Chronic Pain That Hasn't Responded to Surgery, Injections, or Opioids? Ketamine Treats Pain at the Nerve Level.

Treating it — at the receptor level. Ketamine is an NMDA receptor antagonist, and NMDA receptors are central to the "wind-up" phenomenon of chronic pain. By blocking NMDA, ketamine can reset central sensitization rather than just numbing what you feel. Pain relief often outlasts the dose itself — sometimes for days or weeks after a session — which is the opposite of how a typical analgesic works.

No. Many patients start ketamine while still on their current opioid regimen. As your pain responds, your pain physician may help you taper — under their supervision. Some patients reduce or eliminate opioids; some stay on a lower dose. Dr. Mahjoubi coordinates with your existing pain physician when you give consent. Do not stop opioids cold turkey — withdrawal is dangerous and counterproductive for pain.

The conditions listed in the section above have all been documented in the medical literature as ketamine-responsive, and Dr. Mahjoubi treats each of them. Response varies by individual — fibromyalgia and CRPS in particular have well-established positive response patterns. For Lyme pain, ankylosing spondylitis, and other inflammatory or post-infectious syndromes, response is often strong but more variable. Dr. Mahjoubi will give you an honest read on your specific case during the consult.

IV infusions have been the historical standard for severe pain syndromes like CRPS — but they're expensive, time-consuming, and often not covered by insurance. At-home ketamine (nasal spray, troche, RDT) can produce similar long-term outcomes for many patients with significantly more convenience and less cost. For very severe CRPS or refractory cases, Dr. Mahjoubi may recommend combining both, or starting with in-clinic infusions. He'll make that call during your consult based on your history.

Yes. Ketamine is generally compatible with all of these. Many patients eventually reduce or discontinue some adjuvants because they don't need them at the same dose — but any reduction should happen under your prescribing physician's supervision. Dr. Mahjoubi will review your current medications during your consult.

Failed back surgery syndrome is one of the more common reasons patients come to NutraBrain. It often involves a mix of mechanical pain and centrally sensitized neuropathic pain — and ketamine targets the second component specifically. Many failed-back-surgery patients report meaningful improvement, especially in the neuropathic/burning component of their pain.

Chronic Lyme and post-treatment Lyme syndrome often involve persistent neuropathic pain, joint pain, and central sensitization — all of which can respond to ketamine. NutraBrain doesn't treat the underlying infection — that's your Lyme specialist's job — but ketamine can be a powerful tool for the pain component while you address the rest of the syndrome.

At prescribed therapeutic doses, the addiction risk is low. Unlike opioids, ketamine doesn't produce physical withdrawal. NutraBrain's dosing protocol is specifically designed to avoid tolerance and dependence — which is the opposite trajectory of most chronic pain medications, which build dependence over time.

Yes, when prescribed by a physician and used at therapeutic doses. NutraBrain's nasal spray, troche, and RDT formulations are all at sub-anesthetic doses. You'll be screened for contraindications (active psychosis, uncontrolled substance use disorder, certain cardiac conditions, uncontrolled hypertension) during your consult. Anesthesiology-trained oversight matters here — Dr. Mahjoubi has been administering ketamine since 2014.

Mild dizziness, nausea, or short dissociation during dosing are the most common. These resolve within 30–90 minutes. Severe side effects are rare at the doses NutraBrain prescribes. Long-term, the most-studied concern is bladder irritation, which is a high-dose, high-frequency issue — NutraBrain dosing avoids that range.

NutraBrain is cash-pay. Most patients find the $69/mo membership + ketamine cost is less than their pain specialist + medication out-of-pocket. We provide a superbill you can submit for possible out-of-network reimbursement.