© 2020 dr michael bassett

inpatient ketamine infusion

what is ketamine

 

Ketamine is a powerful painkiller and anaesthetic medication.  In high doses, it has been used as the sole anaesthetic agent to perform operations.  In lower doses, it is commonly used as a painkiller both for acute pain (after an operation) and chronic pain.  

 

why has michael recommended that I have a ketamine infusion?

 

Research has demonstrated that following a prolonged infusion (100 hours) of ketamine, prolonged pain relief can be achieved for up to 3 months.  Michael’s aim is that with the improvement of pain, your function, sleep and enjoyment of life will also improve.  The degree and duration of pain relief are variable between patients.  

 

 

 

 

what is the ketamine infusion used for?

 

The overall aim of the ketamine infusion is to act as a circuit breaker for your pain.  This will then allow improved sleep, allow your existing medications to work more effectively and allow you to participate more freely in other therapies such as physiotherapy, yoga, pilates and tai chi (which help to recondition your body and mind for better long-term pain relief).

 

Pain conditions in which a ketamine infusion may be beneficial include:

 

  • chronic pain

  • central sensitisation

  • neuropathic pain (central & peripheral)

  • fibromyalgia

  • complex regional pain syndrome

  • migraines

  • phantom limb pain

  • opioid-induced hyperalgesia

  • ischaemic limb pain

 

how does the ketamine infusion work?

 

Patients suffering from chronic pain often have an overactive nervous system due to a number of factors such as a constant barrage of pain signals (central sensitisation) and medications (opioid-induced hyperalgesia).  Over time, the brain’s ability to tune out pain signals can also be substantially reduced.  An analogy would be turning the volume control in your pain system (spinal cord and brain) from normal to maximum volume.  

 

Ketamine acts on nerves to quieten the messages sent to the brain as well as assisting the brain’s ability to tune out pain signals.  Ketamine therefore effectively turns down your pain volume, thus decreasing your pain. This may make your existing pain medications much more effective and allow Michael to decrease the doses of your pain medications, decreasing any side effects you may be experiencing from them.

 

what is involved with a ketamine infusion?

 

The ketamine infusion involves a 5-day inpatient stay at St John of God Hospital Ballarat. Michael admits ketamine infusion patients every second week from Monday to Friday.  You are required to stay in the hospital for the entirety of the week.  

 

Once you are admitted to the ward, you will have a small needle placed under the skin on your abdomen (tummy) or in a vein.  Blood will also be taken to check on your liver and kidney function.  The ketamine infusion will then be connected and commenced.  You will carry a small pump (the size of a large mobile phone) that slowly infuses the ketamine via a tube to the needle in your abdomen.

 

Michael aims for an infusion time of 100 hours during your stay,  He also aims for a particular ketamine rate (dose of ketamine per hour) which is tailored for each patient.  Michael will start your infusion off at a low rate to assess how you react to the ketamine.  Over the course of your stay, Michael will then turn up the ketamine rate each day until you reach the required dose.  The first admission, therefore, serves as a dose-finding exercise for each patient, so you will be able to reach your effective dose more quickly should you require another ketamine infusion in the future.

 

are there any side effects of the ketamine infusion?

 

Yes, just like any medication, it is possible to experience side effects.  During your stay, you will be regularly monitored by nursing staff for any issues.  Should you have any concerns at any point during your admission, please do not hesitate to speak to the nursing staff who can contact Michael at any time if required.

 

The side effects of ketamine are often dose-dependent, however, it is important to emphasise that you do not have to experience distressing side effects to achieve benefit from the ketamine.

 

Side effects of ketamine that you may experience include:

 

  • Euphoria

  • Increased awareness of senses

  • Dizziness

  • Blurred vision

  • Poor coordination

  • Nausea

  • Vomiting

  • Visual or Auditory Hallucinations

  • Nightmares or vivid dreams

  • Impaired memory

 

If you do experience any of the above symptoms, they will generally settle with a few hours of stopping the infusion, after which time Michael will re-commence the infusion.  It is not uncommon for Michael to stop and start your infusion a couple of times during your admission.

 

It is also possible that you may experience some minor after-effects of the ketamine infusion following discharge from the hospital.  If so, these will generally settle within a couple of days.

 

what are michael's expectations of me during the admission?

 

While you are an inpatient at St John of God Hospital, Michael asks the following of you:

 

  • be courteous and respectful of staff and other patients;

  • shower every day;

  • tend to your own personal hygiene (where possible);

  • spend daylight hours out of bed;

  • have curtains up in daylight hours;

  • wear daytime clothes during daylight hours;

  • bring clothes that can be worn to the gym;

  • spend regular periods of time out of your room (mobilising, visiting sunroom, or cafe);

  • participate in the inpatient pain program.

 

are there any restrictions?

 

Ketamine is a strong medication that can interact with alcohol.  As such, it is a requirement of the admission that you do not drink alcohol during your stay.  Please speak directly to Michael should you have any concerns regarding this.

 

Although Michael encourages you to walk around the ward and is happy for you to leave the ward with a responsible adult (on condition that you are not experiencing any significant side effects), due the nature of the infusion Michael and St John of God Hospital require that you to stay within the hospital for the entirety of your stay.  

 

Smoking is not permitted during your during your admission.  If you require nicotine substitution (patches), please discuss this with Michael.  If you are unable to cease smoking, unfortunately, you will not be suitable for an inpatient ketamine infusion.

 

Please note that these restrictions are for your safety.  Michael does not make exceptions regarding alcohol and cigarettes.

 

what is the inpatient pain program?

 

The inpatient pain management program is run by a highly skilled group of allied health professionals who specialise in pain management. The team includes:

 

  • nursing staff;

  • a physiotherapist;

  • an occupational therapist;

  • an exercise physiologist;

 

The pain program complements your infusion.  Using non-medication based techniques, its aim is to help you manage and improve your pain control, improve your ability to perform day to day activities, and allow you to improve your enjoyment of life.

 

Michael meets with the allied health team on the Tuesday morning of your admission to discuss your individual pain issues and to identify individualised goals for your treatment.  Michael and your therapists will discuss these goals with you over the rest of the week.