Imagine living with pain so severe, so constant, that even a light breeze on your skin feels like fire. For people living with Complex Regional Pain Syndrome (CRPS), severe nerve pain, fibromyalgia, or other chronic pain conditions, this is not an exaggeration — it is daily reality.
Conventional pain medications — nerve pills, opioids, anti-inflammatories — often fall short for these conditions. They treat the signal, not the source. But there is a treatment that works at an entirely different level, one that can offer meaningful relief when everything else has failed: IV ketamine infusion therapy for chronic pain.
In this post, I want to explain what ketamine is, how it works, who it can help, and what you can expect as a patient at University Pain Consultants.
What Is Ketamine?
Ketamine has been an FDA-approved medication since the 1970s, used safely in operating rooms and emergency departments for decades as an anesthetic. Over the past two decades, research has revealed that at much lower, sub-anesthetic doses, ketamine does something remarkable: it can interrupt chronic pain cycles and rapidly improve mood in patients who have not responded to other treatments.
Today, IV ketamine infusions are used at specialized clinics as a carefully supervised, physician-administered treatment for chronic pain, nerve pain, CRPS, fibromyalgia, treatment-resistant depression, PTSD, and more. It is not a new or experimental drug — it is a well-understood medication being used in a precise, targeted way for patients who need a different approach.
Why Chronic Pain Is So Hard to Treat
Normally, pain is a warning signal — your body alerting your brain to an injury. Once the injury heals, the signal quiets down. But in conditions like CRPS or neuropathic pain, the nervous system gets stuck in alarm mode. The pain pathways become overactive even when there is no ongoing injury. The brain and spinal cord essentially re-wire themselves around the pain — a phenomenon called central sensitization.
Think of it like a car alarm that will not shut off even after the car is safe. The alarm itself becomes the problem. Standard pain medications may reduce the noise temporarily, but they do not fix the underlying wiring. This is why so many patients with CRPS, fibromyalgia, and neuropathic pain find that medications help less and less over time — or stop working altogether. IV ketamine for chronic pain does something fundamentally different: it targets the faulty wiring itself.
How IV Ketamine Works for Chronic Pain: Resetting the Pain System
Ketamine’s primary action is to block a receptor in the brain and spinal cord called the NMDA receptor. These receptors act as amplifiers for pain signals. In chronic pain conditions, they become overactive — constantly turned up too loud, reinforcing and perpetuating the pain cycle even without a real injury triggering it.
By blocking these receptors, IV ketamine essentially turns the volume down on the overactive pain system. But its benefits extend beyond that single mechanism:
- Promotes neuroplasticity: Stimulates the brain to form new, healthy connections. Chronic pain and depression actually shrink key areas of the brain over time. Ketamine has been shown to help those areas regrow and reconnect.
- Reduces neuroinflammation: Chronic pain is partly driven by inflammation within the nervous system itself. Ketamine modulates inflammatory signaling, helping calm that underlying process.
- Resets opioid tolerance: For patients on long-term opioid medications, ketamine can help restore the effectiveness of those medications, potentially allowing for dose reductions over time.
- Acts fast: Unlike most pain medications that take weeks to work — if they work at all — IV ketamine for chronic pain can produce measurable relief within 24 to 72 hours of the first infusion.
Conditions IV Ketamine Treats for Chronic Pain Relief
IV ketamine infusion therapy has demonstrated clinical benefit across a wide range of chronic pain and mood conditions. The evidence is strongest for the following:
Complex Regional Pain Syndrome (CRPS)
CRPS is one of the most painful conditions known to medicine — often described as a constant burning pain that is entirely out of proportion to any visible injury. It typically affects one limb and can spread. The skin becomes hypersensitive to even the lightest touch or minor temperature changes. Many patients describe the sensation as wearing clothing made of glass.
CRPS is notoriously resistant to standard treatments. A 2025 narrative review in Current Pain and Headache Reports documented meaningful improvement in CRPS patients treated with IV ketamine, including reductions in pain intensity, improved limb mobility, and prolonged periods of remission. For many CRPS patients, IV ketamine is the first treatment that has produced real, lasting relief.
Neuropathic Pain
Neuropathic pain — pain caused by nerve damage or dysfunction rather than tissue injury — includes conditions like diabetic neuropathy, post-herpetic neuralgia (pain from shingles), chemotherapy-induced nerve pain, and peripheral neuropathy from any cause. A 2023 systematic review and meta-analysis published in Medicine Advances found IV ketamine effective across neuropathic pain conditions with a moderate-to-significant effect size. A 2023 Cochrane review similarly confirmed ketamine’s analgesic effect in neuropathic pain, particularly for patients who have not responded to first-line treatments.
Fibromyalgia
Fibromyalgia is driven by central sensitization — the same overactive pain amplification process that IV ketamine directly targets. Many fibromyalgia patients report improvements in widespread pain, fatigue, and mental clarity (often called “fibro fog”) following a ketamine infusion series. Because ketamine addresses the root neurological mechanism rather than masking symptoms, its effects can outlast those of conventional fibromyalgia medications by weeks or months.
Other Chronic Pain Conditions We Treat
Beyond the conditions above, IV ketamine has strong and growing evidence for treatment-resistant depression, PTSD, chronic migraine, phantom limb pain, failed back surgery syndrome, and chronic radiculopathy that has not responded to other treatments. For depression, the FDA has actually approved a ketamine-derived nasal spray (esketamine/Spravato) — a milestone that reflects the depth of the evidence base and the growing mainstream acceptance of ketamine as a legitimate medical treatment.
You can see our full list of treatable conditions at our IV Ketamine Infusions page.
What to Expect During an IV Ketamine Infusion for Chronic Pain
Many patients are understandably nervous before their first infusion. Here is a clear picture of what the process looks like:
Before your appointment: You will fast for 4–6 hours and arrange for a driver — you should not drive yourself after a ketamine infusion. We also recommend bringing headphones and a playlist of music you find calming or uplifting, as music can significantly enhance the experience.
During the infusion: You recline comfortably in a private, dimly lit room. An IV line is placed and the infusion runs approximately 40–60 minutes for pain indications. Your vital signs are monitored continuously throughout by the physician. At these sub-anesthetic doses, you remain fully conscious. Most patients describe a gentle, dreamlike floating sensation — a quiet disconnection from everyday awareness. The experience is typically peaceful, not frightening.
After the infusion: You rest in our recovery area for 30–60 minutes until discharge criteria are met. Most patients feel well enough for light activity the same evening. Fatigue or a mild dreamlike quality may linger for a few hours — another reason a driver is required.
When will I feel better? Pain relief from IV ketamine can begin within 24–72 hours of the first session. Results accumulate across a treatment series — most patients experience the greatest benefit after 4–6 infusions administered over 2–3 weeks. Many patients benefit from periodic maintenance infusions — typically monthly to quarterly — to sustain their improvement long-term. We create a personalized maintenance plan based on your individual response.
Is IV Ketamine for Chronic Pain Safe?
At the doses used for pain and mood treatment, ketamine has a well-established safety record spanning more than five decades of clinical use. Side effects during the infusion — such as a dreamlike or floating sensation, mild dizziness, or a temporary increase in blood pressure — are transient and typically resolve within minutes of the infusion ending.
That said, ketamine is not appropriate for everyone. It should not be used in patients with uncontrolled high blood pressure, a personal history of schizophrenia or active psychosis, active mania, recent heart attack, elevated intracranial pressure, or active stimulant or dissociative substance use, among other contraindications. This is precisely why a thorough physician consultation before treatment is not optional — it is essential.
At University Pain Consultants, every IV ketamine infusion for chronic pain is personally administered and continuously monitored by Dr. Guiang — a board-certified anesthesiologist and pain management specialist who has used ketamine routinely throughout his career. This is not a new tool: it is one he knows intimately, which significantly improves both safety and outcomes compared to clinics where infusions are delegated to non-physician staff.
Is IV Ketamine Infusion Right for You?
If you have been living with chronic pain, nerve pain, CRPS, or fibromyalgia — and standard treatments have not given you adequate relief — IV ketamine infusion therapy may be worth a serious conversation.
The first step is a one-on-one consultation with Dr. Guiang. He will review your full medical history, discuss what has and has not worked for you, screen for any contraindications, and give you an honest, direct assessment of whether IV ketamine for chronic pain is likely to help your specific situation. He will also tell you clearly if it is not.
The consultation fee is $95, and it is credited toward your treatment cost if you decide to proceed. Most consultations are available within 1–2 weeks.
Learn more on our IV Ketamine Infusions page, or schedule your consultation online.
Chronic pain has a way of making people feel like there are no options left. In my experience, that is rarely true. IV ketamine is one more door worth opening.
— Rainier Guiang, MD
Board-Certified Anesthesiology and Pain Management
University Pain Consultants – Regenerative Medicine
Riverside and Menifee, CA
Frequently Asked Questions About IV Ketamine for Chronic Pain
How many IV ketamine infusions do I need for chronic pain?
Most patients with chronic pain begin with a series of 4–6 infusions administered over 2–3 weeks. This initial series allows the treatment to build on itself and produce the most significant and lasting results. Following the series, many patients benefit from periodic maintenance infusions — typically every 4–12 weeks — to sustain their improvement. The exact number and frequency are tailored to each patient based on their diagnosis, response, and treatment history.
Does insurance cover IV ketamine for chronic pain?
In most cases, insurance does not cover IV ketamine infusion therapy for chronic pain or mood disorders, as it is considered an off-label use of an FDA-approved medication. However, some flexible spending accounts (FSA) and health savings accounts (HSA) may be used. We also offer financing options. At University Pain Consultants, a series of 4 infusions is priced at $2,500 ($625 per session), with a single session available at $700. The $95 consultation fee is credited toward treatment.
How long does IV ketamine pain relief last?
After a full series of infusions, pain relief typically lasts weeks to months. Many patients report significant improvement for 3–6 months or longer. Results vary depending on the underlying condition, the number of infusions received, and whether maintenance infusions are administered. Conditions like CRPS may require ongoing maintenance to prevent relapse, while some patients experience prolonged remission after a single series.
What is CRPS and why does ketamine help?
Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic pain condition typically affecting one limb after an injury — though sometimes with no clear triggering event. It is characterized by burning, constant pain that is disproportionate to the original injury, along with skin sensitivity, swelling, changes in skin temperature and color, and reduced mobility. Ketamine helps CRPS by blocking the NMDA receptors responsible for the central sensitization that drives the condition — essentially interrupting the overactive pain loop that keeps the nervous system in alarm mode.
Is IV ketamine addictive?
When administered in a controlled medical setting at sub-anesthetic doses by a licensed physician, IV ketamine therapy does not carry a meaningful risk of addiction for the vast majority of patients. The doses used for chronic pain treatment are significantly lower than recreational doses, and the structured clinical environment — with physician oversight, scheduled sessions, and no take-home supply — is very different from recreational use. Ketamine is a Schedule III controlled substance, and its use at our clinic is strictly regulated and monitored at every session.
How do I know if I am a candidate for IV ketamine infusions?
The only way to determine candidacy is through a thorough medical consultation. Ideal candidates are patients with chronic pain, CRPS, neuropathic pain, fibromyalgia, or treatment-resistant depression or PTSD who have not achieved adequate relief from conventional treatments. Patients are screened for contraindications including certain cardiac conditions, psychiatric history, and substance use. If you have tried multiple treatments without success, a consultation is well worth pursuing. You can schedule your $95 consultation here.
Disclaimer: This post is for educational purposes only and does not constitute medical advice. Ketamine infusion therapy is an off-label use of an FDA-approved medication for most pain indications. Individual results vary and are not guaranteed. Candidacy is determined following a complete medical evaluation. Ketamine is a Schedule III controlled substance administered only under direct physician supervision. Consult a qualified physician to determine whether this treatment is appropriate for your specific situation.
