Fibromyalgia affects an estimated 4 million adults in the United States, and yet patients with this diagnosis routinely face a healthcare system that struggles to take their pain seriously. The condition was long dismissed as psychosomatic — “all in your head” — but decades of neuroimaging research have established that fibromyalgia involves measurable central nervous system dysfunction, specifically an amplification of pain signals at the spinal cord and brain level that has nothing to do with imagined symptoms. At Nova Health Recovery in Alexandria, Virginia, we approach fibromyalgia as the neurobiologically real condition it is, and IV ketamine therapy is one of the tools we use to address the underlying mechanism driving persistent pain.
The Neurobiological Basis: Central Sensitization
The defining feature of fibromyalgia at the neurobiological level is central sensitization — a state in which the pain-processing circuits of the central nervous system become chronically overactive and hypersensitive. Under normal circumstances, pain signals from peripheral tissues travel through the spinal cord to the brain, are appraised, and diminish when the underlying cause resolves. In fibromyalgia, this system is dysregulated. The spinal cord becomes hyperresponsive, amplifying incoming signals that would be unremarkable in a healthy nervous system, and the descending pain-modulation pathways that the brain uses to dampen those signals become less effective. The result is widespread, persistent pain that does not correspond to tissue damage and does not resolve with treatments aimed at peripheral tissues.
NMDA receptors — a type of glutamate receptor — are central players in central sensitization. When these receptors are persistently activated, they lower the threshold at which neurons fire in response to incoming signals, effectively turning up the volume on pain throughout the central nervous system. Ketamine is a potent NMDA receptor antagonist, meaning it blocks this receptor and may interrupt the amplification cycle. This is the pharmacological rationale for ketamine’s use in fibromyalgia, and it is fundamentally different from the mechanism of drugs like gabapentin, duloxetine, or milnacipran — the FDA-approved medications for fibromyalgia — which act on different targets with different efficacy profiles.
Treatment at Nova Health Recovery
At Nova Health Recovery, IV ketamine for fibromyalgia is administered under the direct supervision of Dr. Christopher Sendi. Dr. Sendi holds board certifications in pain management in addition to psychiatry, internal medicine, and emergency medicine — an unusually broad clinical background that allows him to evaluate fibromyalgia patients comprehensively, including the frequent comorbidities of depression, anxiety, and sleep disturbance that accompany the condition in many patients. Treatment protocols are individualized, and the dose and duration appropriate for fibromyalgia differ from those used for depression. We do not apply a one-size-fits-all approach to pain indications.
The evidence base for ketamine in fibromyalgia includes both controlled trials and observational studies. Results vary across the literature, with some studies reporting meaningful reductions in pain intensity and improved functional capacity, and others showing more modest effects. The honest truth is that ketamine is more strongly evidenced for some pain conditions — such as CRPS — than for fibromyalgia specifically. We tell patients this during consultations. We do not overstate the evidence, and we do not understate the potential benefit. What we can say with confidence is that for patients who have tried standard pharmacological approaches for fibromyalgia and found inadequate relief, IV ketamine represents a mechanistically distinct option worth evaluating.
One barrier we address frequently is the experience many fibromyalgia patients have had of being dismissed by prior healthcare providers — of being told their pain is exaggerated or that there is nothing more to offer. This history understandably creates hesitation about engaging with a new treatment. We want to be clear: at Nova Health Recovery, we take fibromyalgia seriously as a neurobiological condition. The intake evaluation is thorough, the clinical conversation is respectful of your experience and your history, and the treatment plan is developed collaboratively. We also recognize that some patients with fibromyalgia carry significant emotional weight from years of inadequate care, and our interest in addressing barriers extends beyond the pharmacological.
A second practical barrier is the concern about how to fit a series of infusions into daily life when fibromyalgia already makes daily life difficult. Pain variability, fatigue, and unpredictable symptom flares can make scheduling and attending appointments a challenge. We offer telemedicine follow-up, Dr. Sendi is available outside standard business hours, and we work with patients to design a treatment timeline that accommodates the real-world constraints of living with a chronic pain condition. Results vary by individual, and we discuss realistic expectations candidly throughout the process.
Frequently Asked Questions
Is ketamine approved for fibromyalgia?
No. Ketamine used for fibromyalgia is off-label. The FDA-approved medications for fibromyalgia are duloxetine, milnacipran, and pregabalin. Ketamine is a separate option that targets a different neurobiological mechanism and is prescribed at physician discretion for patients who have not responded adequately to approved treatments.
How does ketamine differ from the standard fibromyalgia medications?
FDA-approved fibromyalgia medications generally target serotonin, norepinephrine, or calcium channel signaling. Ketamine acts through the glutamate/NMDA receptor system, addressing central sensitization through a different pathway. This is why ketamine may offer benefit for patients who have not responded to standard medications.
Will I need multiple infusions for fibromyalgia?
Most fibromyalgia protocols involve a series of infusions rather than a single session. The number depends on your clinical profile and response. Maintenance infusions may be needed to sustain benefit. We discuss the full protocol during your consultation.
Can ketamine help with the depression and anxiety that often accompany fibromyalgia?
Yes. Ketamine is also used off-label for depression and anxiety, and many fibromyalgia patients with co-occurring mood symptoms find that ketamine therapy addresses both dimensions simultaneously. This is one reason Dr. Sendi’s dual training in pain management and psychiatry is particularly relevant.
What should I expect during a ketamine infusion for fibromyalgia?
You will be in a reclining chair or treatment bed in a quiet room, with vital signs monitored throughout. The infusion typically lasts 40 minutes to over an hour depending on the protocol. Most patients experience a mild dissociative state that resolves within 30 to 60 minutes after the infusion ends.
Key Takeaways
- Fibromyalgia involves central sensitization — an amplification of pain signals driven partly by NMDA receptor overactivity — which ketamine may interrupt through a mechanism distinct from FDA-approved fibromyalgia medications.
- IV ketamine for fibromyalgia is off-label; Nova Health Recovery protocols are supervised by Dr. Christopher Sendi, board-certified in pain management and psychiatry.
- Clinical evidence supports potential benefit for some fibromyalgia patients, particularly those who have not responded to standard pharmacological approaches; results vary by individual.
- Many fibromyalgia patients have co-occurring depression and anxiety that ketamine may address simultaneously.
- Discuss with your provider whether IV ketamine is an appropriate addition to your fibromyalgia treatment plan.
Conclusion
Fibromyalgia does not yield easily to simple solutions, and we do not pretend otherwise. What we offer at Nova Health Recovery is a serious, evidence-informed evaluation of whether IV ketamine therapy may help address the neurobiological processes driving your pain — delivered by a physician with the clinical depth to treat both the pain and the mood conditions that so often accompany it. If you are in Alexandria or the greater Northern Virginia area and you have been living with fibromyalgia that standard treatments have not adequately controlled, we encourage you to schedule a consultation and discuss your options with a provider who can give you a real answer.
About Dr. Christopher Sendi
Dr. Christopher Sendi, MD is a board-certified psychiatrist with over 25 years of experience in addiction treatment, depression therapies, and IV ketamine for pain and mood disorders. He is board certified in addiction medicine, obesity medicine, internal medicine, emergency medicine, and pain management. Dr. Sendi graduated from Georgetown University Medical School (MD, 1992) and has special interests in the application of ketamine infusions for the treatment of depression, PTSD, anxiety, pain, CRPS, Lyme disease, and neuropathies. He leads Nova Health Recovery in Alexandria, Virginia, offering IV ketamine, ketamine-assisted psychotherapy (KAP), at-home oral ketamine lozenges, ketamine nasal spray, and Spravato, as well as IV NAD+, IV vitamin therapy, and integrated addiction medicine services. Dr. Sendi provides telemedicine follow-up and is available outside standard business hours to accommodate patients’ schedules.
References
National Fibromyalgia Association — https://www.fmaware.org
Centers for Disease Control and Prevention, Fibromyalgia — https://www.cdc.gov/arthritis/types/fibromyalgia.htm
American College of Rheumatology, Fibromyalgia — https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia
National Institutes of Health, Central Sensitization and Fibromyalgia — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849041/
Medical Disclaimer
The information in this article is provided for educational purposes only and does not constitute medical advice. IV ketamine for fibromyalgia at Nova Health Recovery is supervised by a licensed physician; however, individual results vary and this content should not be interpreted as a guarantee of any outcome. Ketamine for fibromyalgia is off-label. Please consult a qualified healthcare provider to determine whether ketamine therapy is appropriate for your specific circumstances.