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

Lyme disease patients oftentimes suffer from ongoing illness following treatment. A study by Bechtold and colleagues found that 31% of patients remained in significant pain for months after a three-week course of doxycycline to treat an EM rash. [1] Six percent of their patients developed post-treatment Lyme disease syndrome (PTLDS). Now, a new case report examines the effectiveness of intravenous ketamine on managing pain in a patient with post-treatment Lyme disease syndrome.

In the International Medical Case Reports Journal, researchers describe a 31-year-old woman with PTLDS “whose pain was refractory to treatment options such as radiofrequency ablation, vitamin infusion therapy, opioid analgesics, and other pharmacotherapies.” [2] Her pain began gradually, 3 years prior and a short time after being diagnosed and treated for Lyme disease, explains Hanna from the Florida Spine Institute in Clearwater, Florida. “The patient complained of diffuse body pain (6–7/10), fatigue, headache, and brain fog (7–8/10).” [2]

The woman’s pain worsened despite treatment, increasing during everyday activity. “Her current treatment regimen,” according to Hanna and colleagues, “included fentanyl transdermal patches, clonazepam, oxycodone hydrochloride, and citalopram hydrobromide.” Physical therapy, IV vitamin infusions, trigger point injections and a radiofrequency ablation procedure did not alleviate her pain.

The authors’ surmised that the woman’s pain may be related to an immune dysfunction brought on by the infection. Ketamine exhibits anti-inflammatory and immunomodulatory actions, explains Hanna, which may be useful in the treatment of PTLDS. [2] It is also an anesthetic and has been proven successful “in placebo-controlled clinical trials for the treatment of depression, suicidal ideations, and pain.”

[bctt tweet=”Ketamine is found to reduce pain in patient with post-treatment Lyme disease syndrome. ” username=”DrDanielCameron”]

The patient was prescribed ketamine off label for pain. “Ketamine has been utilized off-label as an effective option for treating certain neuropathic pain conditions that currently do not have gold standard treatment options such as complex regional pain syndrome (CRPS) and fibromyalgia,” states Hanna. [2]

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

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

The authors did not address the concerns raised by physicians as to whether a persistent Lyme disease infection or tick-borne co-infection might underlie the illness.


Related articles:

The risk of pain and fatigue after three weeks of Lyme disease treatment

Women with chronic Lyme disease may suffer from a severe immune response triggered by the disease



  1. 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.
  2. 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.


4 Replies to "Could ketamine help manage pain in patients with post-treatment Lyme disease syndrome?"

  • kees
    09/18/2023 (8:53 am)


    I had lyme, did discover this because of ACA on one leg, get antibiotics after a test and biopt, I think have not completely cured so I ask here, what does a not cured Lyme?

    For me I have symtomes like a kind of flu like symptoms, fatigue, nog good sleep, (do I sleep well fatigue is much less) have feelings like insects under the skin, stress feelings and massive feelings.

    I do excercise, pain is very light and not present when rest and watch tv, do yoga, then I can feel that muscles are stiff and little painful. I can do make a trip with the bicycle, last I did 60 km, and yes after that I was tyred but are also 66 of age.

    The ACA on the leg is still gone after now 10 months after treatment with doxy, bet have symptoms who do are not pleasant, sleep and tiredness but soemtimes I are quite good feelings. I have not nerve problems, I have the borrelia skin infecting strain.

    I also did hear that symtoms after treatment can be present for some 2 years.

    I am using now starting today ghanese Kinine to try out if it does help.


  • marc
    04/26/2019 (4:33 am)

    good luck trying to get ketamine,,,,I was diagnosed with Lyme in 2005.I was on various abx for 2 1/2 years.I am still very sick and I hurt so bad and my brain is on fire.I had a 2 level back surgery 10 months ago and it sent my Lyme into overdrive…the oxycodone I take seems to only make me more susceptible to’s a joke.I would like to try the ketamine and get off the opioids.. easier said than done I think.

    • Bob
      11/11/2019 (3:03 pm)

      Hello Marc, I hope the very best for you. But I have a back surgery scheduled a few weeks away. I’ve endured on and off minor issues with Lyme disease for 4 years now. What type of surgery did you have? And are you better outside the pain?

    • kees
      09/18/2023 (8:57 am)

      Hi. If I read this, then I have a succesfull treatment because this I do not have, no burning and such, but tiredness and sleep is bad, I can sleep better when use magnesium and oxazepam, last drug is not suitable for longer times. So I start Ghanese kinine and see what it does. I did also read kinabast do work well.

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