Ketamine for Nerve Pain: What the Research Shows
A physician's look at what research shows about IV ketamine for nerve pain, how it fits with standard treatments, and who may be a candidate.
A physician's look at what research shows about IV ketamine for nerve pain, how it fits with standard treatments, and who may be a candidate. From HILLMED in Plano, Texas.
By Jerron C. Hill, M.D., Anesthesiologist and Founder of HILLMED
Nerve pain is often described as burning, shooting, stabbing or electric. It can come with numbness, tingling, or pain from a light touch that shouldn't hurt at all. For many people it disrupts sleep, work and mood, and it doesn't always respond to the usual pain medicines.
When standard treatments haven't brought enough relief, some patients ask about IV ketamine. Here is what the research shows, what it doesn't, and how I think about it as a physician.
What nerve pain is
Neuropathic pain is pain caused by damage to, or disease of, the nerves that carry sensation. It is different from the pain of a sprain or a cut, which comes from injured tissue. Common causes include:
Diabetic peripheral neuropathy
Shingles, which can leave lasting pain called postherpetic neuralgia
Pinched or irritated nerve roots in the neck or lower back (radiculopathy, including sciatica)
Nerve injury after trauma or surgery
Some cases of complex regional pain syndrome, chemotherapy-related neuropathy, and spinal cord injury
Over time, persistent pain signals can make the nervous system more sensitive, a process called central sensitization. The spinal cord and brain begin to amplify pain, so it can continue or spread even after the original injury has healed.
How nerve pain is usually treated
International guidelines recommend several medications as first-line treatments for neuropathic pain: certain antidepressants (tricyclics and serotonin-norepinephrine reuptake inhibitors such as duloxetine) and the anticonvulsants pregabalin and gabapentin. Topical treatments such as lidocaine or high-concentration capsaicin patches may help when the pain is in one area. [1]
These treatments help many people, but the benefit is often modest. In the large review behind those guidelines, roughly 6 to 8 people needed to be treated for one person to get meaningful relief from the first-line medications. [1] Physical therapy, procedures, and treatment of the underlying cause are also important.
How ketamine is different
Ketamine blocks NMDA receptors, which play a key role in how the spinal cord and brain amplify pain signals. Researchers believe this may help calm central sensitization, the "turned up" state of the nervous system in many chronic pain conditions. The mechanism is not fully understood, and not every patient responds.
At HILLMED, we use low-dose IV ketamine therapy, given slowly under physician supervision after a medical evaluation. For a broader overview, see our guide to ketamine for chronic pain.
What the research shows
The evidence for IV ketamine in nerve pain is promising but limited. Most studies are small and follow patients for only a short time.
A 2019 meta-analysis combined 7 randomized, placebo-controlled trials with 211 patients who had neuropathic, mixed or other chronic pain. Ketamine reduced pain by a small amount, about 1.8 points on a 0–10 scale, for up to two weeks after infusion. In the studies that reported it, 51% of patients responded to ketamine, compared with 19% on placebo. Most of the trials were at high risk of bias. [3]
A 2026 meta-analysis focused on neuropathic pain reviewed 15 randomized trials with 251 participants. In the 6 trials included in the main analysis, people receiving ketamine were about 2.8 times as likely as those on placebo to have their pain cut by at least half. Side effects were more common with ketamine, but they were generally mild and short-lived. [4]
US consensus guidelines from 2018, developed by three national anesthesia and pain medicine societies, concluded that evidence supports ketamine for chronic pain, but that the strength of the evidence varies by condition and dose. [2]
These results suggest IV ketamine can provide short-term relief for some people with refractory nerve pain. They do not establish how long relief lasts, how many infusions are best, or which patients will benefit most.
Who may be a candidate
An IV ketamine evaluation may make sense if you:
Have a diagnosed neuropathic pain condition
Have tried first-line treatments, such as the medications above, without enough relief or with side effects you couldn't tolerate
Are working with a physician who manages your pain and any underlying condition
What treatment looks like at HILLMED
Every patient starts with a consultation and a review of their medical history, pain history and current treatments. We coordinate with your other physicians so the rest of your care stays in place. If ketamine is a good fit, treatment usually begins with a series of infusions at our Plano clinic, with your blood pressure, heart rate and oxygen monitored throughout. To learn more about the day itself, read what a first infusion looks like.
We track your pain, sleep and daily function between treatments, and decide together whether additional infusions are appropriate. The goal is better function, not only a lower pain score.
Safety and medical supervision
Ketamine is FDA-approved as an anesthetic. Its use for chronic nerve pain is off-label. Treatment requires informed consent, appropriate medical supervision, and coordination with your ongoing care.
A physician's perspective
My experience administering ketamine as an anesthesiologist informs our approach to evaluation, dosing, and monitoring. We individualize treatment for each patient and review their response throughout care.
In my clinical experience, I have found IV ketamine to be very effective in controlling neuropathic pain. For patients with CRPS, fibromyalgia, or other forms of neuropathy, IV ketamine can help decrease the frequency, duration, and intensity of pain. Mood and sleep can also improve as pain is better controlled.
Ketamine is not a cure for nerve pain, and it does not replace treating the underlying cause, physical therapy, or the medications that work for you.
Frequently asked questions
Can ketamine help diabetic neuropathy or sciatica?
In my clinical experience, IV ketamine infusions (IVKI) have been very useful in helping control diabetic neuropathy and sciatica. Studies of IV ketamine for nerve pain have included several neuropathic conditions, but each condition has only a small number of trials. Whether ketamine is reasonable for you depends on your diagnosis, what you've already tried, and your overall health. [3, 4]
How quickly does IV ketamine work?
In my clinical experience, some patients have experienced resolution of neuropathic pain within an hour of an IV ketamine infusion. I have also seen sustained pain relief after our initial infusion protocol, alongside a tailored wellness regimen following IVKI that includes plant-based supplements and phytocannabinoids.
How many infusions will I need?
It varies. There is no single proven schedule for nerve pain. Your plan is based on your condition, your response and how well you tolerate treatment, and we review it with you as treatment goes on. [2]
Will I have to stop my other pain medications?
No. Ketamine is usually added to your existing treatment plan. Don't change any medication without talking to the physician who prescribes it.
Is ketamine FDA-approved for nerve pain?
No. Ketamine is FDA-approved as an anesthetic. Using it for chronic nerve pain is off-label, which is common in pain medicine.
Does insurance cover ketamine for nerve pain?
Coverage varies by plan, and IV ketamine for chronic pain is often not covered. Contact HILLMED for current pricing and payment information, and check coverage directly with your insurer.
About the author
Jerron C. Hill, M.D., is an anesthesiologist and the founder of HILLMED in Plano, Texas, and Dr. CBD & Nutrition Centers in University Park. He brings decades of anesthesia experience and nine years of clinical experience treating patients with IV ketamine to individualized, physician-supervised care, and personally formulates the Dr. CBD line of third-party-tested CBD products and supplements.
Selected references
Finnerup NB, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–173.
Cohen SP, et al. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain from ASRA, AAPM and ASA. Reg Anesth Pain Med. 2018;43(5):521–546.
Orhurhu V, et al. Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg. 2019;129(1):241–254.
Leão Nunes Filho MJ, et al. Efficacy of intravenous ketamine for neuropathic pain: a systematic review and meta-analysis of randomized clinical trials. Pain Manag. Published online August 11, 2026.
Pfizer. Ketamine Hydrochloride Injection prescribing information.
This article is for education only and is not medical advice. Talk with your physician before starting or changing any treatment.
