Nerve Pain Operates Differently. Your Treatment Should Too.

Neuropathic pain does not follow the rules of ordinary pain. You can have burning, shooting, or electric sensations in a limb where there is no injury and nothing visibly wrong. Touch that should not hurt, does. Temperature that should feel neutral, doesn't. The discomfort can be constant, unpredictable, and exhausting in a way that people who have not experienced it genuinely cannot imagine.

Standard pain medications, NSAIDs, opioids, and even many prescription analgesics, were designed for nociceptive pain, the pain that arises from tissue damage and inflammation. Neuropathic pain arises from dysfunction in the nervous system itself. Different mechanism. Different biology. Different treatment requirements.

At Ketamine Wellness Infusions PA, located minutes from Lower Merion Township in Bala Cynwyd, we offer IV ketamine infusions specifically for patients living with neuropathic pain that has not responded adequately to standard treatments. Of all chronic pain conditions, neuropathic pain has one of the most well-documented relationships with the NMDA receptor system that ketamine directly targets, making it one of the conditions where the clinical rationale for ketamine is strongest and the evidence base is most established.

Our founder Jill Gabay is a senior CRNA with more than 30 years of anesthesia experience and a member of the American Society of Ketamine Physicians, Psychotherapists and Practitioners. She is personally present for every infusion, every patient, every time.

Schedule a consultation and find out whether IV ketamine is the right next step for your nerve pain.

What Neuropathic Pain Is and Why It Is So Resistant to Treatment

The International Association for the Study of Pain defines neuropathic pain as pain caused or initiated by a primary lesion or dysfunction in the somatosensory nervous system. It arises not from damaged tissue sending warning signals to the brain, but from abnormal function in the nerves themselves, or from the central nervous system's reorganization in response to nerve injury or disease.

Common causes include diabetic peripheral neuropathy, postherpetic neuralgia following shingles, chemotherapy-induced neuropathy, nerve compression, spinal cord injury, complex regional pain syndrome, multiple sclerosis-related pain, and post-surgical nerve damage. In many cases, the underlying cause is well identified. In roughly a third of cases, it remains idiopathic, meaning the pain persists without a clearly identifiable structural or pathological source.

What unites these presentations is the neurological mechanism. The somatosensory system has been altered, whether by direct nerve damage, by central nervous system sensitization, or by disrupted descending inhibition, the pathway through which the brain modulates and suppresses pain signals from below. When descending inhibition is impaired, pain signals that should be dampened are amplified instead. The result is allodynia, pain from stimuli that should not cause pain, and hyperalgesia, pain responses that are disproportionately intense.

Standard first-line treatments for neuropathic pain include anticonvulsants like gabapentin and pregabalin, tricyclic antidepressants, SNRIs, and topical agents. These medications provide meaningful relief for some patients. But neuropathic pain is notably treatment-resistant, and a substantial percentage of patients cycle through these options without achieving adequate control.

How IV Ketamine Treats Neuropathic Pain

Ketamine's mechanism of action is specifically aligned with the neurobiology of neuropathic pain at multiple levels.

At the primary level, ketamine blocks NMDA receptors in the spinal cord dorsal horn, directly interrupting the central sensitization and wind-up processes that maintain and amplify neuropathic pain signals. Research published in PMC describes this mechanism precisely: neuropathic pain results from lesions of the somatosensory nervous system that cause alterations in structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are amplified. NMDA receptor upregulation at dorsal horn synapses is a core driver of this amplification. Ketamine's blockade of this receptor reverses the sensitization process rather than simply masking the pain signal.

At a secondary level, ketamine enhances descending inhibition, the brain's own pain-suppression system, which is often impaired in neuropathic pain states. By restoring this inhibitory pathway, ketamine helps the nervous system regain its capacity to modulate pain from above.

The clinical evidence for this mechanism is strong. A 2022 systematic review and meta-analysis published in PMC analyzing 18 randomized controlled trials involving 706 neuropathic pain patients found statistically significant pain reduction with ketamine compared to standard treatment, with results from six RCTs yielding a mean difference of 1.68 points on a zero to ten numerical rating scale. A separate meta-analysis found a mean reduction of 46% from baseline pain when assessing overall pain reduction. A meta-analysis published in Anesthesia and Analgesia examining chronic pain broadly found that 51.3% of ketamine-treated patients achieved a positive outcome compared to 19.4% in placebo groups, a relative risk of 2.43 in favor of ketamine.

The narrative review published in CNS Drugs in 2025 summarizing the current evidence base states directly that ketamine can provide significant short-term analgesia, especially in neuropathic pain, and is fairly well-tolerated in patients with severe refractory pain.

Types of Neuropathic Pain We Treat

Diabetic Peripheral Neuropathy

Diabetes is the most common cause of peripheral neuropathy, accounting for roughly 30% of all cases. The burning, tingling, and numbness that typically begin in the feet and progress upward can be severe and debilitating. When gabapentin, pregabalin, and duloxetine have provided only partial relief, IV ketamine targets the central sensitization component that those medications do not reach.

Postherpetic Neuralgia

Postherpetic neuralgia, the persistent nerve pain that follows a shingles outbreak, can continue for months or years after the rash resolves. It involves direct nerve damage combined with central sensitization, making it one of the classic presentations where NMDA receptor-targeted treatment has shown clinical benefit.

Chemotherapy-Induced Peripheral Neuropathy

Many chemotherapy agents damage the peripheral nerves, producing neuropathic pain, numbness, and functional impairment that can outlast cancer treatment by years. Ketamine's NMDA receptor mechanism and anti-inflammatory properties make it relevant for this population, particularly given the limitations of standard analgesics in chemotherapy-induced neuropathy.

Complex Regional Pain Syndrome (CRPS)

CRPS is among the most severe and debilitating neuropathic pain conditions, characterized by extreme pain, vasomotor changes, and pronounced central sensitization. It is one of the conditions for which IV ketamine has the most documented clinical evidence, with randomized controlled trials demonstrating superior analgesia for up to 12 weeks following infusion courses.

Spinal Cord Injury Pain

Neuropathic pain following spinal cord injury involves significant NMDA receptor-mediated central sensitization and altered descending inhibition. Ketamine directly addresses both mechanisms and has been used clinically for this population as part of comprehensive pain management.

Post-Surgical Neuropathic Pain

Nerve injury during or following surgery can produce persistent neuropathic pain in the surgical area, surrounding tissues, or more distant structures. When standard post-surgical pain management has not resolved this pain, IV ketamine addresses the central sensitization that has developed around the surgical nerve injury.

Idiopathic Neuropathic Pain

Roughly one third of patients with neuropathic pain never receive a clear etiological diagnosis. The mechanism, altered somatosensory function with NMDA-mediated central sensitization, remains the same regardless of cause, and ketamine's effect on that mechanism does not depend on identifying the underlying etiology.

What Treatment Looks Like at Our Clinic

Your path starts with a thorough consultation where Jill Gabay reviews the nature, location, and history of your neuropathic pain, your diagnosis and any underlying conditions, prior treatments and their outcomes, and your current medications. Neuropathic pain frequently coexists with depression, anxiety, and sleep disturbance, and understanding your complete clinical picture shapes the approach.

The standard initial course is six IV ketamine infusions completed over approximately two to three weeks. Each session lasts 40 to 60 minutes in a calm, monitored room with blankets, an eye mask, and essential oil diffusers. Jill or a member of our care team is present throughout every infusion monitoring your vital signs continuously.

After your series, Jill conducts personal follow-up check-ins to assess your pain response and plan next steps. Many patients with neuropathic pain find meaningful reduction in their baseline pain level and in the frequency and intensity of pain flares. Some benefit from periodic maintenance infusions every four to twelve weeks. Your ongoing plan is based entirely on how your nervous system responds to treatment.

Why Lower Merion Township Patients Choose Our Clinic

Our clinic at 146 Montgomery Ave, Suite 202 in Bala Cynwyd sits inside Lower Merion Township, minutes from Ardmore, Wynnewood, Narberth, Penn Valley, Bryn Mawr, and the broader Main Line, accessible without a Philadelphia commute.

Jill Gabay brings more than 30 years of anesthesia expertise to every infusion, with specific clinical depth in ketamine pharmacology and dosing that makes a measurable difference for complex pain presentations. The 2018 consensus guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists identify neuropathic pain as one of the chronic pain conditions for which IV ketamine has established clinical utility. Our clinic follows those protocols in a safe, monitored outpatient setting.

Her physician supervisor Dr. Rubin brings more than 20 years of clinical experience as a board-certified oncologist and Clinical Associate Professor at Drexel University College of Medicine. We hold a 5.0 Google rating from patients whose pain had not been adequately controlled through conventional approaches.

Frequently Asked Questions About Neuropathic Pain Treatment in Lower Merion Township