Can Ketamine Therapy Help With Nerve Pain?

You've tried gabapentin (Neurontin) and pregabalin (Lyrica), maybe duloxetine (Cymbalta) or a tricyclic antidepressant. And the relief, when it came at all, never quite held. The burning is still there when you wake up. Sleep is broken. Walking to the mailbox takes planning. You're looking for something that works on a different part of the problem than everything you've already been through.

You're not alone in this. About 1 in 10 U.S. adults live with chronic nerve pain, and more than half don't get enough relief from first-line medications.

The bottom line: ketamine has been studied for chronic nerve pain, where it may help turn down the nervous system's pain amplification. Innerwell's structured, at-home program is built to support people with nerve pain over 12 weeks, with the goal of lower pain intensity and more daily function.

What Is Ketamine Therapy for Nerve Pain?

Ketamine is an FDA-approved anesthetic that hospitals have used since the 1970s. Over the past two decades, researchers have studied it at much lower doses, well below surgical levels, for chronic pain conditions, including nerve pain. Given this way, ketamine is delivered as a structured series of treatments, not a single session.

How you take it matters. For years, that meant repeated IV infusions at a clinic, which is hard to keep up when nerve pain already makes sitting, driving, and travel difficult. It can also be taken as oral tablets at home under clinician guidance, the model Innerwell uses, so treatment fits around your days rather than the reverse.

As a Schedule III controlled substance, ketamine for chronic pain is used off-label: the FDA hasn't approved it specifically for pain, though a licensed Innerwell clinician can prescribe it based on your evaluation and the available evidence.

Why Standard Nerve Pain Treatments Often Fall Short

If your medications haven't worked well enough, the data backs you up. Even at higher doses, fewer than half of people on the most commonly prescribed nerve pain drugs reach a up to 50% reduction in pain.

Many first-line drugs have modest effects to begin with. Side effects like sedation, stomach problems, and dry mouth can cap the dose or push people to stop before reaching a target dose. And nerve pain varies in its mechanisms, so responses differ widely from one person to the next.

If you've worked through the usual options, gabapentinoids, antidepressants, and topical treatments like lidocaine, without enough relief, your pain may be the kind that hasn't responded to standard medication. That's often the point where a clinician starts to weigh other options, including ketamine in select cases.

What Does the Research Actually Show?

The evidence for ketamine and nerve pain is real, and it's mixed. Here's an honest look at both sides.

What the Trials Found

A 2022 meta-analysis of 18 randomized trials (706 participants) found a statistically significant drop in pain at one week: roughly 2 points on a 0-to-10 scale.

A Cochrane review of 67 trials and more than 2,300 adults reached a more cautious conclusion: it couldn't establish whether ketamine reduces chronic pain intensity. If that sounds frustrating, it is. Part of the gap is that these reviews didn't all define success the same way or include the same studies.

How the Evidence Varies by Condition

The evidence also varies a lot by condition, which is the part that matters most when the question is about your own diagnosis:

• Complex regional pain syndrome (CRPS): the strongest signal. In one controlled study, multi-day ketamine infusions lowered pain meaningfully for several weeks before the effect gradually faded.
• Diabetic neuropathy: some dedicated study data, with short-term pain reduction reported in trials.
• Postherpetic neuralgia, trigeminal neuralgia, and small fiber neuropathy: less condition-specific research, with most evidence drawn from broader nerve pain trials.

A 2024 determination by the U.S. Department of Veterans Affairs took a more restrictive view: it classified ketamine for chronic pain as investigational and experimental. The determination pointed to a lack of high-quality evidence on its safety and effectiveness. Across conditions, relief tends to build gradually over a course of treatment, and results vary by person and by diagnosis.

How Does Ketamine Work Differently for Nerve Pain?

Ketamine works on the nervous system that has been amplifying your pain, rather than on the original injury. That difference matters because chronic nerve pain involves lasting changes in how your nervous system processes pain.

Why Nerve Pain Persists

In chronic nerve pain, signals don't just travel from the injury to the brain. Over time, the spinal cord can become more reactive: signals fire more easily, pain feels amplified, and even light touch can start to hurt. Researchers call this central sensitization, and it's a big reason nerve pain can persist long after the original injury has healed.

At the center of that amplified state sits a receptor called the NMDA receptor, which can stay overactive in chronic pain while the body's normal braking system fails to shut it off.

What Ketamine Targets

Ketamine may help quiet this receptor. As an NMDA receptor antagonist, it can block the channel that keeps the pain-amplification system running. That's a different target from the medications you've likely already tried:

• Gabapentin and pregabalin reduce the excitatory input flowing into sensitized circuits, but they don't directly address the NMDA receptor changes that drive the amplification.
• Opioids turn down the volume on pain signals, but they don't reach the mechanism that got the volume stuck on high. They can also cause opioid-induced hyperalgesia, a paradoxical increase in pain sensitivity.

Beyond quieting pain amplification, ketamine may support neuroplasticity, your brain's ability to form new connections. Researchers studying how ketamine works on these pathways have focused mainly on changes during and shortly after treatment. One reason that matters: for some people, pain relief can outlast the drug itself, though not everyone responds that way.

What Relief Can Look Like

Clinical trials measure pain on a 0-to-10 scale, but a number doesn't tell you whether you'll sleep through the night again. For people who respond, relief is often described as the volume turning down. The pain doesn't always disappear, but it stops being the loudest thing in the room.

You might fall asleep without bracing, sit through a meal without shifting, or take a short walk without planning your recovery around it. Not everyone gets there, and not always on the first round. But for those who do respond, that's what a drop on the scale actually buys back.

When Nerve Pain Comes With Depression or Anxiety

If you're also dealing with depression or anxiety alongside nerve pain, you're far from alone. Both are common in people living with chronic nerve pain.

The relationship runs both ways: pain drags down mood, and low mood ramps pain back up. That's part of the hidden impact of living with pain that rarely shows up on a scan. One large case series found that improvement in depression seemed to explain part of ketamine's effect on pain.

If you're managing both nerve pain and low mood, ketamine's action on pain pathways and mood may be especially relevant to your pain, though how much it helps differs from person to person.

Side Effects and Safety

Common short-term side effects include dissociation (feeling detached from your body or surroundings), dizziness, drowsiness, nausea, and a temporary rise in blood pressure. In controlled studies of people with nerve pain, ketamine was most often linked to drowsiness, dizziness, and nausea. Dissociative effects tend to peak around 30 minutes and ease within an hour.

Long-term risks at clinical doses are lower than those seen with recreational use, but still worth knowing. Bladder and urinary tract effects are a real concern with prolonged, high-dose use, per the FDA label. Liver and cognitive effects are dose-dependent and mostly tied to chronic, high-dose patterns.

Ongoing monitoring is part of any responsible program, which is one reason ketamine safety is handled within a structured plan rather than left to you on your own.

Who Might Be a Candidate

Ketamine therapy for nerve pain is usually considered when standard treatments haven't given you enough relief. You may be a candidate if:

• You've tried first-line nerve pain medications without lasting improvement.
• Your pain is taking a measurable toll on daily function, like sleep, mobility, work, or relationships.
• You don't have conditions that make ketamine unsafe or unsuitable, such as active psychosis, uncontrolled cardiovascular disease, pregnancy, or severe liver disease.

If you're currently using opioids, you may still be a candidate. For people with opioid concerns, some are able to reduce their reliance over time with clinical guidance. Ketamine also has documented interactions with the opioid system that can help with tolerance and opioid-induced hyperalgesia.

Any changes to opioid use are made with your prescribing care team, not on your own. Innerwell's program is for chronic pain management, not opioid detox or addiction treatment.

How Innerwell's 12-Week At-Home Ketamine Program for Nerve Pain Works

By now the practical question is usually simple: what would actually be involved? Innerwell's at-home program is built for chronic pain, including nerve pain. Ketamine may help reduce pain signaling, but the gains that matter, like better sleep and more movement, tend to hold when the medication is paired with ongoing clinical support. The medication opens a door; the clinical support helps you walk through it.

Unlike clinics that hand you a single dose and send you home, Innerwell delivers a structured 12-week program with ongoing clinical guidance, dosage adjustments, and a care team that specializes in pain management.

The program:

1. Initial evaluation: You start with a short online screener, then a clinical evaluation covering your pain history, prior treatments, current medications, and overall health. Care may include lab work and a video consult with a pain-specialized clinician to confirm whether ketamine is appropriate for you.
2. Oral ketamine tablets, delivered home: If you're approved, sublingual tablets are shipped to you for the 12-week protocol, with dosing personalized over time based on how you respond. You'll also receive an Innerwell Welcome Kit ($100 value) to support at-home treatment.
3. Clinician check-ins and psychiatric support: Your care includes about 4 clinician check-ins a month and 4 psychiatric consults across the program, coordinated with your pain plan rather than handled separately. Your clinician also pays close attention to how ketamine interacts with the medications you already take.
4. Behavioral support and integration: Depending on your needs, care can include talk therapy and integration sessions that address the depression, anxiety, and disrupted sleep that often travel with nerve pain and weigh on daily life.
5. Ongoing tracking: A patient portal tracks your symptoms, dosing, and side effects, with asynchronous messaging to the care team between visits.

Cost

Insurance coverage mirrors Innerwell's existing ketamine program and varies by state and plan; self-pay and HSA/FSA options are available.

What to Expect

Many people report improvement in pain intensity, sleep, and daily function within the first month. Results vary by individual.

See if you're eligible for Innerwell's structured pain management program.

Frequently Asked Questions

Will ketamine help my specific type of nerve pain?

Even within nerve pain, response differs by diagnosis and from one person to the next, so no condition name comes with a guarantee. What matters more is your full picture: how long you've had the pain, what you've already tried, the other medications you take, and your overall health. Your Innerwell evaluation weighs all of that, alongside the evidence for your specific diagnosis, before anyone recommends treatment. If it isn't a good fit, you'll be told that.

Can I keep taking my current nerve pain medications?

Often, yes. Many people continue gabapentin, pregabalin, duloxetine, or other medications while in the program. Because ketamine interacts with some drugs, your Innerwell clinician reviews everything you take and flags anything that needs adjusting or closer monitoring. You won't be asked to stop a medication on your own, and any changes are planned with your care team.

What if I'm currently on opioids?

You may still be considered. Current opioid use usually means extra screening, a review of your current doses, and closer monitoring through the program. Active opioid dependence may not be a fit for at-home treatment. Any changes to your opioids are decided with the prescriber who manages them, not on your own. Innerwell's program treats chronic pain; it isn't opioid detox or addiction care.