Most people who’ve heard of ketamine therapy associate it exclusively with depression — but ketamine has been used as an analgesic in clinical medicine for more than 60 years, and a growing body of research supports its use for chronic nerve pain that has not responded to conventional treatments. For patients in the Richmond area who have been living with neuropathic pain despite trying multiple medications and therapies, understanding how ketamine works on the pain system — not the mood system — may open a door worth walking through.
What Neuropathic Pain Actually Is
Pain that originates in the nervous system itself is called neuropathic pain — a category distinct from pain caused by tissue injury or inflammation. Neuropathic pain arises when nerve fibers are damaged, dysfunctional, or abnormally sensitized, and it is notoriously difficult to treat through standard analgesic approaches. Patients often describe it as burning, shooting, stabbing, electric, or tingling — sensations that don’t match the typical experience of acute pain and that can persist long after any identifiable injury has healed.
Common conditions associated with neuropathic pain include diabetic peripheral neuropathy, postherpetic neuralgia (nerve pain that follows shingles), complex regional pain syndrome (CRPS) — a condition involving severe, persistent pain typically in a limb — phantom limb pain in individuals who have undergone amputation, and pain associated with nerve compression, multiple sclerosis, and cancer treatment. In many of these cases, patients cycle through medications — anticonvulsants, antidepressants, topical agents, opioids — with partial response at best and significant side effects that limit long-term use.
This treatment gap is precisely where the clinical interest in ketamine for chronic pain originates.
The Mechanism: How Ketamine Interrupts the Pain Signal
Ketamine’s analgesic effects operate through a different pathway than most pain medications. The primary mechanism involves blockade of NMDA receptors — N-methyl-D-aspartate receptors — which are critical to a process called central sensitization, the neurological phenomenon in which the spinal cord and brain become progressively more reactive to pain signals over time. Central sensitization is one of the core drivers of chronic neuropathic pain, and it is a mechanism that standard opioids and most other analgesics do not directly address.
Research published in the British Journal of Clinical Pharmacology found that low-dose ketamine produces strong analgesia in neuropathic pain states specifically through this NMDA receptor inhibition, and clinical studies on prolonged infusion protocols have demonstrated analgesic effects lasting up to three months following treatment (Niesters et al., 2014). That extended duration — analgesic benefit that continues well beyond the infusion itself — distinguishes ketamine from medications that only provide relief while active in the bloodstream.
Think of it this way: if chronic neuropathic pain has made the spinal cord’s pain processing system hypersensitive — turned the volume knob up too high — NMDA receptor blockade may help turn that dial back down toward a more normal baseline. The effect isn’t permanent, and repeat treatments may be needed over time, but the window of relief it can provide is meaningful for patients who haven’t found sustained relief through other means.
What the Research Shows
The clinical evidence for ketamine in chronic pain treatment has been building over several decades and is strongest for specific neuropathic conditions. A comprehensive review published in Health Psychology Research found that randomized controlled trials support ketamine’s effectiveness for complex regional pain syndrome and phantom limb pain that is refractory — meaning unresponsive — to standard treatment, with reviewers recommending it be considered for patients with refractory mixed neuropathic pain who have not found adequate relief through conventional means (Orhurhu et al., 2021).
A systematic review and meta-analysis in Anesthesia & Analgesia quantified the response rate more precisely: 51.3% of chronic pain patients treated with ketamine infusions met the criteria for meaningful analgesic response, compared to 19.4% for placebo (Orhurhu et al., 2019). That gap — more than double the placebo response rate — reflects a clinically meaningful signal across a broad patient population, not just isolated cases.
Results vary by individual, and the evidence is stronger for some neuropathic conditions than others. CRPS and phantom limb pain have the most robust data; evidence for other neuropathic conditions continues to grow. Not every patient with neuropathic pain is a candidate for ketamine infusion therapy, which is why a thorough evaluation is the necessary first step.
Ketamine for Pain vs. Ketamine for Depression: Key Differences
Patients who have researched ketamine therapy for depression sometimes ask whether the pain protocols are the same. The short answer is no — the infusion parameters, dosing rationale, and treatment goals differ between psychiatric and pain indications, though the underlying drug is the same.
For depression, ketamine infusion therapy for depression works primarily through the glutamate system to promote neuroplasticity — the brain’s ability to form new neural connections — which is associated with rapid antidepressant effects. For chronic pain, the primary target is the NMDA receptor’s role in central sensitization. The two mechanisms overlap at the molecular level, which is one reason ketamine has effects in both domains, but the clinical protocols are tailored to the specific indication being treated.
At InfuseRVA Ketamine & Wellness in South Chesterfield, we evaluate each patient’s primary condition and goals before designing a treatment plan. A patient coming to us for CRPS-related neuropathic pain receives a different clinical consultation than a patient coming for treatment-resistant depression — and some patients who struggle with both chronic pain and mood disorders may find that ketamine addresses dimensions of both at once, which aligns with our integrative, whole-patient approach to care.
What to Expect From the Evaluation and Treatment Process
Before any ketamine infusion is administered, every patient at InfuseRVA is evaluated by our medical director or a licensed physician. That evaluation covers your full pain history, prior treatments and responses, current medications, any comorbid conditions, and potential contraindications to ketamine. This step is non-negotiable — it protects you and ensures that if you move forward with treatment, you’re doing so on the most informed basis possible.
Ketamine is not appropriate for patients with a history of certain psychiatric conditions including active psychosis or untreated mania, or for those with certain cardiovascular or hepatic conditions. It requires a confirmed driver to accompany you home, and post-infusion restrictions include 24 hours of no driving, strenuous activity, or operating machinery. These are safety protocols that exist because your wellbeing matters to us, not bureaucratic obstacles.
A standard series for chronic pain typically involves multiple infusions over a defined period, with the treatment plan individualized based on your condition, your response, and your goals. Maintenance infusions may be appropriate over time depending on how your pain responds. For more about what the experience looks like, our overview of what to expect after a ketamine infusion can help you prepare. We discuss all of this transparently so you can make a fully informed decision.
The Cost Question, Addressed Directly
IV ketamine infusion therapy for chronic pain is not covered by insurance. This is a real limitation and one we won’t minimize. We accept cash and credit cards, and we encourage patients to look into whether HSA or FSA funds may be applicable to their situation. We’ll always review costs with you before treatment begins, because making a financially sound decision is part of making a medically sound one.
We also recognize that the cost of untreated or inadequately treated chronic nerve pain — measured in lost workdays, reduced function, dependence on medications with their own costs and side effects, and the quality-of-life toll of living in persistent pain — is significant in its own right. We’re not suggesting that ketamine therapy is the right financial decision for everyone, but we do think patients deserve complete information to weigh those trade-offs thoughtfully.
Frequently Asked Questions
Which types of nerve pain respond best to ketamine infusion therapy? The strongest clinical evidence is for complex regional pain syndrome (CRPS) and phantom limb pain, both of which have been studied in randomized controlled trials. Ketamine has also been studied for fibromyalgia, diabetic neuropathy, postherpetic neuralgia, and other neuropathic conditions, with varying levels of evidence. The best way to assess whether your specific condition and pain history make you a good candidate is through a consultation with our team.
How long does pain relief from ketamine infusions last? This varies considerably by patient and by pain condition. Some individuals experience relief lasting weeks; others, several months. Research has documented analgesic effects lasting up to three months in some infusion protocols (Niesters et al., 2014). Results vary by individual, and periodic maintenance infusions may be needed over time. We discuss realistic expectations during the evaluation process.
Can I use ketamine therapy alongside my current pain medications? In many cases, yes — but this depends on the specific medications involved and your full clinical picture. Some medications may interact with ketamine or affect its efficacy, which is why our pre-treatment evaluation includes a complete medication review. We coordinate with your existing providers and never recommend altering your current medication regimen without appropriate medical guidance.
Is ketamine therapy the same as recreational ketamine use? No. Medical ketamine infusion therapy uses controlled, sub-anesthetic doses administered by trained medical professionals in a clinical setting with continuous monitoring. The dose, route, setting, and intent are entirely different from recreational use. Ketamine has a well-established safety record spanning more than 60 years in medical contexts when administered appropriately. That said, it is not without risks, which is why comprehensive screening and medical supervision are required.
Do I need a referral to be evaluated at InfuseRVA for chronic nerve pain? You do not need a referral to contact us or schedule a consultation. We do ask that you bring documentation of your diagnoses, prior treatments, and current medications, and we strongly encourage you to keep your primary care provider and pain specialist informed about your interest in ketamine therapy. Coordinated care is better care, and we are committed to working alongside your existing team rather than replacing it.
Key Takeaways
- Neuropathic pain arises from damage or dysfunction in the nervous system itself, making it distinct from injury-related pain and often poorly responsive to standard analgesics including opioids.
- Ketamine produces analgesia in neuropathic pain states by blocking NMDA receptors and interrupting central sensitization — the neurological process by which the nervous system amplifies pain signals over time.
- Clinical evidence, including a systematic review and meta-analysis, supports ketamine infusion therapy for conditions like CRPS and phantom limb pain, with a 51.3% responder rate compared to 19.4% for placebo (Orhurhu et al., 2019).
- Analgesic effects from ketamine infusion protocols may last up to three months in some patients, distinguishing it from medications that only provide relief while active in the body (Niesters et al., 2014).
- Results vary by individual, and all ketamine treatments at InfuseRVA are preceded by a full medical evaluation to assess candidacy, review contraindications, and design an individualized treatment plan.
If nerve pain has taken years of your life and standard treatments haven’t given you enough relief back, that history doesn’t have to define what’s possible going forward. At InfuseRVA Ketamine & Wellness, we specialize in working with patients for whom conventional approaches have fallen short — and we’re here to give you honest answers about what may help. Schedule a consultation today to start the conversation.
References
Niesters, M., Martini, C., & Dahan, A. (2014). Ketamine for chronic pain: Risks and benefits. British Journal of Clinical Pharmacology, 77(2), 357–367. https://pmc.ncbi.nlm.nih.gov/articles/PMC4014022/
Orhurhu, V., et al. (2019). Ketamine infusions for chronic pain: A systematic review and meta-analysis of randomized controlled trials. Anesthesia & Analgesia, 129(1), 241–254. https://pubmed.ncbi.nlm.nih.gov/31082965/
Orhurhu, V., et al. (2021). Ketamine for the treatment of chronic pain: A comprehensive review. Health Psychology Research, 9(1), 25535. https://pmc.ncbi.nlm.nih.gov/articles/PMC8567802/
Medical Disclaimer
The information in this blog is intended for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Chronic neuropathic pain should be evaluated and managed by licensed healthcare providers familiar with your full medical history. Individual results vary. IV ketamine infusion therapy should only be pursued under the supervision of qualified medical professionals following a thorough evaluation and screening process. Never discontinue or alter prescribed pain medications without consulting your prescribing provider. If you are experiencing a medical emergency, please call 911 or go to your nearest emergency room.
