Intranasal Ketamine for Fibromyalgia: A Case Report on Pain Relief and Restored Function

Case Diagnosis: A 66-year-old female with fibromyalgia, diagnosed at age 52, experienced significant pain relief and functional improvement with intranasal ketamine therapy after failing multiple conventional treatments.

Case Description or Program Description: The patient presented with a long-standing history of fibromyalgia, characterized by chronic widespread musculoskeletal pain, fatigue, and sleep disturbances. Despite trials of FDA-approved medications, physical therapy, and alternative treatments, her symptoms persisted, severely limiting daily activities. Seeking alternative pain management, she underwent a series of intranasal ketamine treatments (80-120 mg per session).

Setting: Hillside Health Family Medicine Clinic in St. George, UT.

Assessment/Results: Pain severity and functional impairment were tracked using the Fibromyalgia Impact Questionnaire (FIQ) and depression symptoms using the PHQ-9. Over 13 treatment sessions, the patient reported a substantial reduction in pain scores (from 41 to 12), improved sleep, and enhanced mobility. PHQ-9 scores also indicated alleviation of depressive symptoms decreasing from a high of 7 to a low of 2. The treatment was well-tolerated, with no significant adverse effects.

Discussion (relevance): Fibromyalgia is a complex pain syndrome with central sensitization as a key pathophysiological mechanism. Ketamine, an NMDA receptor antagonist, has shown promise in disrupting central pain pathways and alleviating chronic pain. While intravenous ketamine has been studied for fibromyalgia, intranasal administration offers a non-invasive, accessible alternative. This case supports the potential efficacy of intranasal ketamine in treatment-resistant fibromyalgia and highlights the need for further research to establish standardized protocols.

Conclusions: Intranasal ketamine provided significant pain relief and functional improvements in a patient with treatment-resistant fibromyalgia. This case underscores its potential role as a novel therapy and suggests the need for larger studies to confirm its efficacy and safety in fibromyalgia management.