Ketamine Therapy & Chronic Pain Management
Pain Relief. Movement. Recovery.
Chronic pain is more than a symptom. It can affect the nervous system, movement, sleep, emotional health, and everyday quality of life.
At PRO Sports Medicine, we offer individualized ketamine-based treatment options designed to address persistent pain, support functional rehabilitation, and consider the psychological components that often accompany chronic pain.
Our services include medically supervised IV ketamine infusions, prescribed at-home oral troches, ketamine-assisted physical therapy, and guided sessions with a registered nurse.
When Traditional Pain Management Isn't Enough
Many patients with persistent pain have already tried medications, injections, physical therapy, or other treatments with limited or temporary improvement.
In chronic pain, the nervous system may become increasingly sensitive to sensory input. Pain can continue even after the original injury has healed or when tissue findings do not fully explain the severity of symptoms.
Ketamine is a medication with anesthetic and analgesic properties that acts, in part, through N-methyl-D-aspartate (NMDA) receptor antagonism.
Its effects on pain signaling and central sensitization have led to growing interest in ketamine as an option for selected chronic pain conditions.
Our focus is not simply reducing pain scores. It is helping patients pursue meaningful improvements in comfort, function, mobility, and daily activity.
Four Approaches. One Individualized Plan.
Ketamine treatment is not one-size-fits-all.
We offer several delivery and treatment models based on clinical needs, functional limitations, treatment response, and patient preferences.
Oral Ketamine Troches
Oral ketamine troches are individually prescribed compounded medication formulations designed to dissolve in the mouth.
For selected patients, oral ketamine may be considered as part of an ongoing chronic pain management plan.
This option may provide an alternative to repeated in-office treatments when appropriate, although evidence supporting long-term oral ketamine remains limited.
Treatment requires medical evaluation, individualized prescribing, appropriate supervision, and regular reassessment.
At-home use involves important safety considerations, including altered perception, sedation, blood pressure changes, and possible medication misuse.
IV Ketamine Infusion Therapy
Intravenous ketamine allows clinicians to administer medication in a controlled clinical setting with appropriate physiologic monitoring.
IV ketamine has been investigated as a treatment option for difficult-to-manage chronic pain conditions.
Some patients experience meaningful pain reduction, although the degree and duration of benefit vary considerably.
We evaluate pain history, medical conditions, previous treatments, treatment goals, and potential risks before determining candidacy.
Infusions are performed with monitoring and recovery assessment. Treatment protocols are individualized.
Ketamine-Assisted Physical Therapy
This integrated approach combines an in-office ketamine infusion with a physical therapy session scheduled immediately afterward.
The purpose is to explore whether a period of reduced pain sensitivity may create an opportunity to work toward movement and rehabilitation goals.
Physical therapy may focus on gentle mobility, functional movement, graded activity, and individualized rehabilitation exercises.
Participation requires sufficient recovery from the infusion, clinical clearance, and the ability to move safely.
Ketamine-assisted PT is an individualized treatment model. Research directly evaluating this combined approach remains limited.
RN-Guided Ketamine Sessions
Chronic pain often affects emotional well-being, sleep, stress responses, and a person's relationship with their body.
Our registered nurse offers guided supportive sessions as part of selected ketamine treatment experiences.
Depending on individual needs, sessions may incorporate relaxation, preparation, supportive conversation, grounding techniques, and post-treatment reflection.
These sessions recognize the relationship between physical pain and emotional health without assuming that chronic pain is psychological in origin.
RN-guided support is not a substitute for formal psychotherapy or psychiatric management. Referrals can be considered when specialized mental healthcare is indicated.
The Role of the Nervous System
Pain begins as an important protective signal, but persistent pain can involve much more than ongoing tissue injury.
Over time, changes in pain-processing pathways may increase sensitivity to normal movement, pressure, or other sensory input.
This phenomenon is often described as central sensitization.
NMDA receptors participate in important processes involving neural signaling and pain amplification.
Ketamine's NMDA receptor antagonism provides one rationale for its use in selected chronic pain conditions.
However, chronic pain is complex, and no single medication reliably reverses every contributor to persistent pain.
Chronic Pain May Involve
- Persistent peripheral pain signals
- Central sensitization and heightened pain sensitivity
- Neuropathic pain mechanisms
- Altered movement patterns and guarding
- Reduced activity tolerance
- Sleep disruption and fatigue
- Stress, anxiety, or depressed mood
- Functional limitations and reduced quality of life
Chronic pain mechanisms differ between individuals. A clinical assessment helps identify the most appropriate treatment approach.
Conditions We May Evaluate
Ketamine may be considered for selected patients with persistent or treatment-resistant pain. Supporting evidence varies substantially by condition.
Complex Regional Pain Syndrome
CRPS is associated with persistent regional pain and may include changes in sensation, swelling, temperature, skin appearance, and movement.
IV ketamine has been investigated for some patients with refractory CRPS, although benefits are variable and may be temporary.
Neuropathic Pain
Neuropathic pain develops from injury or disease affecting the somatosensory nervous system.
Ketamine may be evaluated in difficult-to-manage cases when conventional treatments have provided insufficient relief.
Persistent Musculoskeletal Pain
Chronic neck, back, joint, and regional musculoskeletal pain may involve overlapping tissue, neurologic, and functional factors.
Ketamine is not a routine first-line treatment for these conditions, but selected refractory cases may warrant further evaluation.
Centralized Pain Conditions
Some persistent pain disorders involve abnormal pain processing and widespread sensitivity.
The evidence supporting ketamine varies, and the presence of central sensitization alone does not establish treatment candidacy.
Post-Injury or Post-Surgical Pain
Pain sometimes continues well beyond expected tissue healing.
Evaluation may consider nerve injury, residual structural problems, functional limitations, and abnormal pain processing.
Pain With Mental Health Components
Chronic pain frequently coexists with anxiety, depression, trauma-related symptoms, and chronic stress.
Our assessment considers these overlapping factors and whether coordinated behavioral healthcare would be beneficial.
Listing a condition does not imply that ketamine is an approved or established treatment for that diagnosis. Candidacy depends on individual evaluation.
Ketamine-Assisted Physical Therapy
Addressing pain is only one part of recovery. Restoring movement and function is equally important.
Some patients with persistent pain develop significant limitations in movement due to pain sensitivity, guarding, fear of exacerbation, or reduced activity tolerance.
Our ketamine-assisted physical therapy pathway combines an IV infusion with a planned physical therapy session immediately afterward.
The concept is to explore whether short-term changes in pain perception can support carefully supervised rehabilitation.
Physical therapy is initiated only after appropriate recovery assessment and clearance. If sedation, dizziness, impaired balance, perceptual changes, or other safety concerns remain, treatment is modified or postponed.
Potential Rehabilitation Goals
- Improving comfortable joint mobility
- Reducing protective muscle guarding
- Practicing graded movement exposure
- Working toward better functional movement patterns
- Supporting confidence with daily activity
- Establishing a progressive home rehabilitation plan
The combined treatment approach remains investigational. A temporary reduction in pain does not remove normal tissue-loading restrictions or mean that an injury has healed.
Our rehabilitation philosophy: Improvement in pain is most meaningful when it translates into safe, sustainable gains in movement, function, and quality of life.
Chronic Pain & Mental Health
Physical pain and emotional well-being are deeply interconnected.
Persistent pain can disrupt sleep, reduce independence, limit meaningful activities, and contribute to anxiety, depressed mood, or emotional distress.
Similarly, prolonged stress and psychological symptoms can influence pain processing and the experience of chronic symptoms.
Recognizing this relationship does not mean that pain is imaginary or purely psychological.
Ketamine & Mood Symptoms
Ketamine has been studied for its potential rapid antidepressant effects, particularly in treatment-resistant depression.
Evidence and treatment standards differ between IV ketamine and FDA-approved intranasal esketamine.
Our primary focus is chronic pain, while recognizing and addressing coexisting emotional and behavioral health needs.
Supportive Guided Sessions
Our registered nurse provides supportive guidance for selected ketamine treatment experiences.
Sessions may address preparation, relaxation, grounding, emotional responses, and reflection after treatment.
When formal psychotherapy, psychiatric treatment, or specialized trauma therapy is needed, appropriate licensed professionals should be involved.
Oral Ketamine vs. IV Ketamine
Route of administration, supervision requirements, pharmacokinetics, and available evidence differ between oral and IV treatment.
At-Home Oral Troches
- Prescription-based treatment for selected patients
- No IV access required
- Absorption and response can vary
- Requires clear administration and safety instructions
- Requires assessment of the home environment, supervision needs, and potential medication interactions
- Ongoing clinical follow-up is necessary
In-Office IV Infusions
- Controlled intravenous administration
- Direct clinical supervision
- Physiologic monitoring during treatment
- Recovery assessment before discharge
- Can be coordinated with rehabilitation or guided support
- Requires transportation and post-treatment safety planning
Compounded oral ketamine products are not FDA-approved. Both oral and IV ketamine use for chronic pain require individualized off-label prescribing decisions and risk-benefit assessment.
Pain Management Should Lead Toward Better Function
The objective is not simply to experience less pain during treatment. It is to pursue meaningful, sustainable improvement in everyday life.
By integrating medical pain management with rehabilitation and supportive care, we aim to address more than one component of persistent pain.
Your Ketamine Treatment Experience
Each patient's plan begins with an individualized clinical evaluation.
Clinical Evaluation
We review pain history, diagnoses, medications, previous treatments, mental health factors, and relevant medical risks.
Treatment Planning
We discuss whether oral treatment, IV infusions, guided sessions, or integrated rehabilitation are appropriate.
Monitored Treatment
Treatment proceeds under the applicable prescribing, administration, monitoring, and safety requirements for the chosen pathway.
Response & Function Review
We assess pain, function, activity tolerance, adverse effects, and whether continued therapy remains appropriate.
Responsible Ketamine Treatment Matters
Ketamine is a prescription medication and Schedule III controlled substance.
Potential adverse effects include dissociation, sedation, dizziness, nausea, changes in perception, increased blood pressure and heart rate, and impaired coordination.
Repeated or prolonged exposure may also carry risks involving urinary tract dysfunction, liver abnormalities, tolerance, misuse, and dependence.
At-home ketamine use can present additional risks because direct clinical monitoring is not continuously available.
Appropriate patient selection, prescribing oversight, monitoring, and reassessment are essential.
Important Screening Considerations
- Cardiovascular disease and uncontrolled hypertension
- History of psychosis, mania, or significant psychiatric instability
- Substance misuse history
- Liver or urinary tract disease
- Pregnancy or breastfeeding
- Sedating medications, alcohol, and drug interactions
- Ability to comply with safety instructions
- Transportation, support, and follow-up needs
Treatment may be deferred or declined when contraindications, inadequate monitoring resources, or other clinical safety concerns are identified.
Understanding Ketamine Therapy
How does ketamine help with chronic pain?
Ketamine blocks NMDA receptors involved in pain transmission and sensitization. This may reduce certain forms of pain amplification. Clinical response varies substantially by diagnosis and treatment protocol.
Is ketamine an opioid medication?
No. Ketamine is a dissociative anesthetic whose primary mechanism involves NMDA receptor antagonism. It has analgesic properties but is not classified as an opioid.
Is ketamine FDA-approved for chronic pain?
No. Ketamine injection is FDA-approved for certain anesthetic uses. Its use to treat chronic pain is off-label. Compounded oral ketamine formulations are not FDA-approved.
What are oral ketamine troches?
Troches are compounded medication preparations designed to dissolve in the mouth. They may be prescribed for selected patients, but they require careful screening, specific administration instructions, and ongoing monitoring.
What is ketamine-assisted physical therapy?
At PRO Sports Medicine, this is a coordinated service in which a physical therapy session is scheduled immediately after an IV ketamine infusion.
The goal is to explore opportunities for rehabilitation during a period when pain perception may be altered. Physical therapy takes place only if the patient has recovered sufficiently and can participate safely. Evidence for the combined approach remains limited.
Can ketamine help with depression or anxiety?
Ketamine has demonstrated antidepressant effects in some clinical research, particularly for treatment-resistant depression.
Evidence is more limited for many other psychiatric conditions. Our primary treatment focus is chronic pain, while also considering coexisting mental health concerns and appropriate specialist care.
What are RN-guided sessions?
Our registered nurse can provide supportive guidance that may include preparation, grounding, relaxation, and reflection surrounding a ketamine treatment.
These sessions complement medical care and are distinct from formal psychotherapy provided by a licensed mental health professional.
How many infusions will I need?
There is no single treatment schedule appropriate for every patient. Recommended frequency and duration depend on the clinical indication, previous response, adverse effects, and ongoing treatment goals.
How long do results last?
Some patients experience temporary reduction in pain, while others may experience longer periods of benefit or no meaningful response.
Treatment is not guaranteed to produce sustained improvement. Continued care is based on documented benefit and safety.
Can I drive after treatment?
Patients must follow individualized driving restrictions after ketamine. Driving or operating machinery while impaired is unsafe.
Transportation arrangements are required for in-office infusions, and discharge instructions must be followed.
Does insurance cover ketamine therapy?
Coverage varies by payer, diagnosis, route of administration, and treatment setting.
Many off-label ketamine services are self-pay. Coverage should be verified before treatment.
How do I know which treatment option is right for me?
A consultation allows us to review your medical history, pain symptoms, prior treatment response, functional goals, mental health considerations, and safety risks.
We can then discuss whether ketamine therapy is appropriate and which available pathway may best fit your needs.
Explore a Different Approach to Chronic Pain
Persistent pain can affect every part of daily life. Your treatment plan should recognize that complexity.
Our team provides individualized ketamine consultations, IV infusion services, at-home oral treatment evaluation, ketamine-assisted rehabilitation, and supportive guided sessions.
Together, we can evaluate your treatment history, discuss potential benefits and risks, and determine whether ketamine belongs in your overall pain management plan.
Medical information is provided for educational purposes only. Ketamine treatment for chronic pain and most psychiatric conditions is off-label. Compounded oral ketamine products are not FDA-approved. Treatment is subject to clinical evaluation, appropriate prescribing oversight, safety protocols, and applicable regulations. Ketamine-assisted physical therapy is an individualized approach with limited direct clinical evidence. No particular outcome or duration of benefit is guaranteed.