronic pain treatment, its application in this domain is marked by considerable variability in indications, dosing protocols, monitoring standards, and reimbursement practices.
Recently published guidelines in Regional Anesthesia and Pain Medicine address the demand for clarity from a diverse group of stakeholders, including healthcare providers, insurers, patients and their advocacy organizations, as well as healthcare administrators with respect to the application of ketamine within chronic pain management clinics. These guidelines offer recommendations across several critical aspects confronting practitioners, such as indications, monitoring protocols, dosing strategies, contraindications, recommended pre-infusion assessments, and criteria for defining a positive therapeutic response.
Concurrently, guidelines concerning the administration of IV ketamine for acute pain management have also been released. These recommendations advocate for the consideration of sub-anesthetic ketamine infusions for patients undergoing significant painful procedures, individuals with opioid dependency, chronic pain patients experiencing acute exacerbations, and those at heightened risk of adverse effects from high opioid dosages, including patients with obstructive sleep apnea, as articulated by James P. Rathmell, MD, professor of anesthesia at Harvard Medical School and Chair of the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women’s Health Care in Boston, MA, in an accompanying editorial.