At Avesta, we place our trust in science and therefore, base our clinical approach on research-backed theses. After years of teaching about ketamine to graduate students at Georgetown University, our lead clinician, Dr. Ladan Eshkevari, opened Avesta because recent scientific research has shown that ketamine can help decrease symptoms for many individuals with mood disorders, PTSD and chronic pain.
Ketamine acts on the glutamate system. Glutamate is a neurotransmitter that is present throughout the brain, and regulates brain functionality. It connects with many other neurotransmitter pathways to ensure normal physiological function.
When glutamate is not connecting the right neurons to the right receptors, physical and mental health problems can arise. Ketamine blocks neurons from connecting to certain glutamine receptors and sends them to different receptors where they can be more functional. This can lead to a decrease in mental health and pain symptoms. Ketamine works with a variety of receptors to exert its effects, some of which we are just starting to discover. (https://www.sciencedirect.com/science/article/pii/S2210844014200062)
Scientifically, ketamine for pain management makes sense. Individuals with chronic pain commonly have an overactive N-methyl-D-aspartate (NMDA) receptor. The NMDA receptor is a glutamate receptor and ion channel found in neurons, but when it is not functioning at the level it should be, it can cause chronic pain. As published in USPharmacists.com, a resource for practicing pharmacists, (https://www.uspharmacist.com/article/the-emerging-role-of-nmda-antagonists-in-pain-management), “the activation of NMDA receptors has been associated with hyperalgesia, neuropathic pain, and reduced functionality of opioid receptors.” Ketamine blocks this receptor, which is how it can be helpful in regulating pain. Ketamine can also change the route of the neurons so they are no longer activating the NMDA receptor at the same levels.
According to an NIH meta-analysis, Ketamine for chronic pain: risks and benefits, “current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4-14 days) show long-term analgesic effects up to 3 months following infusion.”(1,2) There have been limited studies on ketamine's effects on long term pain; however, there is some data to support that it has helped some chronic pain patients.
Prior to coming in, we will schedule a free phone consultation with you and Dr. Eshkevari, who has years of experience in anesthesia and pain management, to develop a treatment plan for your pain. This might mean coming in every day for a week for 2-4 hour sessions. During your first session, we will go over anything else you would like to discuss, take your vitals, and set up the infusion. Our treatment rooms are cozy, aesthetically pleasing and private. We provide blankets, and we have a comfortable waiting room if you bring a loved one with you. We recommend bringing headphones and a gentle playlist to listen to during your infusion. We will come in to take vitals and check on you a few times throughout the session, and when you are done, we will take final vitals and provide snacks and water.
First, we understand that chronic pain is difficult to live with, both for the patient, and their loved ones. As providers, we try to understand what is causing it. The overactivation of certain receptors is certainly part of the cause. Is ketamine going to work for your pain? The short answer is: maybe. We genuinely hope it does, but we cannot tell you with certainty that it will. We have patients in whom it has been immensely helpful; however, as with all treatment resistant health problems, no drug works the same for everyone. While our brains are all made up of the same components, the varying levels of neurotransmitters, hormones, and pathways make each one unique.
Ketamine is promising and growing as a treatment option for a variety of health issues. It is also being studied more and more, and with more research comes more answers. Contact us today for a free consultation to see if it is right for you.