Fibromyalgia affects an estimated 4 million adults in the United States and is characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive impairment — yet it remains one of the most underdiagnosed and undertreated conditions in American medicine, in part because its neurological underpinnings were poorly understood for decades. The central insight that has transformed fibromyalgia research over the past twenty years is that it is fundamentally a disorder of central pain processing — not a peripheral tissue injury — which explains why anti-inflammatory medications and standard pain protocols frequently fail these patients. At Infuse RVA in South Chesterfield, our team offers IV ketamine infusion therapy for fibromyalgia and related chronic pain conditions precisely because its mechanism addresses central pain sensitization in a way that most conventional treatments do not.
Understanding Central Sensitization
The term “central sensitization” refers to a state in which the central nervous system — the brain and spinal cord — becomes hyperactivated and amplifies incoming pain signals far beyond what the peripheral source of those signals would predict. In fibromyalgia, this amplification is pervasive: stimuli that would not be painful to an unaffected person become painful, and stimuli that are mildly painful become intensely so. The same process is implicated in other conditions we treat at Infuse RVA, including complex regional pain syndrome (CRPS), chronic migraine, and certain types of neuropathic pain. What these conditions share is a nervous system that is no longer processing pain accurately — it has been recalibrated upward by the cumulative biological toll of sustained pain, stress, inflammation, or injury.
How Ketamine Interrupts Central Sensitization
Ketamine acts on NMDA receptors, which are glutamate receptors that play a central role in the synaptic plasticity processes underlying central sensitization. By blocking NMDA receptor activity, ketamine can interrupt the excitatory signaling cascade that perpetuates central sensitization and, in some patients, effectively recalibrate the pain threshold toward a more normal baseline. This is not a peripheral anti-inflammatory mechanism — it is a central nervous system intervention, which is exactly what conditions driven by central sensitization require. Our team administers IV ketamine for these indications as an off-label application, meaning it is not FDA-approved specifically for fibromyalgia or CRPS, but is used on the basis of published clinical evidence and individual clinical judgment.
Our Evaluation Process for Chronic Pain Patients
At Infuse RVA, our evaluation process for chronic pain patients mirrors the thoroughness we apply to psychiatric evaluations. We review the full pain history — onset, character, distribution, prior treatments tried, prior procedures, current medications, and comorbid conditions — before making any recommendation. Fibromyalgia frequently co-occurs with depression, anxiety, and PTSD, and our team’s familiarity with the full spectrum of both psychiatric and pain conditions means we are equipped to address the whole clinical picture rather than treating pain and mood as separate problems. A patient whose fibromyalgia is entangled with treatment-resistant depression may benefit from a treatment approach that addresses both dimensions simultaneously, and we are positioned to offer that.
The co-occurrence of pain and mood disorders is not incidental — it reflects shared neurobiological mechanisms. Chronic pain activates stress response systems, depletes neuroplasticity-supporting neurotransmitters, and produces structural changes in pain-processing brain regions that are similar in important respects to changes seen in depression. Conversely, depression lowers pain thresholds and amplifies the subjective intensity of pain. This bidirectional relationship means that treating pain without addressing mood, or treating mood without addressing pain, often produces incomplete results. Our approach at Infuse RVA recognizes this interconnection and builds it into our clinical thinking. To explore this connection further, see our post on PTSD and chronic pain and how they feed each other.
Overcoming Barriers to Treatment
One barrier we encounter regularly with chronic pain patients considering ketamine is the experience of prior treatment failure and the resulting emotional resignation. Many fibromyalgia patients we work with have seen numerous specialists, tried many medications, and been told — sometimes explicitly — that their pain is “in their head” or that nothing more can be done. Our team takes a different approach: we review what has been tried before taking a position on what comes next, and we explain the neurological rationale for why ketamine may help with chronic pain when other interventions have not. We do not pretend the evidence is more definitive than it is, but we do believe that a patient who understands the mechanism has a better basis for making an informed decision about trying a new approach. Results vary by individual, and we are honest about the range of outcomes we see.
Insurance and Financial Access for Ketamine Treatment
A second barrier is insurance and financial access. Most commercial insurance plans do not cover ketamine for fibromyalgia or chronic pain as a primary indication, and the cost of a ketamine infusion series is a real consideration for many patients. We provide transparent pricing at Infuse RVA and work with patients to understand the full financial picture before treatment begins. We also incorporate NAD+ therapy and vitamin support into some chronic pain treatment plans — nutrients that support neurological recovery and may enhance the durability of ketamine’s effects — and we discuss these as a holistic package rather than a series of isolated add-ons. Discuss your treatment goals and financial situation with our team, and we will work with you to design an approach that is both clinically appropriate and accessible.
Frequently Asked Questions
Does Ketamine Actually Reduce Pain in Fibromyalgia Patients?
Clinical research, including multiple randomized controlled trials, has demonstrated statistically significant reductions in pain intensity in fibromyalgia patients following IV ketamine infusion series. The effect is not universal — results vary by individual — and the duration of pain relief varies. Our team will help you understand the realistic range of outcomes based on your specific clinical history.
How Is IV Ketamine Different from Oral or Topical Pain Medications?
Most oral and topical pain medications target peripheral mechanisms — nerve endings, inflammation, or opioid receptors at the site of pain. IV ketamine acts centrally, at NMDA receptors in the brain and spinal cord, to reduce the neurological amplification that drives pain in conditions like fibromyalgia. This makes it meaningfully different — not just quantitatively stronger, but mechanistically distinct.
Is Ketamine for Chronic Pain FDA-Approved?
No. Ketamine for fibromyalgia and other chronic pain conditions is an off-label application. Our team administers it based on clinical evidence and individual evaluation. We provide a thorough informed consent process that explains the evidence, the risks, and the alternatives before any treatment begins.
Can I Receive Ketamine for Pain If I Am Also Struggling with Depression?
Yes, and co-occurring depression and chronic pain are a common presentation in our practice. Our team will evaluate both dimensions and design a treatment approach that addresses your full clinical picture. The same ketamine infusion series can have effects on both pain and mood, though the protocols for each may differ in some respects.
Will I Need Ongoing Ketamine Infusions to Maintain Pain Relief?
Many patients require maintenance infusions at varying intervals to sustain the pain relief achieved during the initial series. The frequency of maintenance depends on individual response, and our team monitors each patient over time to make data-informed decisions about when booster infusions are warranted. Discuss your specific situation with us during your evaluation.
Key Takeaways
- Fibromyalgia and related chronic pain conditions are driven by central sensitization — a dysregulation of how the central nervous system processes pain.
- IV ketamine blocks NMDA receptors to interrupt central sensitization, acting through a mechanism that most conventional pain medications cannot address.
- At Infuse RVA, we evaluate chronic pain patients thoroughly before recommending ketamine, including a review of co-occurring mood disorders.
- Depression and chronic pain frequently co-occur and share neurobiological mechanisms; our team addresses both in treatment planning.
- Results vary by individual; ketamine for fibromyalgia is an off-label application — discuss your candidacy honestly with our team.
Conclusion
Fibromyalgia and central pain syndromes are real neurological conditions that deserve real neurological treatments. At Infuse RVA in South Chesterfield, our team brings the clinical knowledge and the treatment tools to address the underlying biology of your pain rather than just its surface expression. If you are in the greater Richmond area and have not found adequate relief from conventional pain management, we encourage you to schedule a consultation and explore whether IV ketamine belongs in your care plan.
References
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Fibromyalgia. https://www.niams.nih.gov/health-topics/fibromyalgia
American College of Rheumatology. Fibromyalgia. https://rheumatology.org/patients/fibromyalgia
Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology. 2018;129(2):343–366. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051899/
Cleveland Clinic. Ketamine therapy. https://my.clevelandclinic.org/health/treatments/ketamine-therapy
About Infuse RVA Team
At InfuseRVA Ketamine & Wellness in South Chesterfield, VA, our team works specifically with patients in the greater Richmond area who have not found adequate relief through conventional treatment — those whose depression, PTSD, anxiety, or chronic pain persists despite prior medication and therapy trials. We evaluate each patient individually before recommending any treatment approach, with IV ketamine infusion therapy and SPRAVATO® (esketamine) available for patients who meet criteria for treatment-resistant depression following a thorough clinical review. Our care is built around both the physical and emotional dimensions of mental health: we take the whole patient seriously, from unexplained physical symptoms to the longer history that brought them to our door.
Medical Disclaimer
This content is provided by Infuse RVA for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. IV ketamine for fibromyalgia and chronic pain is an off-label use of an approved medication. Only a qualified medical provider can determine whether ketamine therapy is appropriate for your specific situation. Results vary by individual, and no outcomes are guaranteed. Please discuss all treatment options with your provider before making any decisions about your care.
