Ketamine Therapy To Treat Lower Back Pain: What Is It And How Does It Work?

Imagine living each day with an unrelenting ache that robs you of mobility, productivity, and joy. Low back pain does just that for millions of people worldwide, making it the number one cause of work-related disability. For those trapped in its grip, relief isn’t just a hope—it’s a necessity. Enter ketamine therapy, an innovative treatment that’s capturing attention for its potential to rewrite the story of chronic back pain.

In this article we take a look at this trending new treatment for back pain and explore some of the pros and cons of managing chronic pain conditions with it.

Common Questions About Ketamine

In this article, we delve into an emerging trend in chronic pain management: ketamine therapy for low back pain. You’ll discover answers to critical questions such as:

• What is Ketamine?

• What is Ketamine used for?

• How does Ketamine work?

• What are the risks associated with ketamine use?

• Why is ketamine being used for low back pain?

• What evidence is there to support the use of ketamine for lower back pain?

• Who can benefit from ketamine therapy?

By the end of this article, we hope that you’ll have a clearer understanding of ketamine therapy and its potential to change how we treat low back pain.

Low back pain is challenging to treat, as pain perception is highly subjective, with each person experiencing and responding to pain—and its treatments—differently. This information can serve as a helpful starting point for a thorough discussion with your healthcare provider to determine the most effective treatment for you.

Let’s get to it!

What Is Ketamine?

Ketamine is not a new drug, in fact it has been around since 1962 when it was first discovered by an American scientist by the name of Calvin Stevens. Ketamine actually came from the discovery of another drug called PCP (phencyclidine) that had been in use since 1926 as an anesthetic. PCP and Ketamine both fall under a class of drug known as hallucinogens, meaning that they can alter people’s thoughts, perceptions and feelings.

What Is Ketamine Used For?

Ketamine and PCP were both originally used as anesthetics - they help numb or relieve pain. Doctors stopped using PCP in the 1960s because of the harmful effects that it had on patients causing them to become delusional and agitated. Ketamine became its replacement. Ketamine is actually still used as an anesthetic for humans and animals, especially for horses.

While the FDA has only officially approved Ketamine for anesthetic purposes, Ketamine is also often used off-label to treat depression.

How Does Ketamine Work?

Ketamine is an NMDA (N-methyl-D-aspartate) receptor antagonist. NMDA is a receptor for the excitatory neurotransmitter glutamate. That sounds very complicated but basically, NMDA is a sort of home for a substance called glutamate. Glutamate is a key element that plays an important role in how our nervous system functions and it sends messages from one nerve cell to another.

At high doses Ketamine blocks glutamate from going "home" and stops it from sending the messages to the nerve cells. This is what makes it an effective anesthetic. Ketamine also works with glutamate and other neurotransmitters in the brain which is why it is being looked at for its use in treating depression.

What are the risks associated with Ketamine use?

While the FDA has approved the use of ketamine for several indications, including anesthesia, and more recently depression (but only esketamine nasal spray), the long term use of the drug at low doses to treat pain hasn't actually been studied very much. The studies that have been done often have conflicting results in terms of side effects and concerns, making it hard to know for certain just how risky this treatment is.

While ketamine is generally considered to be safe for use in a controlled medical practice there are instances where it can be dangerous. Research presented at the Anesthesiology 2019 annual meeting reported that more than one out of every three patients treated with ketamine experience side effects like hallucinations and visual disturbances.

Some common side effects of ketamine include:

• Increases in blood pressure and heart rate (this increase will continue until the medication is stopped)

• Agitation

• Confusion

• Abnormal heart rhythms

• Breathing difficulties/ respiratory depression

• Cognitive issues like memory problems

• Intracranial pressure

The American Society of Regional Anesthesia and Pain Medicine as well as the American Society of Anesthesiologists both support using ketamine infusions for acute pain management, but they do have some concerns around long term use and what those effects might be.

Why is ketamine being used for low back pain?

For years opioids were the gold standard in treating and managing low back pain but this treatment came at an impossibly high personal cost, with many individuals becoming addicted to these drugs. As the opioid epidemic continues to take its toll on the US, ketamine is being looked at as an alternative pain management tool.

What evidence is there to support the effectiveness of ketamine for chronic low back pain?

When it comes to clinical studies that support the use of ketamine for chronic low back pain, the results are often quite varied. One meta-analysis of around 200 patients from 7 different studies found that ketamine infusions for neuropathic and non neuropathic pain were effective with pain reduction lasting significantly up to 4 weeks after the treatment.

A different study that looked at ketamine use for patients with fibromyalgia found that quite a high dose of ketamine couldn’t control the pain for longer than 45 minutes.

When you consider the high risk of side effects, as well as how expensive and time-consuming ketamine treatment can be, it is important that pain relief is felt for some time after treatment. So far, ketamine has shown some very mixed results with regards to its ability to show longer term pain relief, especially for chronic low back pain.

Who can benefit from ketamine therapy?

Ketamine has a very specific mode of delivery with a very specific action taking place in the spinal cord. Not all patients in pain have these specific NDMA receptors activated so not everyone will respond to the medication in the same way. Experts therefore feel that there are generally two types of chronic pain patients that stand to benefit the most from this treatment.

The first group is chronic pain patients who have no other alternative than surgery to manage their pain, and the second group is chronic pain patients who have not responded to other treatments or pain medications such as opioids.

Who should avoid ketamine treatment?

While ketamine is a generally safe treatment there are specific types of patients that should avoid this drug. These include:

• Patients with a history of psychosis

• Patients with a history of schizophrenia

• Patients with PTSD

• Patients with cardiovascular disease

• Patients with liver problems

Conclusions

Back pain is a condition that will affect 80% of people at some point in their lives. It is notoriously difficult to diagnose and treat, as the subjective nature of pain requires a personalized approach to pain management for many individuals.

While healthcare providers are always seeking effective tools to manage low back pain, it's crucial that these treatments are backed by clinical evidence. The effectiveness of any intervention must be clearly demonstrated to ensure it benefits the patient without introducing unnecessary risks.

The risk-benefit ratio of treatments should always be carefully considered. People understandably don't want to reduce their pain if it comes at the expense of damaging their liver or raising blood pressure to dangerous levels.

If you decide to explore ketamine as a treatment for your low back pain, it's essential that your healthcare provider closely monitors your response and watches for any potential side effects. There isn't much point in swapping one dependency risk for another, because that would defeat the purpose of finding safer, more sustainable pain relief solutions.

As the body of data on ketamine use continues to grow, both patients and healthcare providers will be better equipped to make informed decisions about its risks and benefits for chronic low back pain, hopefully leading to safer, more effective treatment options in the future.