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

Would you do anything to stop the agony of low back pain? For many people, the answer is a resounding "Yes!".


Low back pain is a debilitating condition that often leads to loss of function, social isolation, and it is the leading cause of work-related disability. These are just a few of the reasons that millions of people who suffer from lower back pain will try almost anything to get rid of the pain.


Low back pain is one of the leading cause of work-related disability.

Common Questions About Ketamine


In this article we take a look at a growing trend in the treatment of low back pain - Ketamine. Some questions we answer:


  • 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?


After reading this article we hope that you will have some understanding of Ketamine treatment, as well as an idea of the risks and benefits associated with it.


Low back pain is notoriously difficult to treat and the subjective nature of pain perception means that everyone feels pain, and responds to it (and pain treatments) differently. Hopefully you will be able to use this information as a starting point in a thorough discussion with your healthcare provider to find a treatment that works best for you.


Let’s get to it!


LivaFortis looks at ketamine therapy for low back pain.

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 was a derivative 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.


Ketamine is used to manage low back pain.

What Is Ketamine Used For?


Ketamine and PCP were both used as anesthetics. 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 still in use 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.


Ketamine works on the nervous system and interrupts pain messages.

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 substance that plays an important role in how our nervous systems function and it sends messages from one nerve cell to another.


At high doses Ketamine blocks glutamate from going home and stops it from sending 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.


Ketamine use does come with certain risks.

What are the risks associated with Ketamine use?


While the FDA has approved the use of ketamine for several indications, including anesthesia and depression, the long term use of the drug at low doses to treat pain haven’t 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.


LivaFortis looks at some of the side effects of ketamine.

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.



Ketamine has shown mixed results for managing low back pain in the long term.

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 a 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.


More studies are needed to see the long term effectiveness of ketamine for back pain.

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.


LivaFortis looks at the type of patient that ketamine treatment could work for.

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. 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.



Patients with schizophrenia and psychosis should avoid using ketamine.

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


People with cardiovascular disease should avoid ketamine.

Conclusions


Back pain is a condition that will affect 80% of the population at some point in their lives. It is notoriously difficult to diagnose, and challenging to treat. The subjective nature of pain means that many individuals require a unique and personalized approach to pain management.


Any tools that healthcare providers can add to their tool box for managing low back pain are welcome, but having clinical evidence to support the effectiveness of the treatment is important.


Person making informed healthcare choices.

Looking at the risk benefit ratio for treatment is also important. People don’t want to reduce their pain if it means damaging their liver or raising their blood pressure to concerning levels.


If you do choose to try ketamine to help manage your low back pain it is important to make sure that your healthcare provider closely monitors for any symptoms, as well as ensuring that using ketamine doesn’t lead to abuse of the drug. We don’t want to swap an opioid for something else that can cause substance use problems.


More data on ketamine use is being gathered as this treatment expands its use and as that data comes in, patients and their healthcare providers will hopefully be able to make more informed choices as to the risks and benefits of this treatment for chronic low back pain.


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