Ketamine Infusion for CRPS in Personal Injury Cases: Attorney Guide

Amar Lunagaria — Co-Founder & Chief Pharmacist, LienScripts | January 17, 2026 | 9 min read

Complex Regional Pain Syndrome (CRPS) is one of the most debilitating sequelae of traumatic injury — and ketamine infusion is an evidence-supported treatment. Understanding ketamine in the PI context helps attorneys document and present CRPS cases effectively.

CRPS in Personal Injury: The High-Stakes Pain Condition

Complex Regional Pain Syndrome (CRPS) — formerly called Reflex Sympathetic Dystrophy (RSD) — is one of the most severe and difficult-to-treat pain conditions that can follow a traumatic injury. The International Association for the Study of Pain rates CRPS as producing some of the highest pain scores ever recorded on standardized scales.

In personal injury cases, CRPS typically develops after:

• Fractures (particularly wrist/Colles' fractures)
• Crush injuries
• Soft tissue injuries with nerve involvement
• Post-surgical complications
• Repetitive motion injuries with nerve sensitization

CRPS is characterized by:

• Burning, severe, often disproportionate pain in an extremity
• Skin color and temperature changes (hyperthermia or hypothermia)
• Abnormal sweating
• Swelling and skin texture changes
• Extreme sensitivity to touch (allodynia — pain from light contact)
• Motor dysfunction (tremor, weakness, limited range of motion)

For PI attorneys, a CRPS diagnosis in the medical record dramatically increases case value — both because of the documented severity and because of the long-term, high-cost treatment the condition requires. Ketamine is a significant component of that treatment picture.

[!KEY] CRPS/RSD is a recognized medical diagnosis with established diagnostic criteria (Budapest Criteria). A client who develops CRPS after a traumatic injury has an objective, physician-diagnosed condition — not a subjective complaint. The ketamine infusion record, together with pain management records, provides concrete economic damages documentation for what is often a seven-figure PI case.

What Is Ketamine and How Does It Treat CRPS?

Ketamine is an NMDA receptor antagonist — it blocks N-methyl-D-aspartate receptors in the central nervous system. These receptors are central to the process of central sensitization: the abnormal "rewiring" of pain pathways in the brain and spinal cord that underlies chronic pain conditions like CRPS.

According to FDA prescribing information, ketamine is FDA-approved as an anesthetic. Its use for CRPS pain management is off-label — but supported by a growing body of clinical evidence and widely practiced in pain management and anesthesiology.

How ketamine is used for CRPS:

IV Ketamine Infusions (Inpatient/Outpatient Infusion Centers): Low-dose ketamine infusions (subanesthetic doses — typically 0.5 mg/kg over 40–60 minutes) are administered in supervised settings (infusion centers, hospital anesthesia departments). A typical course may involve 4–6 infusions over consecutive days.

Ketamine infusions for CRPS are expensive — often $500–$2,000 per infusion session. A full course may cost several thousand dollars. When covered through a pharmacy lien program (or when the infusion center operates on a lien basis), these costs are deferred to settlement.

Oral/Sublingual Ketamine (Off-Label Compounded Formulations): Some pain management physicians prescribe compounded oral or sublingual ketamine for ongoing CRPS management between infusion courses. This lower-dose, at-home formulation can be dispensed through a pharmacy lien program.

Topical Ketamine Compounded Creams: Compounded ketamine cream applied to affected extremities is used for localized CRPS pain. These compounded preparations are a pharmacy lien item.

CRPS Treatment Regimen and the Pharmacy Record

A PI client with CRPS typically has a complex, multi-drug medication profile:

For the pain itself:

• Ketamine (infusions and/or compounded oral/topical)
• Gabapentin or pregabalin (neuropathic pain)
• Tricyclic antidepressants (amitriptyline, nortriptyline) at pain doses
• Topical agents (lidocaine patches, compounded ketamine cream)
• Low-dose naltrexone (LDN) — emerging evidence for central sensitization

For accompanying sympathetic dysfunction:

• Alpha-1 blockers (phenoxybenzamine) — to address sympathetically mediated components
• Bisphosphonates (in some cases) — for bone changes in CRPS

For sleep disruption and psychological sequelae:

• Sleep medications (trazodone, zolpidem)
• Antidepressants (duloxetine, SSRIs)

For inflammatory components:

• Corticosteroid courses (early CRPS with inflammatory features)

This multi-drug, chronic regimen creates an extensive pharmacy record — each medication serving a documented clinical purpose, each fill evidencing ongoing treatment necessity.

Using Ketamine Treatment in the PI Demand

Economic damages: Ketamine infusion courses are high-value economic damage line items. A series of 5 infusions at an infusion center represents significant documented medical cost. Compounded oral or topical ketamine fills further add to the economic record.

Non-economic damages: CRPS is so severe that it is often cited in PI demands with reference to the McGill Pain Index rankings. The documented treatment course — IV infusions in medical settings, ongoing medication management, functional limitations — creates a narrative of severe, disabling, long-term pain that supports substantial non-economic damages.

Causation: CRPS is an objective diagnosis made by specialists using the Budapest Criteria. The physician's diagnosis, confirmed by a pain management specialist or neurologist, is the anchor. The pharmacy record corroborates the diagnosis by showing the medical treatment the physician prescribed in response to it.

[!KEY] No physician prescribes expensive IV ketamine infusions to a patient without genuine refractory pain — the infusion record is itself evidence of clinical severity that no defense IME can easily dismiss.

[!KEY] The CRPS medication profile — gabapentin, ketamine, low-dose naltrexone, tricyclic antidepressants, bladder agents — creates an extensive pharmacy record where each medication serves a documented clinical purpose, making the aggregate medication cost an objective and defensible damages component.

[!WARNING] Defense counsel in CRPS cases frequently retain IME physicians who dispute the diagnosis (characterizing it as "psychosomatic" or "inconsistent with the objective findings"). Prepare responses based on Budapest Criteria documentation and the treating physician's clinical observations over multiple visits. The ketamine infusion record is particularly powerful because no physician would prescribe expensive IV ketamine to a patient without genuine refractory pain.

Pharmacy Lien Coverage for Ketamine

IV ketamine infusions are typically billed as a medical procedure (infusion center fee) rather than as a pharmacy dispensing. Whether they are covered under a pharmacy lien or a medical lien depends on how the infusion center is structured.

Compounded oral and topical ketamine dispensed by a compounding pharmacy is a pharmacy lien item. LienScripts covers compounded medications prescribed by treating physicians for accident-related conditions.

For the demand package, ensure documentation of:

• The prescribing physician's order for ketamine (establishing medical necessity)
• The infusion center's records (if IV infusions occurred)
• Compounding pharmacy dispense records (through POGOS)
• The clinical rationale — typically a pain management specialist's note documenting refractory CRPS

Related Resources

• CRPS/RSD Medication Protocol and Pharmacy Liens
• Non-Opioid Pain Management in 2025
• Compound Medications in Personal Injury
• Central Sensitization and PI Pain Science
• Low-Dose Naltrexone for Chronic Pain

[!SOURCE] FDA Prescribing Information: Ketamine Hydrochloride Injection — FDA label for ketamine, including approved indications and pharmacology relevant to its off-label use in pain management.

[!SOURCE] Harden RN et al., "Validation of Proposed Diagnostic Criteria (the 'Budapest Criteria') for Complex Regional Pain Syndrome," Pain, 2010 — Validation study for the Budapest Criteria — the current standard for CRPS diagnosis, widely cited in PI demands and expert testimony.