Ketamine for Neuropathy & Nerve Pain in Baltimore
Targeting the central amplifier that makes nerve pain far worse than the nerve damage itself.
Ketamine for neuropathy in Baltimore costs $1,499.99 per session ($1,125 for Vitality Circle members — a $374.99 saving) and is anesthesiologist-led care, under the medical direction of Dr. Brijen Joshi MD, a Johns Hopkins anesthesiologist — evaluated for the central amplifier behind chronic nerve pain: the NMDA-mediated central sensitization that makes neuropathic pain far worse than the nerve damage itself. It is evaluated across five conditions — diabetic peripheral neuropathy (DPN), complex regional pain syndrome (CRPS), post-herpetic neuralgia (PHN), chemotherapy-induced peripheral neuropathy (CIPN), and post-surgical nerve damage — which share NMDA central sensitization as the dominant chronic pain mechanism, making ketamine's NMDA blockade relevant across all five. CRPS has the strongest published ketamine evidence — a randomized controlled trial (Sigtermans et al., Pain 2009). FDA-approved first-line treatments for DPN and PHN must be explored first; CRPS and CIPN have none. Ketamine treats the pain amplifier, not the underlying cause — glucose control, oncology, and neurology care continue unchanged. Ketamine is off-label and results vary.
Mon–Fri: 1PM–8PM · Sat: 10AM–2PM
513 Bayview Blvd, Canton, Baltimore MD 21224
(443) 563-1059
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Neuropathic Pain Conditions Evaluated at Vita Nova
Neuropathic pain is pain arising from damage to or dysfunction of the nervous system — characterized by burning, electric, shooting, or stabbing sensations, often accompanied by allodynia (pain from normally non-painful stimuli) and hyperalgesia (amplified pain responses). The five conditions evaluated at Vita Nova have distinct peripheral causes but share a common neurological denominator in the chronic phase: NMDA-mediated central sensitization that sustains pain independently of the original injury or disease.
Severe, chronic pain condition characterized by burning pain, swelling, skin and temperature changes, and extreme allodynia — typically following trauma, surgery, or injury. Involves the most pervasive central sensitization of any common neuropathic pain condition. Sigtermans et al. (2009, Pain) — an RCT — demonstrated significant pain reduction with subanesthetic S-ketamine. The strongest ketamine evidence on this page.
Peripheral nerve damage from chronic hyperglycemia — burning, tingling, and numbness typically in feet and hands. In the chronic phase, central sensitization amplifies the neuropathic signal beyond the peripheral nerve damage. Duloxetine and pregabalin are FDA-approved first-line and must be tried before ketamine. Metformin-treated patients must have B12 status reviewed — see section 06.
Persistent severe neuropathic pain following shingles (herpes zoster) — typically in older adults. Results from permanent damage to sensory nerve fibers by the varicella zoster virus. Produces burning, stabbing, and extreme skin sensitivity in the affected dermatome. Pregabalin, gabapentin, and topical capsaicin patch (Qutenza) are FDA-approved. Ketamine is evaluated for inadequate responders.
Peripheral nerve damage caused by chemotherapy agents — platinum compounds (cisplatin, oxaliplatin), taxanes (paclitaxel, docetaxel), and vinca alkaloids. Produces burning, tingling, and numbness in hands and feet. No FDA-approved condition-specific pharmacological treatment exists. Duloxetine has the most evidence among available options but is not FDA-approved for CIPN. Ketamine is evaluated for central sensitization-driven CIPN pain.
Chronic neuropathic pain following surgical procedures — including post-thoracotomy pain, post-mastectomy pain, phantom limb pain, and chronic pain after abdominal surgery. Involves both peripheral nerve injury and central sensitization. The central sensitization component is the target for ketamine — particularly in patients whose pain has persisted 3+ months post-surgery despite conventional treatment. See also the Post-Surgical Pain page →
FDA-Approved First-Line Treatments — And Where Ketamine Fits
Diabetic peripheral neuropathy and post-herpetic neuralgia have FDA-approved pharmacological treatments that must be explored before ketamine evaluation. CRPS and CIPN have no FDA-approved condition-specific pharmacological treatments — making ketamine evaluation more immediately relevant for those presentations.
For diabetic neuropathy and post-herpetic neuralgia, the following FDA-approved treatments should be evaluated with your neurologist or pain specialist before ketamine evaluation.
SNRI enhancing descending pain inhibitory pathways — first-line for diabetic peripheral neuropathy. Also has evidence for CIPN though not FDA-approved for that indication. Available by prescription from your physician or neurologist. Well-tolerated in most patients with gradual dose titration.
Alpha-2-delta calcium channel ligand reducing central sensitization signaling — approved for both diabetic neuropathy and post-herpetic neuralgia. Also first-line for fibromyalgia. Common side effects include dizziness, weight gain, and sedation. Gabapentin (Neurontin) has comparable evidence for PHN though not FDA-approved for DPN.
High-concentration capsaicin 8% patch applied by a healthcare provider — depletes substance P in peripheral sensory nerve endings, reducing pain signaling. Produces local burning during and after application but provides weeks of pain relief. Particularly useful for patients who cannot tolerate oral medications.
Topical lidocaine 5% patch applied over the painful area — approved specifically for post-herpetic neuralgia. Provides local anesthetic effect with minimal systemic absorption. Can be combined with oral neuropathic agents. Well-tolerated. Multiple patches may be used simultaneously for larger affected areas.
For CRPS and CIPN: No FDA-approved condition-specific pharmacological treatments exist. Standard approaches include gabapentinoids, SNRIs, tricyclics, and opioids — none with specific regulatory approval for these conditions. This makes ketamine evaluation more immediately clinically relevant for CRPS and CIPN patients — there is no established first-line to exhaust first. CRPS patients with documented treatment failure of standard approaches are among the strongest candidates for ketamine evaluation at Vita Nova.
Complex Regional Pain Syndrome — The Most Mechanistically Aligned Condition
CRPS is the neuropathic pain condition with the most compelling published ketamine evidence and the most intense central sensitization of any common pain condition. It deserves its own dedicated treatment here.
Complex regional pain syndrome (CRPS) involves the most pervasive and severe central sensitization of any common neuropathic pain condition. The burning pain, extreme allodynia, swelling, and skin changes of CRPS are driven by NMDA receptor hyperactivity that has become self-sustaining — generating and amplifying pain signals far beyond any ongoing peripheral injury. The sympathetic nervous system, neuroinflammation, and cortical reorganization all contribute, but NMDA-mediated central sensitization is the dominant, treatable pain mechanism. There are no FDA-approved condition-specific pharmacological treatments for CRPS — ketamine is evaluated not as a last resort but as one of the most mechanistically appropriate available treatments.
The most rigorous published trial of ketamine for CRPS Type I: 60 patients randomized, double-blind, to a 4-day continuous infusion of subanesthetic S-ketamine or placebo. Pain scores were significantly lower in the ketamine group, and the difference persisted for up to 11 weeks after the infusion ended — although functional improvement was limited. The trial provided direct controlled evidence that NMDA blockade produces meaningful, durable analgesia in CRPS, supporting the central sensitization rationale.
Double-blind, placebo-controlled trial of a 10-day outpatient ketamine infusion protocol (about 4 hours a day) in CRPS patients who had failed standard treatments. Ketamine produced significantly greater pain relief than placebo, with benefit lasting up to 12 weeks, and disease duration did not predict response. At Vita Nova, CRPS protocol duration is discussed individually based on patient history and clinical evaluation.
CRPS Type I involves no identifiable nerve lesion. CRPS Type II involves a documented nerve injury. Both types share the same central sensitization mechanism and both are evaluated at Vita Nova. Prior treatment documentation is reviewed during the clinical evaluation.
Peripheral Sensitization vs. Central Sensitization — Ketamine's Target
Not all neuropathic pain is the same from a treatment perspective. The distinction between peripheral and central sensitization determines whether ketamine is likely to be helpful — and why chronic duration matters so much for patient selection.
In the acute phase of nerve injury, peripheral sensitization — heightened sensitivity of the damaged nerve itself — is the dominant pain mechanism. The nerve ending is generating the pain signal, and central processing is not yet pathologically altered. Standard analgesics, anti-inflammatory agents, and nerve-targeted treatments are appropriate at this stage.
Limited. Central sensitization features are not yet established. Standard treatments are more appropriate first. As the neuropathic pain becomes chronic — typically after 3+ months — central sensitization develops and ketamine evaluation becomes more relevant.
In chronic neuropathic pain (typically 3+ months), NMDA receptor hyperactivity in the spinal cord and brain becomes the dominant pain driver — amplifying signals far beyond what the peripheral nerve damage predicts, generating pain that spreads beyond the nerve territory, and producing allodynia. At this stage, treating only the peripheral nerve may leave the central mechanism untouched.
Most mechanistically aligned. Direct NMDA blockade interrupts the hyperexcitable spinal cord and supraspinal circuits generating and amplifying chronic neuropathic pain. The central sensitization features — allodynia, hyperalgesia, spreading pain — are the strongest positive indicators for ketamine evaluation.
The practical implication: patients with allodynia, pain spreading beyond the original nerve territory, or pain disproportionate to the nerve injury are the strongest candidates. Patients within the first weeks of nerve injury with no central sensitization features are better served by conventional neuropathic pain management first.
The Research Supporting Ketamine for Neuropathic Pain
Joint guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists on IV ketamine infusions for chronic pain. They rate the evidence as strongest for CRPS, note moderate short-term benefit for other neuropathic pain conditions, and set out patient selection, dosing, and monitoring standards — the framework Vita Nova's anesthesiologist-led protocols follow.
Randomized, double-blind, placebo-controlled trial of a 4-day subanesthetic S-ketamine infusion in 60 CRPS Type I patients. Pain scores were significantly lower with ketamine, and the benefit lasted up to 11 weeks after the infusion. Provided controlled trial evidence for ketamine in CRPS — the strongest level of evidence for ketamine in any specific neuropathic pain condition.
Prospective study of 32 patients with diabetic polyneuropathy and post-herpetic neuralgia treated with ketamine (IV test infusion, then oral) over 3 months. The most common side effects were dizziness (44% during infusion, 22% on oral therapy), drowsiness (25%), and dry mouth (19%); 15.6% stopped for lack of efficacy and 12.5% for side effects. Honest, condition-specific data on what long-term ketamine feels like for the two neuropathies with FDA-approved alternatives — most patients tolerated it, and not all benefited.
Comprehensive review establishing central sensitization as the shared mechanism across neuropathic pain conditions — documenting NMDA receptor hyperactivity as the core driver. Established the mechanistic foundation for NMDA-targeted therapy (ketamine) across all neuropathic pain conditions regardless of peripheral origin. The most cited paper establishing the central sensitization rationale for ketamine in neuropathic pain.
Double-blind, multicenter dose-response trial of 416 wrist-fracture patients: 500 mg of vitamin C daily for 50 days after the fracture reduced the incidence of CRPS from about 10% with placebo to about 2%, and the authors recommended 500 mg for 50 days as standard prophylaxis (Level I evidence). Provides the basis for High-Dose Vitamin C IV as a relevant complementary wellness service for CRPS patients — addressing oxidative stress and neuroinflammation relevant to CRPS pathophysiology.
The B12-Metformin Connection — Is Your Medication Causing Your Neuropathy?
This is one of the most clinically important and under-discussed connections in diabetic neuropathy management. Metformin — the most commonly prescribed diabetes medication — depletes B12 in up to 30% of long-term users by interfering with B12 absorption in the terminal ileum. And B12 deficiency itself is a direct cause of peripheral neuropathy — producing exactly the burning, tingling, and numbness that diabetic neuropathy produces. A patient with type 2 diabetes who has been on metformin for years may have both diabetes-related nerve damage and B12 deficiency-related nerve damage occurring simultaneously — yet only the diabetes is typically addressed clinically.
What to do: Ask your physician to check serum B12 and methylmalonic acid (MMA) levels — MMA is a more sensitive marker of functional B12 deficiency than serum B12 alone. If deficiency is confirmed, B12 replacement is indicated — and may improve neuropathy symptoms alongside or before ketamine evaluation. IM B12 at Vita Nova achieves therapeutic repletion that oral supplementation may not reliably provide in metformin-treated patients. This is a wellness service — not a neuropathy treatment — and B12 status management decisions are made with your prescribing physician.
Pricing at Vita Nova
| Service | Non-Member | Vitality Circle Member | Saving |
|---|---|---|---|
| Ketamine — Chronic Pain / session Off-Label | $1,499.99 | $1,125 | $374.99/session |
| CRPS Protocol (extended duration — if applicable) | Duration and pricing discussed individually at clinical evaluation | ||
If you have a documented co-occurring mental health condition alongside neuropathic pain: treating it may additionally reduce pain through improved descending pain inhibition — which is why a single evaluation considers your whole pain picture. See our co-occurring depression & chronic pain page.
Self-pay, with a superbill. Every session is anesthesiologist-led care, under the medical direction of Dr. Brijen Joshi MD — Johns Hopkins faculty and Chief of Thoracic Anesthesia at Johns Hopkins Hospital — in a private treatment room with continuous cardiac and vital-sign monitoring, so the price reflects physician-level, monitored care rather than a walk-in drip. Vita Nova is self-pay for ketamine and provides an itemized superbill you can file with your insurance. HSA and FSA accepted; Community Heroes discounts available. Vitality Circle membership ($99.99/month) pays for itself on a single session — the member rate saves $374.99, more than the membership — and adds one included monthly perk (1 standard IV drip, 2 IM shots, 2 IV pushes, or 1 shot + 1 push) plus 25% off premium IVs. The number of sessions is set individually based on the condition, severity, and response. Pricing August 2026 — subject to change. Full pricing guide →
Complementary Treatments Supporting Neuropathic Pain Relief
Several wellness services at Vita Nova have specific relevance to neuropathic pain — addressing nerve function, NMDA receptor sensitivity, mitochondrial energy in neural tissue, and inflammatory pathways relevant to CRPS and post-surgical neuropathy.
The most clinically important wellness service for neuropathy patients. B12 is essential for myelin synthesis and nerve conduction — deficiency directly causes peripheral neuropathy. Metformin-treated diabetic patients are at particular risk of B12 depletion causing or worsening DPN. IM delivery achieves reliable therapeutic repletion that oral B12 may not reach in patients with absorption issues.
Magnesium naturally modulates NMDA receptor sensitivity — directly relevant to ketamine's central sensitization mechanism. Magnesium deficiency increases NMDA excitability, worsening the central amplification of neuropathic pain. Diabetic patients frequently have magnesium depletion from urinary losses. IM delivery achieves immediate therapeutic repletion.
High-dose Vitamin C has documented evidence for CRPS prevention in surgical and trauma contexts (Zollinger et al., 2007) — addressing oxidative stress and neuroinflammation relevant to CRPS pathophysiology. Also relevant for CIPN patients experiencing chemotherapy-related oxidative stress. The anti-inflammatory signaling may complement ketamine's NMDA mechanism in inflammatory neuropathic presentations.
Relevant in two situations. Chemotherapy patients with CIPN are frequently anemic, and when bloodwork confirms iron-deficiency anemia, IV iron restores stores faster than oral iron many patients tolerate poorly. Low iron and low ferritin are also the leading driver of restless legs syndrome — uncomfortable nighttime leg sensations that often coexist with, or are mistaken for, peripheral neuropathy, and that frequently ease once a confirmed deficiency is corrected.
Mitochondrial dysfunction is documented in CIPN — impaired cellular energy production in peripheral nerve cells contributes to the neurotoxic effects of platinum and taxane chemotherapy. NAD+ IV Therapy supports mitochondrial function in neural tissues — addressing the cellular energy deficit relevant to CIPN neuropathology and the cognitive fatigue common in post-chemotherapy patients.
Clinical note: These wellness services are not treatments for neuropathic pain and are not part of Vita Nova's ketamine clinical protocols. B12 deficiency management is a clinical decision made with your prescribing physician — not a wellness service decision made independently. Always discuss supplemental therapy with your neurologist, pain specialist, or prescribing physician before beginning.
Special Pricing for Those Who Serve
Veterans and first responders carry elevated rates of nerve injuries from combat, occupational trauma, and cumulative physical demands — leading to chronic neuropathic pain conditions that conventional medicine often manages inadequately.
Neuropathy & Ketamine — Questions Answered
Real, high-intent questions from neuropathic pain patients evaluating ketamine and IV therapy in Baltimore.
The Nerve Damage Happened.
The Amplifier Can Still Be Reset —
Ketamine's NMDA mechanism targets the central sensitization that makes neuropathic pain so severe — not the nerve damage itself, but the amplification system that turns it into something unbearable. CRPS evidence is strong. DPN and PHN first-line options reviewed first. Off-label, self-pay with an itemized superbill you can file with your insurance. Community Heroes discounts available.
Canonical URL: https://vitanovawellnessclinic.com/ketamine-neuropathy-treatment-baltimore/ · Last reviewed August 26, 2026
Medically reviewed by Dr. Brijen L. Joshi MD — Assistant Professor of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine · Chief of Thoracic Anesthesia, Johns Hopkins Hospital · Medical Director, Vita Nova Ketamine & Wellness Clinic. · View full credentials →
