Two Infusions a Year, Two Years of Relief: Inside a 92 Patient Fibromyalgia Ketamine Study
A North Carolina pain clinic just published two years of outcome data on 92 fibromyalgia patients treated with ketamine. The paper landed in the Journal of Pain Research on August 19, 2026. The headline number is durability. The more useful number is the schedule. These patients came in roughly twice a year.
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| Key Takeaway | Detail |
|---|---|
| The study | Retrospective chart review at Carolinas Pain Institute in Winston-Salem, North Carolina |
| Size and design | 92 consecutive female patients, single arm, no control group, treated 2018 to 2024 |
| Ketamine protocol | 300 to 500 mg total, about 1.5 mg/kg/hour across a single three hour session |
| Schedule | Three loading infusions one week apart, then repeat every 3 to 10 months |
| Reported result | Median pain fell from 8 to 5 by month three and held at 5 through month 24 |
| The catch | No control arm. Medications changed across the follow up period for most patients |
What the Clinic Actually Ran
The study comes from Leonardo Kapural and colleagues at Carolinas Pain Institute. The team pulled records for every fibromyalgia patient treated between January 2018 and December 2024. All 92 were women, aged 24 to 78, with a median age of 49. On average each carried two additional chronic pain diagnoses.
Every patient got the same regimen. Ketamine ran at roughly 1.5 mg/kg per hour over three hours. That is a total of 300 to 500 mg in one sitting.
That is a large single session dose by any standard. It is delivered under monitored sedation, not in a recliner with a blood pressure cuff.
The Sedation Setup Is the Real Barrier
This protocol requires an anesthesia footprint. Patients received 3 to 6 mg of midazolam before the infusion, specifically to blunt hallucinations.
Ondansetron and promethazine went into the saline bag alongside the ketamine to head off nausea. An attending anesthesiologist observed directly, with automated blood pressure monitoring and pulse oximetry running throughout.
Every patient had to bring a family member or friend. That person stayed for the full session and drove them home.
Most infusion practices are not built for this. It is closer to a procedure suite than a mental health chair.
The Cadence Is Unusual
Patients started with three loading infusions spaced no more than a week apart. After that, they returned only when pain crept back.
The gap ran 3 to 10 months, with a median of six. Individual patients received anywhere from 1 to 32 infusions over the study window.
Compare that to a common US cash pay model. Six infusions in two or three weeks, then boosters every four to eight weeks. Winston-Salem ran high dose, low frequency. Two visits a year for most patients.
That is a different revenue model entirely. Fewer appointments, far higher cost per appointment, and a maintenance relationship measured in years rather than months.
What They Found Over 24 Months
Median baseline pain was 8 out of 10. It dropped to 5 at the three month follow up and stayed at 5 through the full two years.
At three months, 32 of 92 patients reported more than 50 percent pain relief. At 24 months, 30 of 92 still did.
The authors report additional 24 month figures in their discussion. Fifty eight percent held more than 30 percent relief. Seventy five percent achieved at least a two point drop, the threshold generally treated as clinically meaningful.
Nineteen patients reported minimal or no benefit at all. That is roughly one in five who did not respond.
The Opioid Number Is Modest
Thirty three patients were taking opioids at baseline, at a median of 30 morphine milligram equivalents daily.
By 24 months, 27 were still on opioids. The median daily dose had not moved.
Six patients off opioids across two years is a real result. It is also a small one, and worth quoting accurately rather than rounding up. Anyone marketing this protocol as opioid sparing is getting ahead of the data.
Side Effects and What the Team Changed
Nineteen patients experienced infusion related side effects. Nausea accounted for 12, hallucinations for 10, vomiting for 3, with single cases of confusion and post infusion nightmares.
No serious adverse events occurred. The authors specifically note the absence of liver injury and cystitis, both documented risks with prolonged continuous ketamine dosing.
One practice note is buried in the limitations. The team saw more hallucinations at the 500 mg end of the range. They concluded 300 mg delivered comparable duration of relief with fewer. Recent infusions there run 300 to 350 mg adjusted for weight.
That is a dosing lesson worth more than most of the outcome data.
What This Study Cannot Tell You
It is a single arm retrospective chart review. There is no control group, so placebo response and natural symptom fluctuation cannot be ruled out.
Medication changes complicate everything. Across the 24 months, most of the 92 patients switched membrane stabilizers, antidepressants, muscle relaxants, opioids, or anti inflammatories. Three received joint injections during the loading phase.
Ketamine was an adjunct here, not a monotherapy. The authors say plainly that a large randomized prospective study is warranted. They report no conflicts of interest and no industry funding.
Read It Alongside the Toronto Trial
Two ketamine pain studies published within a week of each other took opposite approaches to durability.
Winston-Salem answers it with more medicine, indefinitely. The Toronto team answers it with less medicine paired to structured therapy. We covered their three infusion protocol.
They are not competing results. Different conditions, different doses, different outcome measures, different timelines. Toronto excluded fibromyalgia patients outright.
What both papers establish is that the field now has documented alternatives to the standard six infusion schedule. For background on the earlier fibromyalgia evidence, see our review of ketamine research in fibromyalgia.
The Bottom Line
This is the largest long term data set published on repeated ketamine infusions for fibromyalgia. That matters in a literature where prior studies enrolled 11 to 34 people.
It is not evidence that high dose beats low dose. It is evidence that a twice yearly high dose model held pain scores steady for two years in a real clinic. The side effect profile was manageable.
Patients looking for supervised care can start with our directory of verified ketamine clinics.
This article is for informational purposes and is not medical advice. Ketamine for fibromyalgia is an off label use. Discuss treatment options with a qualified clinician.
