IV ketamine infusions at sub-anesthetic doses are used to treat chronic pain conditions driven by central sensitization. Dr. Rainier Guiang, MD, a board-certified anesthesiologist and pain management specialist at University Pain Consultants, answers the most common questions patients have before their first infusion.
How does ketamine relieve chronic pain?
Ketamine is an NMDA receptor antagonist that blocks the N-methyl-D-aspartate receptors involved in central sensitization, the process by which the nervous system becomes overactive in chronic pain states. At sub-anesthetic infusion doses, ketamine can interrupt the self-sustaining pain cycle, reset aberrant pain signaling, and provide relief that outlasts the infusion itself by weeks to months.
What chronic pain conditions does IV ketamine treat?
IV ketamine has the strongest evidence base for complex regional pain syndrome (CRPS), fibromyalgia, neuropathic pain, refractory migraines, and central sensitization syndromes. It is also used for chronic low back pain, post-surgical pain syndromes, and as an adjunct when opioid-based regimens are no longer effective. Dr. Guiang also offers ketamine for treatment-resistant depression as a co-occurring condition with chronic pain.
How many infusions will I need?
The standard induction protocol is 4 to 6 infusions given over 2 to 3 weeks, typically on alternating days. Most patients who respond to ketamine notice meaningful improvement by the third or fourth infusion. After the induction series, maintenance infusions are scheduled based on the duration of your response, commonly every 6 to 12 weeks. Some patients maintain benefit with a single annual booster.
What should I expect during an infusion?
Each infusion runs 40 to 60 minutes in a private recliner room with continuous monitoring of blood pressure, heart rate, and oxygen saturation. Most patients experience mild dissociation, a dreamlike or floating sensation, during the infusion. This resolves completely within 20 to 30 minutes of stopping the drip. You must arrange a driver, as you may not drive on infusion days.
Is IV ketamine the same as Spravato (esketamine)?
No. Spravato is an FDA-approved intranasal formulation of esketamine approved specifically for treatment-resistant depression. IV racemic ketamine uses the full molecule administered intravenously, allowing precise dosing and faster onset. IV ketamine has a much larger clinical evidence base for chronic pain and generally offers more predictable dosing. It is used off-label for pain but remains the standard in specialized pain practices.
Is ketamine infusion therapy safe?
At sub-anesthetic doses in a monitored clinical setting, IV ketamine has a well-established safety profile over decades of use. Dr. Guiang is a board-certified anesthesiologist, meaning his core training involves ketamine administration in much higher-dose settings. Side effects at pain doses are generally mild: transient dissociation, nausea managed with premedication, brief blood pressure fluctuation, and vivid dreaming. Addiction risk at these doses and in this context is very low.
Does insurance cover IV ketamine for pain?
Insurance coverage for IV ketamine remains limited. Most payers do not cover it as a primary pain treatment, though some will consider coverage for CRPS with prior authorization. We provide detailed documentation to support insurance appeals and offer self-pay pricing. Many patients find the cost favorable compared to ongoing medications, repeated interventional procedures, or emergency visits driven by uncontrolled pain.
Can ketamine treat both my chronic pain and depression at the same time?
Yes. This is one of ketamine’s most clinically significant advantages for our patient population. Chronic pain and depression share overlapping neurobiology, and up to 50 percent of patients with chronic pain meet criteria for depression. Ketamine acts on both pathways simultaneously. Patients often report improvements in mood, motivation, and sleep alongside pain relief. Dr. Guiang coordinates with your mental health provider when ketamine is being used to address both conditions.
Who is not a candidate for IV ketamine?
Absolute contraindications include uncontrolled hypertension, active psychosis or schizophrenia, recent stroke, and active substance use disorder involving ketamine or PCP. Relative contraindications include a history of mania, severe heart disease, or poorly controlled thyroid disease. A thorough intake evaluation is completed before any infusion is scheduled.
Schedule an IV ketamine consultation
University Pain Consultants serves patients throughout the Inland Empire from our Riverside and Menifee locations. Call 951-900-3253 or request an appointment online with Dr. Guiang.
