Ketamine therapy referrals are most helpful when they are grounded in a clear clinical picture: prior treatment history, current symptoms, safety considerations, and goals for care. This provider guide outlines when referral may make sense, what information supports a better consult, and how coordinated care can help patients explore ketamine therapy responsibly.

Anesthesiology increasingly contributes to the care of complex pain and treatment-resistant mental health conditions by applying expertise in neurophysiology, pharmacology, and systems-level monitoring. This role extends beyond procedural care into multidisciplinary, longitudinal treatment models that address central nervous system dysregulation.¹

Traditionally, anesthesiology has focused on acute, time-limited interventions: perioperative anesthesia, procedural sedation, and critical care. Over the last decade, however, the specialty’s scope has expanded as neuroscience has clarified the shared mechanisms underlying chronic pain and certain psychiatric conditions.

This evolution reflects a broader shift in medicine away from siloed diagnoses and toward mechanism-informed care.

One of the most clinically interesting shifts in the last decade is not just that ketamine can help certain patients with treatment-resistant depression. It is that the same medication has a history in anesthesiology and pain medicine, and it continues to be studied and used across both pain and mood contexts, with overlapping questions about mechanisms, patient selection, and safe implementation.¹⁻⁴

At the same time, it is exactly this “promise + complexity” combination that makes standards and restraint important. This is not casual medicine.

When providers refer a patient for ketamine therapy, they are not trying to create a second care plan. They are trying to add a targeted intervention that supports the work already in motion, with clear guardrails and clear communication.

At Vitalitas Denver, our job after a referral is to make the handoff clean, keep communication tight, and protect continuity so the patient experiences one coherent plan, not a reset button on their whole clinical story.

You are not imagining it: high-intensity clinical work can make it feel like the job is never done, the needs are never fully met, and the “right thing” keeps expanding.

As clinicians, if we are not careful, we start responding to that pressure in one of two ways:

• We overextend until we have nothing left.

• We detach to survive, and our standards quietly erode.

I think there is a third option. You can practice sustainable medicine by making your standards explicit, setting boundaries that protect them, and building systems that reduce your load.

When is ketamine considered for chronic pain?
Ketamine may be considered for chronic pain when standard, multimodal treatments have not provided adequate relief and when central sensitization is suspected to play a significant role. It is not a first-line therapy and is evaluated as part of a broader, physician-guided care plan.

Chronic pain is one of the most complex clinical challenges providers manage. While many patients improve with medications, physical therapy, interventional procedures, and behavioral support, others continue to experience persistent pain that interferes with function and quality of life.

For referring providers, understanding where ketamine fits, which patients may be appropriate, and how care is coordinated is essential to responsible referral and continuity of care.