Innovative integration of high dose ketamine infusion, psychological services, and specialized multidisciplinary pain care for refractory pain syndromes.

Abstract

Ketamine is a noncompetitive antagonist of the N-methyl-D-aspartate receptor that has garnered significant interest as a treatment for both chronic pain and mental health symptoms in the last two decades. The authors introduce the methodological framework of the Ketamine Infusion Pain Program (KIPP) at Toronto Western Hospital (TWH) and outline a high dose ketamine infusion (HDKI) regimen for refractory pain syndromes implemented through an innovative multidisciplinary care model. HDKIs have been offered at TWH since 2010 and in 2023, the KIPP was formally established and reconceptualized to include multidisciplinary services. The redesign included peri-ketamine psychology services to provide education, support, and post-ketamine integration, and to optimize adaptive behaviors in the post-ketamine period. At KIPP, ketamine (0.5 mg.kg^-1) is provided intravenously as a bolus, followed by an infusion dose up to 1 mg^-1.kg.hr^-1 IV for six hours. The KIPP is collecting data on pain, psychological factors, sleep, and functioning pre- and post-HDKI to evaluate patient outcomes, which will be presented in a future article. Future directions include further refinement of dosing protocols and co-administration of other medications and the expansion of peri-infusion psychology services with increased focus on preparation and integration, as well as the evaluation of these initiatives.