Could ketamine help manage pain in patients with post-treatment Lyme disease syndrome?

A 31-year-old woman with post-treatment Lyme disease syndrome (PTLDS) had pain that was refractory to radiofrequency ablation, vitamin infusion therapy, opioid analgesics, and other pharmacotherapies. Her pain began gradually three years after being diagnosed and treated for Lyme disease, explains Hanna from the Florida Spine Institute.

The patient complained of diffuse body pain, fatigue, headache, and brain fog. Her pain worsened despite treatment, increasing during everyday activity. Her regimen included fentanyl transdermal patches, clonazepam, oxycodone hydrochloride, and citalopram hydrobromide. Physical therapy, IV vitamin infusions, trigger point injections, and radiofrequency ablation did not alleviate her pain.

Why Ketamine Was Considered

The authors proposed that the woman’s pain may be related to immune dysfunction brought on by the infection. Ketamine exhibits anti-inflammatory and immunomodulatory actions that may be useful in the treatment of PTLDS. It is also an anesthetic and has been proven successful in placebo-controlled clinical trials for the treatment of depression, suicidal ideation, and pain.

Ketamine has been utilized off-label as an effective option for treating neuropathic pain conditions that do not have gold standard treatment options — including complex regional pain syndrome (CRPS) and fibromyalgia.

Results: 71% Pain Reduction

Ketamine was found to effectively lessen the woman’s pain, decreasing it by approximately 71%. Her pain relief was achieved without increased doses of opioid analgesics. In fact, the patient was able to reduce her fentanyl dosage by 40%, from 125 μg to 75 μg every 48 hours. The patient’s depression and suicidal ideation were also eliminated post-ketamine infusion.

Given these findings, Hanna suggests that opioid-sparing therapies such as ketamine should be used more frequently for the management of chronic pain.

Clinical Perspective

This case demonstrates the severity of chronic pain in PTLDS and the potential role of ketamine when standard pain therapies fail. The 71% pain reduction — along with opioid dose reduction and resolution of depression — suggests ketamine may address central sensitization mechanisms that opioids cannot reach.

The authors did not address the question of whether a persistent Lyme disease infection or tick-borne co-infection might underlie the illness. It would be reasonable to revisit whether this patient was adequately treated for her original infection before concluding that her symptoms were purely post-infectious.

Frequently Asked Questions

Can ketamine help with Lyme disease pain?
In this case report, ketamine reduced PTLDS pain by 71% when opioids and other therapies had failed. Its anti-inflammatory and NMDA receptor effects may address central sensitization that drives chronic Lyme pain.

Why didn’t opioids work for this patient?
PTLDS pain is often driven by central sensitization and neuroinflammation rather than peripheral tissue damage. Opioids primarily target peripheral pain pathways, which is why they were insufficient.

Did ketamine help with symptoms beyond pain?
Yes. The patient’s depression and suicidal ideation also resolved after ketamine infusion, consistent with ketamine’s established antidepressant effects.

Is ketamine a standard treatment for PTLDS?
No. Ketamine use for PTLDS is off-label and based on individual case reports. More research is needed, but this case suggests it deserves further investigation for patients with refractory pain.

Could this patient’s pain have been caused by persistent infection?
The authors did not evaluate for persistent infection or co-infections. Some clinicians would consider whether inadequate initial treatment contributed to ongoing symptoms before attributing them solely to post-infectious mechanisms.

References

1. Hanna AF, Abraham B, Hanna A, Smith AJ. Effects of intravenous ketamine in a patient with post-treatment Lyme disease syndrome. Int Med Case Rep J. 2017;10:305–308.
2. Bechtold KT, Rebman AW, Crowder LA, Johnson-Greene D, Aucott JN. Standardized symptom measurement of individuals with early Lyme disease over time. Arch Clin Neuropsychol. 2017;32(2):129–141.

Related Reading

• Lyme Disease Pain: Why It Moves and What Helps
• Lyme Disease Pain After Dental Surgery: A PTLDS Case
• Lyme Disease and CRPS: When Infection Drives Chronic Pain
• Allodynia: When Normal Touch Becomes Painful
• Burning Pain With Normal EMG: Understanding the Disconnect
• PTLDS and Lyme Disease Recovery