Ketamine-Assisted Therapy –

A Comprehensive, Multidisciplinary Approach for Treatment-Resistant Cases

Chronic pain is not only a physical symptom, but a complex bio-psycho-social condition that affects the nervous system, mood, sleep, and overall quality of life. At our clinic, ketamine-assisted therapy offers a modern, scientifically grounded option for patients in whom conventional treatments have not provided sufficient improvement.

What Is Ketamine Infusion Therapy?

Ketamine is a medication known for decades and safely used in medical settings, originally as an anesthetic. In recent years, research has shown that controlled-dose infusion therapy can be effective in certain chronic pain conditions, as well as in alleviating psychological symptoms often associated with chronic pain—such as anxiety, mood instability, depressive symptoms, and sleep disturbances—especially when conventional treatments have failed(1-3).

It is important to emphasize that:

  • ketamine is not a “miracle drug”
  • effects may vary between individuals
  • improvement may be temporary
  • in rare cases, no noticeable benefit occurs

The goal of therapy is not only pain reduction, but also improvement in quality of life and functional ability.

In Which Conditions Can It Be Considered?

Based on the literature, ketamine infusion therapy may be used in:

  • neuropathic pain
  • complex regional pain syndrome (CRPS)
  • fibromyalgia
  • chronic musculoskeletal pain
  • depression and anxiety associated with chronic pain
  • pain symptoms related to PTSD

It is particularly relevant for patients who have not responded to multiple pharmacological and non-pharmacological treatments.

How Does Ketamine Work?

Ketamine affects the nervous system’s pain-processing and mood-regulating networks. Research suggests that it:

  • reduces central sensitization
  • promotes the formation of new neural connections
  • improves neuroplasticity
  • may positively affect mood and sleep3,5.

During treatment, some patients may experience temporary altered states of consciousness (dream-like experiences, dissociation, “out-of-body” sensations). These are dose-dependent, temporary, and safely managed under medical supervision. The dose can be adjusted if necessary.

When Is It Not Recommended?

The treatment is not recommended in cases of:

  • acute psychosis
  • untreated schizophrenia
  • unstable cardiovascular conditions
  • severe untreated internal medical diseases
  • active substance use disorder

Eligibility is always determined through individual medical evaluation.

The Therapeutic Process at Our Clinic

1. Medical Evaluation

A pain specialist is responsible for establishing the medical indication, confirming the diagnosis, assessing inclusion and exclusion criteria, and ensuring structured follow-up. The decision is based on a comprehensive evaluation of the patient’s clinical status, previous treatments, and risk–benefit ratio1.

The process begins with a specialist consultation, including:

  • detailed assessment
  • ECG and laboratory tests
  • anesthesiology evaluation
  • detailed patient information about the procedure

2. Psychiatric and Psychological Consultation

Since chronic pain is a bio-psycho-social condition, psychological factors are essential to consider4.

The consultation aims to:

  • screen for psychiatric contraindications
  • identify anxiety or mood disorders
  • assess psychological resources
  • support long-term therapeutic outcomes

International guidelines suggest that ketamine therapy is most effective when combined with psychological support1.

3. Ketamine Infusion Treatments6

During treatment:

  • ketamine is administered via slow intravenous infusion
  • each session typically lasts 4–5 hours
  • continuous monitoring is performed (blood pressure, heart rate, oxygen saturation, ECG)
  • dosing is individualized

The number of treatments depends on the patient’s condition and initial response. Therapy may consist of a single session or a series of treatments for longer-lasting effects.

4. Monitoring and Follow-up

  • short observation period after treatment
  • no driving on the day of treatment
  • follow-up within 2–4 weeks
  • regular monitoring of pain, function, and quality of life

5. Psychological Preparation and Integration

Ketamine therapy is preceded by psychological preparation sessions and followed by integration consultations.

Preparation focuses on:

  • psychological readiness
  • enhancing sense of safety
  • clarifying therapeutic goals
  • addressing treatment-related concerns

Integration sessions focus on:

  • processing experiences
  • reinforcing positive changes
  • strengthening coping strategies
  • supporting long-term effects

Research suggests that ketamine-induced neuroplasticity creates a sensitive period where psychological work may be particularly effective5.

Possible Side Effects

Most side effects are temporary and dose-dependent. These may include:

  • nausea, dizziness
  • temporary increase in blood pressure and heart rate
  • drowsiness
  • vivid dreams
  • dissociative experiences
  • blurred vision

Medical staff are present throughout, and any symptoms can be reported immediately.

How Long Do the Effects Last?

This varies individually, but often:

  • sustained improvement is observed
  • treatment can be repeated if needed
  • in rare cases, no noticeable change occurs

How Can Patients Improve Outcomes?

Best results are achieved as part of a complex approach:

  • psychotherapy
  • movement therapy
  • regular sleep
  • stress management
  • healthy nutrition
  • weight optimization

Important Information

  • Ketamine use for chronic pain is currently off-label in Hungary, but internationally recognized and reimbursed in some countries
  • Treatment can only be performed in a medical setting
  • Detailed information and written consent are required
  • Safety is ensured by a multidisciplinary team: pain specialist, anesthesiologist, psychiatrist, psychologist, and nursing staff

The anesthesiologist and advanced practice healthcare professional are responsible for assessing anesthetic fitness, ensuring safe treatment delivery, continuous monitoring, and emergency preparedness. Ketamine infusions must be performed in a properly equipped, monitored medical environment with a trained anesthesia team present1,2.

Source:

  1. Cohen, S. P., et al. (2018). Consensus guidelines on the use of intravenous ketamine infusions for chronic pain. Regional Anesthesia and Pain Medicine, 43(5), 521–546.
  2. Niesters, M., Martini, C., & Dahan, A. (2014). Ketamine for chronic pain: Risks and benefits. British Journal of Clinical Pharmacology, 77(2), 357–367.
    International Association for the Study of Pain (IASP). (2021). Ketamine use in chronic pain management – Position and clinical guidance.
  3. Finnerup, N. B., et al. (2021). Neuropathic pain: From mechanisms to treatment. Physiological Reviews, 101(1), 259–301.
    Vollenweider, F. X., & Preller, K. H. (2020). Psychedelic drugs: Neurobiology and potential for treatment of psychiatric disorders. Nature Reviews Neuroscience, 21(11), 611–624.
  4. Yang, Y., Maher, D. P., & Cohen, S. P. (2020). Emerging concepts on the use of ketamine for chronic pain. Expert Review of Clinical Pharmacology, 13(2), 135–146. https://doi.org/10.1080/17512433.2020.1717947
  5. Vollenweider, F.X., Preller, K.H. Psychedelic drugs: neurobiology and potential for treatment of psychiatric disorders. Nat Rev Neurosci21, 611–624 (2020). https://doi.org/10.1038/s41583-020-0367-2
  6. Wang, Sheri, Brian O’Connell, Rebecca Shue DeSensi, et al. ‘Impact of Ketamine Infusions on Healthcare Utilization and Chronic Pain: A Comparative Effectiveness Study with Insights from Real-World Data’. Chronic and Interventional Pain. Regional Anesthesia & Pain Medicine, ahead of print, 3 March 2026. https://doi.org/10.1136/rapm-2025-106975