Navid Farahmand, M.D., is a specialist in interventional pain management. He uses IV ketamine infusions to treat various disease states that have not responded to more conventional forms of therapy. Dr. Farahmand serves residents of Los Angeles and Beverly Hills, California.
Ketamine is a unique and rapid-acting anesthetic that helps to decrease pain by inhibiting special receptors in the body called NMDA receptors. It is given intravenously (IV) as an adjunctive medication during surgery or invasive procedures like a colonoscopy. The medication has a strong pain-relief effect but does not suppress reflexes like swallowing and does not depress breathing like narcotics. It is also referred to as a “dissociative anesthetic” for its tendency to produce feelings of detachment or dissociation from the environment or one’s body when given in high doses.
IV ketamine is typically used when other pain management strategies are ineffective. It has been used in therapy-resistant states of depression such as major depressive disorders, bipolar disorders, post-partum depression, and severe states of anxiety. It is also useful in treatment of therapy-resistant chronic pain syndromes, especially those that have a significant component of neuropathic (nerve-related) pain such as complex regional pain syndrome (CRPS), phantom limb pain, postherpetic neuralgia (nerve pain after an episode of shingles), and peripheral neuropathy from disease states such as diabetes. There is also evidence for its use in other chronic pain states such as fibromyalgia, migraines, and chronic daily headaches, as well as individuals suffering from chronic spine and joint pain that have not responded to other forms of treatment.
A ketamine treatment usually lasts about 45 to 60 minutes but may take several hours. The doctor will start an IV in a vein of the arm or hand. The medication is delivered very gradually using a special pump connected to the bag of IV fluid in which the ketamine is dissolved. A doctor or nurse monitors the patient constantly during the infusion process. Patients report they feel relaxed (some doze) and may lose awareness of the body while the mind remains very active. Awareness of your surroundings returns to normal usually within 15 minutes of the completion of the infusion. A driver is required after the treatment, as patients cannot drive themselves for 24 hours.
Most patients report immediate effects from IV ketamine therapy. However, long-lasting effects usually require several treatments. Since individual response will vary, it’s hard to predict in advance just what will be needed. The treatment ― such as the dose administered, length of the infusion, or the number of treatments necessary ― may be modified depending on the patient’s response.