Statement on Ketamine for the Treatment of Chronic Pain
Developed by: Committee on Pain Medicine
Original Approval: October 18, 2023
Ketamine is an anesthetic that may be used to treat chronic pain conditions including neuropathic pain when more conservative options have failed. Ketamine can be used for anesthesia, analgesia, and mood modulation. The clinical context of administration and dosing can cause cardiovascular and central nervous system alteration due to ketamine’s complex pharmacology. The American Society of Anesthesiologists (ASA) recommends that patients who receive ketamine for chronic pain treatment be monitored by a pain physician or anesthesiologist familiar with its wide range of effects to avoid adverse sequelae. Patients receiving ketamine for pain treatment by any route should be under the care of a physician specialist with expertise and training in pain medicine. Ketamine treatment for chronic pain relief should occur within a comprehensive multidisciplinary treatment approach. ASA recognizes the need for further research in chronic pain management to align evidence with patient needs and ensure access via payors.
The complex nature of the practice of Pain Medicine requires a multidisciplinary approach from a team that includes a pain medicine physician to enable effective diagnosis and treatment planning. Pain Medicine is a subspecialty involving many areas of interest and medical disciplines. The Accreditation Council for Graduate Medical Education (ACGME) defines specific educational requirements for Pain Medicine fellowship programs. It recognizes the importance of specific clinical training in anesthesiology, neurology, physical medicine and rehabilitation and psychiatry (see ASA Statement on the Practice of Pain Medicine). As national leaders in patient safety, ASA strongly opposes the independent practice of Pain Medicine by non-physician providers, including the administration of ketamine to treat chronic pain.
In preserving patients’ best interests, ASA maintains an ongoing commitment to delivering safe, high-quality, multidisciplinary, physician-led chronic pain care.