For millions of individuals living with chronic neuropathic and centralized pain, conventional pharmaceuticals, physical therapy, and epidural nerve blocks often fail to deliver sustained functional relief. Ketamine IV infusions offer meaningful clinical hope for treatment-resistant chronic pain conditions, particularly fibromyalgia, complex regional pain syndrome (CRPS), and chronic intractable migraines.
Ever since ketamine was first synthesized in the 1960s, clinical researchers have recognized its multifaceted impact on human pain pathways. Decades of peer-reviewed clinical investigation continue to clarify how ketamine modulates complex neural pain circuits.
A key driver behind the research supporting ketamine infusion therapy is the urgent medical necessity to find effective alternatives to long-term opioid regimens. Unlike opioid medications, ketamine possesses no physical addictive properties and does not suppress respiratory drive at sub-anesthetic pain doses.
Medical and Regulatory Context: Ketamine is FDA-approved as an anesthetic agent. Its administration for chronic pain management, while established through extensive academic literature and hospital protocols developed at institutions like Johns Hopkins Medicine, is an off-label clinical application.
What Is Ketamine and How Is It Used for Chronic Pain?
Ketamine is an FDA-approved anesthetic that clinicians also use off-label to treat chronic pain. It acts on the nervous system instead of masking pain, which is why Avesta offers it when standard treatments have not given enough relief, after a clinician screens each patient.
Scientifically, Ketamine is a drug with sedative (sleep-producing), analgesic (pain-relieving), and amnesic (short-term memory loss) effects. It combats pain by acting against a specific chemical receptor known as N-methyl-D-aspartate, or NMDA, which is found in the nervous system and, in part, modulates pain. These neurotransmitters are decreased at pain receptors in the brain and spinal cord.
Ketamine also interacts with other receptors as well, broadening its clinical uses. As noted in my recent article “Is Ketamine Safe,” “Ketamine is deemed a complete anesthetic with minimal effects on cardiovascular function, respiratory drive, and airway reflexes. It is used extensively for pediatric and adult treatment in surgery, emergency departments, trauma medicine, and war zones.”
How Does Ketamine Relieve Chronic Pain?
Ketamine relieves chronic pain on two fronts. It interacts with opioid receptors to raise the pain threshold without opioids’ addictive properties, and it blocks NMDA receptors that keep an overactive nervous system sensitive to pain. Relief can begin as early as the first infusion.
If you are reading this article, you already know that Chronic Pain is difficult to treat. It can be both physically and emotionally taxing because the pain itself can be unbearable, while the emotional toll on your personal life and the lives of your loved ones can be equally as taxing.
Chronic Pain is not only difficult to treat but it is largely misunderstood. The good news is that there is hope. While Chronic Pain is challenging to treat, we have found that Ketamine infusions are often able to get your nerves to stop sending pain signals which effectively allows you to get back to your regular life.
Raising the Pain Threshold Through Opioid Receptors
Ketamine interacts with some of the same opioid receptors in the central nervous system that opioid medications affect, which raises the pain threshold. Unlike opioids, it has no physical addictive properties.
Calming Central Sensitization
Chronic pain can leave the nervous system hypersensitive to pain signals, a process called central sensitization. Ketamine blocks NMDA receptors, which play a central role in amplifying pain signals and creating pain memory. Interrupting that signaling dampens hyperactive pain pathways in the spinal cord and brain, so normal sensations such as a light touch stop feeling painful.
Restoring Descending Pain Inhibition
Chronic pain weakens the body’s built-in pain control system. Ketamine helps reinforce the natural painkillers serotonin and norepinephrine at the spinal cord and brain level, which restores the brain’s ability to regulate pain.
A patient with Chronic Pain may benefit from Ketamine IV Infusion treatments if they have not had much success with other pain medications or treatments. Ketamine reduces some types of pain more effectively than others.
The important thing to understand about Ketamine IV infusions is that the dose of Ketamine that is administered during a Ketamine infusion treatment is significantly lower than what is administered to patients undergoing anesthesia. The reason for introducing Ketamine into the bloodstream through IV infusion is to provide stimulation to the brain to help it create new neurotransmitters that ideally provide more effective communication between the brain and the body. The result is significantly lessened pain and a retraining of the brain because it learns to decrease the sensation of pain over time.
Which Types of Chronic Pain Respond to Ketamine Infusions?
Avesta treats pain related to complex regional pain syndrome (CRPS), fibromyalgia, Ehlers-Danlos syndrome, migraines, long COVID, Lyme disease, pre- and post-surgical pain and opioid withdrawal symptoms. Each plan is built around the specific diagnosis and history, and a clinician screens candidacy before anything is booked.
Ketamine Infusion treatments are effective for the following types of pain:
- Migraines
- Fibromyalgia
- Traumatic spinal cord injury
- Complex regional pain syndrome
- Some types of cancer-related back pain
- Certain kinds of nerve and back pain
Complex Regional Pain Syndrome
CRPS is one of the most studied pain conditions for ketamine and a top reason pain patients seek this therapy. A systematic review found that 13 of 14 studies showed ketamine significantly reduced CRPS pain, with infusions delivered slowly over hours to several days.
Fibromyalgia and Central Pain Amplification
Avesta treats fibromyalgia with ketamine using the same Johns Hopkins protocol, customized to the diagnosis. Fibromyalgia is also one of the pain types Dr. Eshkevari lists as commonly responding to ketamine infusions.
Neuropathic Pain
Ketamine’s nervous system reset makes it a treatment option for neuropathic pain caused by nerve damage or dysfunction, including post-herpetic neuralgia, peripheral nerve damage, chemotherapy-induced neuropathy, spinal cord injury pain, phantom limb pain, and trigeminal and temporomandibular pain. Pain that has failed surgery, nerve blocks and opioids is classed as treatment-resistant pain.
Chronic Migraines
Avesta treats migraines that have not responded to standard treatment, and the research on ketamine for migraine is still emerging. One observational study described a multi-day infusion that gave significant short-term relief to hospitalized patients with treatment-resistant chronic migraines.
My patients who have had success with Ketamine infusions like them because their pain relief can last much longer than with some other types of treatment. Many patients report feeling better for days, weeks, or even months, depending on what kind of pain they have.
What Does a Ketamine Infusion Series for Chronic Pain Look Like?
Avesta follows the Johns Hopkins protocol for chronic pain: 3 to 5 infusions over consecutive days, each about four hours, with additional medications added to the infusion. A clinician stays with you and monitors vitals for the entire session, and some patients feel relief the same day.
Chronic pain sessions run about four hours, delivered on consecutive days. Due to the complexity of Chronic Pain management, pain regimens are very individualized to the patient. The majority of my patients report feeling effects within the first day or so and are recommended to continue their regular care.
Free Consultation and Medical Screening
A clinician reviews your pain history, prior treatments and current medications in a free 30-minute consult and tells you candidly whether ketamine is a reasonable next step. Blood pressure, cardiac history and current prescriptions are reviewed before anything is scheduled.
The Infusion Session
Do not eat for at least 5 to 6 hours before the appointment, avoid drinking for 1 to 2 hours before, and arrange a ride home. Most people describe a floaty, dreamlike state with an altered sense of time and body that settles within about 20 minutes of the infusion ending. Dizziness, blurred vision and mild nausea are treatable on the spot.
Reassessment and Maintenance
Your provider compares your response with your baseline and adjusts the plan. Booster infusions are scheduled by response, not by package, and if you are not responding, Avesta says so and helps you look at other options.
Pain Protocol Compared With the Depression Protocol
The two protocols differ in session length and series size, as Avesta lists them:
| Chronic pain | Mood disorders (depression) | |
| Series | 5 consecutive sessions (Johns Hopkins protocol: 3 to 5 infusions) | At least 6 sessions over 2 to 3 weeks |
| Session length | About 4 hours | 45 to 60 minutes |
| Added medications | Additional medications added to the infusion to work toward reducing pain | Not listed |
| After the series | Booster infusions scheduled by response | Maintenance program if needed |
| Source | /condition/chronic-pain/ and /treatment/iv-ketamine/ | /treatment/iv-ketamine/ |
A 2014 review of 37 randomized trials in the British Journal of Clinical Pharmacology found that short infusions relieve pain mainly during the infusion, and that prolonged infusions of 4 to 14 days gave effects lasting up to about 3 months in CRPS.
Who Qualifies for Chronic Pain Ketamine Infusions, and Who Is Referred Out?
A diagnosed chronic pain condition lasting months or longer, with standard treatments that have not given enough relief, makes a patient a likely candidate. Screening happens before anything is booked, and being told no is a legitimate outcome of the consult.
| Likely a good fit | Avesta pauses or refers out |
| A diagnosed chronic pain condition lasting months or longer | Uncontrolled high blood pressure, or a recent heart attack or stroke |
| Medication, physical therapy or nerve blocks have not given enough relief | Active, untreated psychosis or mania |
| Blood pressure and cardiac history are stable or well managed | Pregnancy or breastfeeding |
| Able to arrange a ride home after each four-hour session | Active, unmanaged substance use (Avesta helps sequence care first) |
| Able to commit to 3 to 5 consecutive treatment days | A history that points to a different treatment |
Safety standards apply on every visit: a full medical and psychiatric history is reviewed before the first visit, a clinician is present and vitals are monitored for every dose, and emergency protocols and medications are on site at every clinic.
Is Ketamine Approved for Chronic Pain, and What Are the Risks?
Ketamine is FDA-approved as an anesthetic, not for chronic pain, so Avesta uses it off-label following protocols such as the Johns Hopkins ketamine infusion protocol. Individual results vary, and nothing here promises an outcome or replaces an evaluation by a clinician.
The most common side effects are nausea, mild dizziness and, for some patients, blurred vision; each is treatable during the session.
How Much Do Ketamine Infusions for Chronic Pain Cost, and Does Insurance Help?
On Avesta’s pricing table, the chronic pain protocol is cash-pay for any payer, except Workers’ Compensation, at $1,400 per session for 5 sessions. IV ketamine for pain is off-label, so most insurers do not cover it, and Avesta’s insurance specialist gives a plan-specific estimate before the first session.
Out-of-network patients receive detailed superbills for reimbursement claims, and can file them through the plan’s member portal or through Reimbursify. HSA and FSA funds are usually eligible. Veterans can use VA Community Care, and Avesta also works with TRICARE. Financing is available through Advance Care. See the ketamine pricing guide and insurance and coverage pages for every payer.
Which Avesta Clinic Treats Chronic Pain Near You?
Avesta has five clinics across Washington DC, Maryland and Virginia, and a licensed clinician staffs every session at every location. Not every clinic offers every treatment, so the team matches you to the nearest location that offers the route you need.
| Clinic | Address | Phone |
| Washington, DC | 1400 16th St NW, Suite 101 | (202) 735-1183 |
| Bethesda, Maryland | 4833 Rugby Ave, #400 | (301) 200-9333 |
| Columbia, Maryland | 5840 Banneker Rd, Suite 270 | (301) 381-8381 |
| Tysons, Virginia | 8000 Towers Crescent Dr, Suite A150 | (703) 646-6343 |
| Norfolk / Virginia Beach, Virginia | 6275 E. Virginia Beach Blvd, Suite 103 | (301) 381-8381 |
How Do You Start Ketamine Treatment for Chronic Pain at Avesta?
Start with a free 30-minute consult. A clinician reviews your pain history, prior treatments and medications, benefits are checked up front, and no referral is needed. The team tells you honestly whether ketamine is a reasonable next step, at no cost and with no obligation.
To learn more about Avesta, visit about Avesta or the ketamine for chronic pain page. Book a free consultation to begin.
