Ask The Pharmacist: The Role of Ketamine in Workers’ Compensation

What potential role does ketamine play in pain management for workers' compensation cases?

Developed in the 1960s as an anesthetic, ketamine quickly became a staple in emergency and battlefield medicine. Its ability to act as a powerful, rapid-acting anesthetic was vital for surgeries and acute care, particularly in situations where other anesthetics were unavailable or impractical. Today, while it remains U.S. Food and Drug Administration (FDA)-approved for anesthesia, ketamine is being used off-label for chronic pain management and mental health disorders, particularly for patients who have not responded to traditional treatments.

Many injured employees suffer from long-term pain, and traditional treatments, especially opioid-based therapies, have led to issues with dependency, addiction and even overdose. Ketamine offers a different mechanism for pain relief, working through N-methyl-D-aspartate (NMDA) receptors in the brain rather than opioid pathways, which has the potential to reduce opioid reliance in pain management protocols.

Despite these benefits, ketamine faces significant stigma. Much of this stems from its misuse as a recreational drug, where it is referred to as “Special K” due to its hallucinogenic properties. This association has led to reluctance among both patients and providers to consider ketamine as a legitimate treatment option. However, the medical use of ketamine is far removed from its illicit use. Administered in a controlled, clinical setting, ketamine is effective, particularly for patients who have exhausted other options. 

For patients experiencing chronic pain, particularly those who have failed to find relief through opioids, ketamine can be a game-changer. Studies have demonstrated that ketamine is effective for chronic pain, particularly neuropathic pain. In workers' compensation, this could mean a faster, more effective route to recovery for injured employees, reducing disability duration and improving quality of life.

Beyond pain, ketamine is gaining recognition for its rapid and effective treatment of mental health conditions, particularly depression and post-traumatic stress disorder (PTSD). Many individuals who experience severe injuries also face mental health challenges, from anxiety to depression and PTSD. Ketamine has been shown to improve symptoms of depression quickly, often within hours or days, compared to traditional antidepressants, which can take weeks to take effect. For injured employees, this dual benefit of pain relief and mental health improvement could offer a comprehensive approach to recovery.

As attitudes toward ketamine evolve and more clinical trials are conducted, its acceptance in pain management and mental health treatment is likely to grow. This shift may lead to increased use of ketamine as an alternative to opioids in workers' compensation programs. With its potential to manage chronic pain and address mental health issues, ketamine could significantly impact the recovery of injured employees. Staying informed about its benefits will be essential for both clients and adjusters as the landscape of treatment options continues to change.

This information is meant to serve as a general overview, and any specific questions should be more fully reviewed with your health care professional such as the prescribing doctor or dispensing pharmacist.

Do you have a workers’ compensation or auto related pharmacy question? Send us an email at AskThePharmacist@enlyte.com.

To read more Ask The Pharmacist articles, please visit enlyte.com/ask-the-pharmacist.

References:

https://pubs.asahq.org/anesthesiology/article/113/3/678/10426/Taming-the-Ketamine-Tiger

https://adaa.org/sites/default/files/Ketamine%20JAMA%20Journal%20Article%20-%20Charlie%20Nemeroff.pdf

https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.12094

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2011.03576.x

https://onlinelibrary.wiley.com/doi/full/10.1111/cns.12111

https://www.sciencedirect.com/science/article/pii/S0165178123001166