Special K: How ketamine could be a gamechanger for people with chronic pain

Determined to shake its bad rap as a recreational street drug, Kate Brayden says ketamine is a gamechanger for persistent pelvic pain

A joint study between researchers at Trinity College Dublin and St Patrick’s Mental Health Services found small doses of ketamine under professional supervision can produce mental health benefits and treat chronic female pain.

Despite being a pain patient for about five years, the first time I heard of oral ketamine as a chronic pain treatment was when I met Dr Kirk Levins in the National Maternity Hospital in Holles Street. I was attending him for scar tissue and nerve pain in the lower back and pelvis, having already seen dozens of various consultants in Dublin, London, Washington, and Zurich for various (mostly unsuccessful) surgeries and treatments over that period.

My physiotherapist spoke wonders about a consultant who had worked with St Vincent’s pain team for years, now treating Ireland’s countless pelvic pain patients. After waking up from a day procedure, my pain levels skyrocketed. Instead of offering me the usual temporary aid of fentanyl, Dr Levins prescribed me liquid ketamine. Building up in my system, I could take small amounts per day and could stop the medication anytime, without the usual withdrawals. That part I found hard to believe, but he confirmed that Brexit had led to a sudden but brief shortage of liquid ketamine in Ireland, and some patients were suddenly cut off from the supply. He has been prescribing it since he was a trainee at St Vincent’s University Hospital, which has used liquid ketamine for over 15 years. Instead of experiencing withdrawals, as with opioids and medications like Lyrica (pregabalin), his patients were fine when they stopped taking liquid ketamine; apart from their pain levels rising, of course.

Ketamine, when used in anaesthesia, causes a dissociative state, essentially disconnecting the part of our brain and spinal cord where we receive and transmit signals from the body part, working on the whole central nervous system. The medication is routinely used in anaesthetic practice to reduce acute pain, and also for severe depression.

I’ve since been taking it three times a day for around four months now, and I’ve noticed undeniable benefits, specifically in allowing me to taper off Lyrica and completely ditch opioids. I’ve been dependent on Lyrica for four years, and tapering off the drug is known to be incredibly difficult — not least if you have fibromyalgia, like myself. Liquid ketamine works differently to recreational use, leading to highly contrasting effects. Rather than give you a high, the liquid version simply reduces acute and chronic pain as well as anxiety. Dr Levins described to me how he switched his opioid-dependent patients to liquid ketamine.

"The initial response is one of fear, as many people have heard it is used as a horse tranquilliser,” says Dr Kirk Levins, Consultant Anaesthetist, Pain Specialist at SVUH and National Maternity Hospital. “I typically explain that it's an anaesthetic agent that can be used on animals. However, it was a potent analgesic right from the first time it was tested.” The original precursor to it was phencyclidine, developed in 1958. In 1962, ketamine was synthesised by Parke Davis consultant and organic chemist Calvin Stevens. Human trials began in 1965, with prisoners in the United States given infusions.

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“When it was initially introduced in 1970, they were using very high doses for anaesthetics,” Dr Levins offers. “Over the last decade or so, it’s been used more and more in anaesthesia, pain medicine and depression.” According to research, ketamine may change dysfunctional brain cell pathways and connections through the process of neuroplasticity. Its effects come about by the way it acts on the signals of a particular chemical messenger, glutamate.

I had heard about recent trials involving ketamine and severe depression, seeing as one was taking place in Trinity College Dublin and St Patrick’s Mental Health Services, led by Professor Declan McLoughlin. Dr Levins has also noticed immense mental health benefits for his patients.

“We conducted a study of 79 patients, though we have many more who have been treated with ketamine in the last 15 years, and they had a 41.6% decrease in pain relative to their baseline with oral ketamine,” he explains.

“We also noticed a significant decrease in depression and an improvement in quality of life. Multiple studies have shown that liquid ketamine works far more rapidly than antidepressants. We also haven’t seen any problems with long-term use,” Dr Levins adds. 

“The 79 patients we looked at are just the tip of the iceberg. There are many more patients with excellent responses to ketamine. It works for all neuropathic pain states. Generally, I’ve been able to treat pelvic pain with interventions.” When you have chronic pain, pathways both in the spinal cord and the brain change. Over time, these pathways reduce the requirement for stimulus to be painful. A proposed mechanism for the long-term benefit of chronic pain is that ketamine may alter the affective-motivational component of pain.

“Potentially, because ketamine blocks the NMDA receptor, these connections in the brain become weaker and weaker over time,” Dr Levins continues, enthusiastically. “It's one of the few drugs that has the potential to reverse central nervous system changes. It also acts on other receptors, working differently to opioids.” 

While Dr Levins is also an expert at pain intervention — treating Holles Street’s pelvic pain patients with huge success — it’s incredibly comforting to know that there are pharmaceutical aids for those of us who frequently deal with failed treatments; especially ones without the withdrawals and mood issues that opioids bring. With the data and first-hand patient feedback to support the hypothesis, it seems like ‘Special K’ is here to stay.