The Role of Ketamine Infusion Therapy in the Treatment of Pain Disorders
At McElroy Parris Trial Lawyers (MPTL), we have sat across the table from many people whose injuries never really healed. The fracture mended. The scars faded. But the pain stayed, along with sleepless nights, depression, anxiety, and memories of the trauma that caused it all.
Chronic pain is one of the least understood and most overlooked injuries in the law. Because it cannot be seen on an X-ray, it is too often doubted or dismissed, especially when the person suffering is a woman or a person of color. At MPTL, we do not accept that. We believe people living with pain deserve to be heard. They also deserve clear, honest information about treatments that may help them get their lives back.
One of those treatments is ketamine infusion therapy. Here is what the research shows.
What Is Ketamine Infusion Therapy?
Ketamine has been used as an anesthetic for decades. At much lower doses, given slowly through an IV over several hours, it works differently. It acts on NMDA receptors in the brain and spinal cord, which play a central role in “central sensitization.” That is a process in which the nervous system remains in a heightened pain state long after the original injury has healed.
In other words, ketamine may target the kind of pain many of our clients describe: pain that seems to have taken on a life of its own.
Doctors’ use of IV ketamine for chronic pain has grown over the past two decades. In 2018, three leading medical societies, the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists, issued joint guidelines concluding that evidence supports ketamine for certain chronic-pain conditions. The strength of that evidence depends on the condition and dose. (ASRA)
Ketamine and CRPS
Complex Regional Pain Syndrome, or CRPS, is one of the most painful and misunderstood conditions we see. It often develops after trauma, such as a fracture, crush injury, surgery, or even a sprain. (Schwartzman et al., Pain, 2009)
People with CRPS describe burning pain, swelling, changes in skin color and temperature, and sensitivity so extreme that the touch of a bedsheet can be unbearable. It is pain far out of proportion to the injury that started it. That is one reason it is so often doubted.
CRPS is also one of the conditions for which ketamine has been studied most closely:
Drexel University study (2009). In a double-blind, placebo-controlled trial, people with CRPS received outpatient ketamine infusions for four hours a day over 10 days. The ketamine group saw statistically significant reductions in multiple measures of pain. The placebo group did not. (PubMed)
Netherlands study (2009). Sixty people with CRPS received a five-day hospital infusion of ketamine or saline. After one week, average pain in the ketamine group dropped from 7.2 to 2.7 on a 10-point scale, compared with 6.9 to 5.5 for placebo. Meaningful relief lasted about 11 weeks. Importantly, how long someone had suffered from CRPS did not predict whether ketamine would help. (Sigtermans et al.)
A 2023 review of CRPS research found that roughly half of patients experienced some form of longer-term relief from ketamine infusions. It also found that multi-day treatment appeared more effective than a single-day infusion, which generally did not provide meaningful benefit beyond about a week. Medical guidelines rated the evidence for ketamine in CRPS as Grade B, meaning low-to-moderate certainty. (Lii et al.)
Ketamine is not a cure for CRPS. Relief often fades over weeks or months, and many people need repeat treatments. But for someone who has tried other options without meaningful relief, it may be a treatment worth discussing with a qualified pain specialist.
Ketamine for Depression
Pain and depression can feed each other. When you cannot work, cannot sleep, and cannot do the things that made you who you are, depression often follows. Research suggests ketamine may reduce depressive symptoms more quickly than many traditional antidepressants.
An international analysis of individual patient data found that 45.5% of people with depression responded to a ketamine infusion, compared with 20.5% on placebo. (Molecular Psychiatry, 2022)
A systematic review found a strong effect within four hours of a single infusion, peaking at 24 hours and easing somewhat by day seven. A series of infusions produced stronger, longer-lasting results. (PubMed)
In 2019, the FDA approved esketamine, sold under the brand name Spravato, as a nasal-spray treatment for adults with treatment-resistant depression. (Johnson & Johnson) IV ketamine infusions are generally prescribed “off-label.” That is legal and common, but it can make insurance companies reluctant to pay.
Ketamine for PTSD
Many of the people we represent, including survivors of car and truck crashes, workplace accidents, assaults, and other violent events, carry the effects of trauma long after their physical injuries. For them, PTSD can be as disabling as any broken bone.
In a randomized controlled trial of repeated ketamine infusions for chronic PTSD, researchers at Mount Sinai gave participants six infusions over two weeks. Sixty-seven percent of those who received ketamine improved significantly, compared with 20% in the comparison group. For many, relief began within 24 hours of the first infusion and lasted a median of about four weeks. Depression improved as well, and the treatment was generally well tolerated. (Mount Sinai)
These results are encouraging. However, the studies are still relatively small, and ketamine is not yet a standard first-line treatment for PTSD.
The Honest Picture: Risks and Limits
At MPTL, we believe our clients deserve the whole truth, not just the hopeful parts.
Side effects are common but usually mild and brief. The most frequent include drowsiness, dizziness, sedation, and dry mouth. Some people also experience temporary dissociative effects during an infusion, such as feeling detached, vivid dreams, or hallucinations. (Niesters et al.)
The evidence for chronic pain in general is mixed. A 2023 Cochrane review of 67 studies across many types of chronic pain concluded that it remains unclear whether IV ketamine reduces pain intensity overall and noted that it may increase the risk of side effects. CRPS, where targeted trials exist, has stronger support than chronic pain as a whole. (Cochrane)
Relief is often temporary. Many people need repeat infusions, sometimes for years, to maintain a benefit.
It must be done properly. Infusions should be given by qualified providers in a monitored setting, following established screening and safety protocols.
Why This Matters to Your Case
If you developed CRPS, chronic pain, depression, or PTSD after an injury that was not your fault, ketamine therapy may become part of the care your doctors recommend. These treatments can be expensive. They may need to be repeated over many years. And insurance companies often resist paying for them.
We have seen, again and again, how insurance companies and defense lawyers try to minimize chronic pain and the emotional injuries that come with it. They call it “subjective.” They say it is exaggerated. They ignore the science.
At MPTL, we do not let that happen. We are trial lawyers, and we prepare every case with the expectation that it may one day be presented to a jury. We work closely with your doctors and medical experts to document the full reality of your injuries, including the treatment you need today and the care you may need for the rest of your life.
When the insurance company knows we are ready to tell your story in a courtroom, they have a stronger reason to take your pain seriously.
Start a Conversation
When life changes in an instant, we are here to help. If you or someone you love is living with chronic pain, CRPS, depression, or trauma after a serious injury, we would be honored to listen.
Call MPTL at (805) 272-4001 to talk with our team.
We listen. We care. We demand justice.
This article is for general informational purposes only and is not medical or legal advice. Please talk with a qualified physician about whether ketamine therapy is right for you, and contact an attorney about your specific situation.
