California Pain Center was the first site in California to administer ketamine for chronic pain

In 2005, at the urging of Dr. Robert Schwartzman, Dr. Prager performed the first ketamine infusion for chronic pain in California.  Dr. Schwartzman, one of the world leaders in treatment and research related to complex regional pain syndrome had performed research initially in Germany and later in the United States regarding the use of ketamine for complex regional pain syndrome.  

In Germany, they induced ketamine coma for 5 days on the most difficult cases with remarkable short-term results.  This prompted Dr. Schwartzman to begin research on outpatient ketamine treatment and in 2005 his important work was published (See reference).  Dr. Schwartzman contacted Dr. Prager who had a thriving complex regional pain syndrome practice and indicated to Dr. Prager that if he wanted to have a state of the art CRPS practice he had to include ketamine infusions in his treatment options for patients.  

Dr. Prager started using ketamine extremely conservatively according to the same protocol that Dr. Schwartzman had published.  However, as an anesthesiologist, he felt comfortable increasing the dosages, monitoring for side effects and achieved impressive results.  The program has increased in volume in the time since 2005 and has now performed approximately 7000 infusions.  

Ketamine is administered by intravenous infusion in a state-of-the-art licenses outpatient surgical facility recovery room.  The ketamine patient are staffed by a physician, who is board certified in Pain, as well as highly skilled nurses. All nurses have extensive cardiac care unit, intensive care unit or emergency room experience and have worked with Dr. Prager for decades.   There is one physician supervisor at all times and the care is carried out by these critical care nurses.   

Because ketamine is known to have potential side effects, for the first 10 years of performing infusions, all side effects were cataloged and pharmacological solutions were determined to be successful. 

Before committing to a full course of ketamine infusion treatment, the patient is given a 3 consecutive day trial of ketamine.  Doses are started modestly and increased daily during the 3 day trial.  Adjuvant medications are provided.  The purpose of the trial is two fold: 

1. To determine whether at the end of 3 days the patient will potentially benefit from full ketamine treatment.  
2. To determine if all side effects can be managed so that the patient can tolerate a 10 day infusion.  

The 10-day infusion is performed Monday through Friday during 2 consecutive weeks for patients who have had a successful 3 day trial.  Doses are escalated on a daily basis, depending on how well the patient is tolerating the infusion.  

Most of our patients after the 10 day infusion, receive at least 3 months of relief and are able to assume normal activities of daily living.  At the end of 3 months, approximately half the patients do not need further ketamine and the remaining half return for booster treatment.  We have found the patients who participate in our comprehensive interdisciplinary functional rehabilitation program have a greater chance of not requiring ketamine at the end of 3 months.  The rehabilitation program, for those who participate, commences the week after the 10 ketamine infusions are completed.