Lidocaine and ketamine infusions may be considered for selected patients with refractory neuropathic, centralized, CRPS-related, pelvic, or complex chronic pain.
Learn how Dr. Aranguren uses lidocaine and ketamine infusions to help manage chronic pain by calming the nervous system and supporting long-term symptom relief.
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If you’ve been dealing with chronic pain that feels widespread, constant, burning, or difficult to control, sometimes the issue is not just the original injury — it’s that the nervous system itself has become stuck in an amplified pain state. That’s where treatments like lidocaine and ketamine infusions may help.
These infusions work by calming overactive pain signaling within the nervous system. They’re often used for conditions involving nerve pain, central sensitization, CRPS, chronic migraine, fibromyalgia-type symptoms, and other difficult-to-treat pain conditions.
Some patients also experience overlap between chronic pain, anxiety, PTSD, or autonomic dysfunction, and part of the goal is helping reduce the nervous system’s constant “high alert” response. Lidocaine works by helping stabilize irritated nerves and decrease abnormal pain firing. Ketamine works on specific receptors in the brain and nervous system that are involved in pain processing and sensitization.
The infusions are given through an IV in a closely monitored setting, and treatment plans are individualized depending on the patient’s symptoms and goals. My approach is always to understand both the pain itself and the nervous system patterns keeping the body stuck in that cycle.
These treatments are not about masking symptoms temporarily. The goal is to create enough nervous system calming that patients can start moving, functioning, sleeping, and healing more effectively again. If you feel like your pain has become constant, overwhelming, or resistant to standard treatments, lidocaine or ketamine infusions may be worth discussing as part of a broader, coordinated treatment plan.
Lidocaine and ketamine infusions are medically supervised IV treatments that may be considered for selected patients with refractory neuropathic, centralized, CRPS-related, pelvic, post-viral, or complex chronic pain. These infusions are not wellness IVs and are not first-line treatments. They require careful diagnosis, safety screening, medication review, monitoring, and realistic expectations.
At Manhattan Pain Medicine, lidocaine and ketamine infusions are considered only when the patient’s symptoms, medical history, prior treatment response, and care goals suggest that infusion therapy may have a role. The goal is to determine whether lidocaine, ketamine, or another treatment pathway is clinically appropriate.
MPM specialists evaluate whether lidocaine or ketamine infusions may be appropriate by first clarifying the patient’s pain diagnosis, symptom pattern, medical history, medication use, psychological context, autonomic symptoms, and prior treatment response. A patient with CRPS may require a different infusion strategy than a patient with small fiber neuropathy, chronic pelvic nerve pain, fibromyalgia, migraine overlap, post-COVID pain, or Medical PTSD.
Infusion therapy may require cardiac screening, lab review, medication clearance, mental health safety review, vital sign monitoring, and coordination with neurology, rheumatology, pelvic specialists, psychiatry, or primary care when appropriate.
Patients often search for lidocaine and ketamine infusions in NYC after standard treatments have not provided enough relief. Many have tried medication management, injections, physical therapy, pelvic floor therapy, pain psychology, biofeedback, acupuncture, or specialist care. Some are dealing with burning nerve pain, allodynia, CRPS, small fiber neuropathy, post-viral pain, chronic pelvic pain, fibromyalgia, autonomic symptoms, or complex multi-system symptoms.
MPM approaches infusion therapy as an advanced pain-modulating option for selected patients, not as a general pain treatment. Lidocaine and ketamine work differently, carry different risks, and require different safety considerations. Ketamine may affect pain signaling and can involve sedation, dissociation, mood effects, and blood pressure or heart rate changes. Lidocaine may affect nerve signaling and requires careful cardiac and neurologic monitoring. The right option depends on diagnosis, safety, treatment goals, and clinical judgment.
Lidocaine and ketamine infusions intersect with several MPM Zones of Expertise, including Complex Chronic Pain, Autonomic Dysfunction, Psychology of Pain, Headache, and Pelvic Pain. For complex chronic pain, infusion therapy may be considered when symptoms remain severe despite standard treatment. For autonomic dysfunction or post-viral pain, safety screening and monitoring are especially important. For Psychology of Pain, preparation may need to account for trauma, dissociation, anxiety, or prior difficult medical experiences.
For headache and migraine overlap, infusion therapy may require careful distinction from headache-specific treatments. For pelvic pain, pudendal neuralgia, pelvic dystonia, PGAD, or pelvic floor dysfunction, infusions may be considered only when the broader pain pattern supports this approach. MPM’s role is to determine whether infusion therapy fits safely into the patient’s diagnosis-first care plan.
Before an infusion, MPM reviews the treatment plan, preparation instructions, medications, safety considerations, monitoring needs, and post-infusion expectations. Depending on the infusion type, patients may need cardiac review, lab work, medication adjustments, transportation planning, or coordination with another clinician. During the visit, medication is delivered through an IV while the care team monitors the patient’s response.
The experience differs by medication. Lidocaine infusions may require monitoring for dizziness, numbness, metallic taste, ringing in the ears, neurologic symptoms, or cardiac concerns. Ketamine infusions may involve sedation, dissociation, mood changes, nausea, anxiety, blood pressure changes, or heart rate changes. After treatment, patients may need observation before leaving. Follow-up helps determine whether the infusion provided meaningful benefit and whether the plan should continue, change, or stop.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Lidocaine and ketamine infusions are medically supervised IV treatments that may be considered for selected patients with refractory neuropathic, centralized, CRPS-related, pelvic, post-viral, or complex chronic pain. They are not wellness IVs and are not appropriate for every pain condition. Lidocaine and ketamine are different medications with different mechanisms, risks, and monitoring requirements. MPM evaluates the patient’s diagnosis, medical history, medication use, safety profile, prior treatments, and care goals before deciding whether infusion therapy may be appropriate.
Lidocaine infusions may help selected pain conditions by temporarily affecting nerve signaling and pain transmission. They have been studied in some neuropathic pain contexts, including burning nerve pain and refractory nerve-related symptoms. The response can vary, and benefit may be temporary. Lidocaine infusions require careful safety review because lidocaine can affect the nervous system and heart rhythm at certain levels. MPM considers cardiac risk, neurologic history, medications, diagnosis, and monitoring needs before recommending IV lidocaine infusion NYC care.
Ketamine infusions may help selected chronic pain patterns by affecting pain signaling pathways, including NMDA receptor-related mechanisms involved in central sensitization and some refractory pain states. Ketamine has been studied for conditions such as CRPS and other complex pain patterns, but response varies and long-term benefit is not guaranteed. Ketamine infusion for chronic pain NYC care requires medical supervision, psychological safety review, vital sign monitoring, and careful discussion of risks, benefits, alternatives, and expectations.
Lidocaine and ketamine are different medications. Lidocaine is an anesthetic medication that may influence nerve signaling and neuropathic pain in selected cases. Ketamine affects NMDA receptor-related pain pathways and may be considered for certain refractory or centralized pain patterns. Their side effects and monitoring needs are different. Lidocaine may involve cardiac or neurologic risks. Ketamine may involve sedation, dissociation, mood effects, nausea, and blood pressure or heart rate changes. MPM determines which, if either, fits the patient’s diagnosis and safety profile.
Lidocaine infusions may help selected patients with neuropathic pain, including some patients with burning pain, nerve sensitivity, small fiber neuropathy symptoms, or refractory nerve-related pain. They do not cure neuropathy and are not appropriate for every nerve pain condition. MPM evaluates the likely nerve pain source, prior treatments, medication history, cardiac risk, neurologic risk, and monitoring needs before considering lidocaine infusion for neuropathic pain NYC care. Additional evaluation or specialist coordination may still be needed.
Ketamine infusions may be considered for selected patients with complex regional pain syndrome when symptoms remain severe despite standard treatments. Some studies suggest benefit for certain CRPS patients, but response varies, treatment is not curative, and durability is not guaranteed. Ketamine infusion for CRPS NYC care requires careful safety screening, monitoring, and coordination with the broader treatment plan. MPM may also consider rehabilitation, pain psychology, sympathetic blocks, medication management, and functional restoration as part of CRPS care.
Infusions may be considered for selected patients with small fiber neuropathy symptoms or burning nerve pain, especially when standard medications have not worked or caused side effects. Lidocaine may be considered in certain neuropathic pain contexts, and ketamine may be considered in selected refractory pain patterns. These infusions do not cure small fiber neuropathy or replace evaluation for underlying causes. MPM considers diagnosis, autonomic symptoms, medication history, safety factors, and specialist input when appropriate.
Infusions may be considered for selected patients with fibromyalgia or centralized pain patterns, but they are not first-line treatments and do not cure these conditions. Patients with centralized pain often need a coordinated plan that may include pain psychology, biofeedback, pacing, sleep support, movement-based care, medication management, and evaluation for overlapping medical contributors. MPM considers infusion therapy only when the clinical picture, prior treatment response, safety profile, and care goals support a medically supervised trial.
Infusions may be considered for selected chronic pelvic pain patterns, especially when symptoms suggest neuropathic, centralized, CRPS-like, or refractory pain mechanisms. This may include some patients with pudendal neuralgia, pelvic nerve pain, pelvic dystonia, PGAD, endometriosis-related pain overlap, or pelvic floor dysfunction. Infusions do not replace pelvic specialty care, pelvic floor therapy, gynecology, urology, pain psychology, or nerve-targeted evaluation when needed. MPM evaluates the full pelvic pain pattern before considering infusion therapy.
Infusions may be considered in selected headache or migraine contexts, but the appropriate approach depends on the diagnosis. Chronic migraine, cluster headache, hemicrania, tension headache, and trigeminal autonomic cephalalgias require careful headache classification. Lidocaine or ketamine-based infusions may not be appropriate for every headache pattern. MPM evaluates headache diagnosis, neurological symptoms, prior treatments, medication use, red flags, and whether headache-specific care, nerve blocks, medication management, or other treatments may be more appropriate.
MPM considers the patient’s diagnosis, pain mechanism, severity, prior treatments, medication history, medical risks, psychological safety, autonomic symptoms, cardiac history, neurologic history, liver function concerns, substance use considerations, pregnancy or breastfeeding considerations, and care goals. The team also reviews whether infusion therapy should be coordinated with pain psychology, biofeedback, procedures, neurology, rheumatology, pelvic specialty care, or primary care. Candidacy is individualized and requires a medically supervised plan.
Monitoring depends on the medication and patient risk profile. Lidocaine infusions may require cardiac and neurologic monitoring, observation for dizziness, numbness, metallic taste, ringing in the ears, confusion, seizure risk, arrhythmia, or toxicity symptoms. Ketamine infusions may require monitoring for sedation, dissociation, mood changes, anxiety, nausea, blood pressure changes, heart rate changes, and recovery before discharge. MPM determines monitoring needs before treatment and may recommend additional clearance or testing when appropriate.
The length of an infusion depends on the medication, protocol, dose, monitoring requirements, and patient response. The full visit may include preparation, IV placement, baseline assessment, medication administration, monitoring during treatment, and recovery time afterward. Some patients may need transportation planning, medication adjustments, or post-infusion observation. MPM reviews expected timing and preparation instructions before treatment based on the specific infusion being considered.
Repeat timing depends on the diagnosis, infusion type, response, side effects, and medical judgment. Infusions should not be repeated automatically. MPM evaluates whether the patient had meaningful benefit, how long any benefit lasted, whether side effects occurred, and whether the broader care plan should change. Some patients may not benefit enough to continue. Others may need coordinated treatment that includes rehabilitation, medication management, pain psychology, procedures, or specialist care.
Lidocaine risks may include dizziness, numbness, metallic taste, ringing in the ears, confusion, seizure, arrhythmia, cardiac effects, neurologic symptoms, or toxicity. Ketamine risks may include sedation, dissociation, hallucinations, nausea, blood pressure or heart rate changes, mood changes, anxiety, urinary symptoms, liver considerations, medication interactions, and psychological safety concerns. Both treatments can involve allergic reactions or other medical complications. MPM reviews risks, contraindications, monitoring needs, and alternatives before recommending infusion therapy.
Infusion therapy may need to be avoided or delayed with significant cardiac disease, uncontrolled hypertension, seizure history, severe liver disease, active psychosis, severe uncontrolled psychiatric instability, substance use concerns, pregnancy or breastfeeding considerations, medication interactions, unstable medical conditions, or unclear diagnosis. Urgent evaluation is needed for chest pain, trouble breathing, fainting, severe confusion, severe agitation, suicidal thoughts, new neurological deficits, seizure, severe allergic reaction, fever, severe abdominal or pelvic pain, bowel or bladder dysfunction, rapidly worsening weakness, or rapidly worsening symptoms.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Lidocaine and ketamine infusions are medically supervised IV treatments that may be considered for selected patients with refractory neuropathic, centralized, CRPS-related, pelvic, post-viral, or complex chronic pain. These treatments are not wellness IVs. They are not first-line treatments and are not appropriate for every pain condition.
At Manhattan Pain Medicine (MPM), lidocaine and ketamine infusions NYC care begins with diagnosis-first evaluation. The goal is to understand the patient’s pain mechanism, prior treatment response, medical safety profile, psychological context, autonomic symptoms, and treatment goals before deciding whether infusion therapy belongs in the care plan.
Lidocaine and ketamine are different medications with different purposes and risks. Lidocaine is an anesthetic medication that may influence nerve signaling and has been studied for selected neuropathic pain conditions. It may be considered for certain patients with burning nerve pain, small fiber neuropathy symptoms, refractory neuropathic pain, or nerve-related pain patterns when safety factors support treatment.
Ketamine affects NMDA receptor-related pain signaling and may be considered in selected complex chronic pain or CRPS-related pain patterns. It may be relevant when central sensitization, severe pain amplification, allodynia, or refractory pain mechanisms are part of the clinical picture. Response varies, and long-term benefit is not guaranteed.
Patients seeking infusion therapy for refractory neuropathic pain often have symptoms such as burning, electric pain, severe sensitivity, allodynia, numbness, tingling, or persistent pain despite nerve medications. Conditions may include small fiber neuropathy, CRPS, post-viral pain, pelvic nerve pain, or complex neurological pain patterns.
Ketamine infusion for complex regional pain syndrome NYC care may be considered for selected patients, but it should be integrated with the rest of CRPS treatment. This may include rehabilitation, pain psychology, medication management, sympathetic blocks, functional restoration, and specialist coordination. Infusions do not cure CRPS, but they may help some patients reduce symptom burden enough to participate more effectively in care.
Some patients with chronic pelvic pain, pudendal neuralgia, pelvic dystonia, PGAD, pelvic floor dysfunction, endometriosis-related pain overlap, or pelvic nerve pain may ask whether infusions can help. MPM evaluates whether the pain pattern appears neuropathic, centralized, refractory, or CRPS-like before considering infusion therapy. Pelvic pain often requires coordinated care, including pelvic floor therapy, gynecology, urology, pain psychology, nerve-targeted procedures, or other specialty evaluation.
Patients with fibromyalgia, post-COVID pain, EBV-related pain, Medical PTSD, autonomic symptoms, mast cell activation concerns, gastroparesis, or POTS-like symptoms may need even more careful screening. These conditions can affect medication tolerance, monitoring needs, psychological safety, and recovery planning.
Lidocaine infusions may involve cardiac and neurologic risks, including dizziness, numbness, metallic taste, ringing in the ears, confusion, seizure, arrhythmia, or toxicity. Ketamine infusions may involve sedation, dissociation, hallucinations, nausea, blood pressure or heart rate changes, mood changes, anxiety, urinary symptoms, liver considerations, medication interactions, and psychological safety concerns.
MPM uses caution in patients with significant cardiac disease, uncontrolled hypertension, seizure history, severe liver disease, active psychosis, severe uncontrolled psychiatric instability, substance use concerns, pregnancy or breastfeeding considerations, medication interactions, or unstable medical conditions. Patients may need medication review, lab work, cardiac screening, mental health safety review, medical clearance, or coordination with other clinicians before treatment.
Infusion therapy works best when it is connected to the rest of the pain plan. A patient may also need medication management, pain psychology, biofeedback, acupuncture, procedures, sympathetic blocks, pelvic specialty care, neurology, rheumatology, or rehabilitation. MPM monitors whether the infusion changes pain intensity, function, flare patterns, mood, autonomic symptoms, or treatment tolerance.
If an infusion helps, future treatment may be considered at clinically appropriate intervals. If it does not help, or if side effects are significant, MPM may recommend a different pathway. The goal is not to continue infusions automatically, but to use response data to guide care.
Patients should seek urgent evaluation for chest pain, trouble breathing, fainting, severe confusion, severe agitation, suicidal thoughts, new neurological deficits, seizure, severe allergic reaction, fever, severe abdominal or pelvic pain, bowel or bladder dysfunction, rapidly worsening weakness, or rapidly worsening symptoms.
For selected patients, lidocaine and ketamine infusions may be meaningful advanced tools in complex pain care. MPM’s role is to determine whether the diagnosis, safety profile, monitoring needs, and treatment goals support their use within a coordinated, medically supervised plan.
