Chronic pain affects more Americans than heart disease, diabetes, and cancer combined, yet access to specialized pain management in rural Montana — where patients may travel two or three hours each way for a single appointment — remains one of the most significant healthcare inequities in the state. For patients in the Livingston area and across the Yellowstone River valley who are managing fibromyalgia, neuropathic pain, or restless legs syndrome alongside the isolation of rural life, Cassidy Boyer, CRNA, offers IV ketamine therapy as a clinically grounded option for conditions where the standard pain management toolkit has run out of answers.
Understanding Central Sensitization and Ketamine’s Mechanism
The chronic pain conditions that Cassidy treats at Mend the Mind — fibromyalgia, neuropathic pain, and restless legs syndrome among them — share a common neurological feature: they are driven or substantially amplified by processes occurring within the central nervous system rather than at the peripheral site of apparent injury. This phenomenon, called central sensitization, involves the upregulation of excitatory signaling in the brain and spinal cord, producing pain amplification, widespread hypersensitivity, and the persistence of pain long after any peripheral injury would be expected to have resolved. Standard pain management approaches — anti-inflammatory medications, muscle relaxants, opioids, and many interventional procedures — primarily address peripheral mechanisms and frequently fail to produce adequate relief in centrally sensitized conditions.
Ketamine’s mechanism makes it one of the few pharmacological tools capable of directly addressing central sensitization. As an NMDA receptor antagonist, ketamine blocks the receptor subtype that plays a central role in the excitatory amplification process underlying central sensitization. By interrupting this process — not just dampening its output, but blocking the receptor through which the amplification occurs — ketamine can produce pain relief in patients for whom other analgesics have been inadequate. This is an off-label application: ketamine is not FDA-approved for fibromyalgia, neuropathic pain, or restless legs syndrome. The use is based on a body of clinical research that Cassidy follows carefully and discusses honestly with every patient she evaluates.
Fibromyalgia and Ketamine Research
Fibromyalgia, in particular, has been the subject of a meaningful body of ketamine research. The condition’s hallmark — widespread musculoskeletal pain that is disproportionate to any identifiable peripheral injury, accompanied by fatigue, sleep disturbance, and cognitive fog — maps directly onto the central sensitization model. Multiple clinical studies have demonstrated statistically significant reductions in fibromyalgia pain intensity and related symptoms following IV ketamine infusion series, with effects that persist for weeks to months in responders. Cassidy presents this evidence to fibromyalgia patients without embellishment: the research is encouraging but not definitive, response rates are not universal, and maintenance infusions are typically needed to sustain relief. She sets these expectations clearly before treatment begins.
Neuropathic Pain: A Rational Pathway for Ketamine
Neuropathic pain — pain caused by damage to or dysfunction of the nervous system itself — is another area where ketamine’s central mechanism offers a rational pathway. Peripheral nerve injuries, post-surgical neuropathy, diabetic neuropathy, and other neuropathic conditions produce pain through mechanisms that involve abnormal NMDA receptor activity, and ketamine’s blockade of these receptors can reduce the neurological “noise” that manifests as burning, stabbing, or electric shock-like pain. Cassidy evaluates each neuropathic pain patient individually, including a review of the nerve injury or dysfunction history, prior analgesic trials, and any central nervous system involvement, before determining whether ketamine is an appropriate candidate for their situation.
Navigating Cost and Access in Rural Montana
One barrier to chronic pain treatment with ketamine in Livingston and across Montana is the financial reality. Ketamine is not covered by most commercial insurance plans for chronic pain as a primary indication, and the cost of an IV infusion series is a significant consideration for many patients, particularly in a state where median household incomes vary widely and rural economic pressures are real. Cassidy addresses this honestly: she discusses costs transparently, provides superbills as an out-of-network provider for potential reimbursement, and explores with patients whether a combination approach — initial IV infusions followed by ketamine troche maintenance — might be a more sustainable financial model than repeated IV series alone. She does not promise what she cannot deliver, but she does work to find a clinical and financial approach that is realistic for each patient’s situation. Results vary by individual.
Building Trust Through Honest Evaluation
A second barrier is the skepticism that chronic pain patients have often developed after years of treatments that promised more than they delivered. Cassidy understands this skepticism intimately — her evaluation process is specifically designed to address it. She reviews each patient’s full pain history, explains exactly what the research supports and where it is still developing, identifies realistic goals for ketamine treatment specific to that patient’s condition and history, and makes clear that she will be honest with them when the evidence does not support a strong prediction of benefit. The trust Cassidy aims to build with chronic pain patients is rooted in that honesty, and it is the foundation on which any meaningful treatment relationship depends. To learn more about whether you may be a candidate, you can review ketamine therapy candidacy criteria and then discuss your specific pain history — including what has been tried, what worked partially, and what failed — openly with Cassidy during your evaluation.
Frequently Asked Questions
What chronic pain conditions does Cassidy Boyer treat with ketamine at Mend the Mind?
Cassidy treats fibromyalgia, neuropathic pain, and restless legs syndrome, among other chronic pain conditions with central sensitization components. She evaluates each patient individually to determine whether their specific pain condition is likely to respond to ketamine based on the available research and their personal treatment history.
How many IV ketamine sessions are typically needed for chronic pain?
The initial treatment course typically involves four to six infusions over two to three weeks. Some patients require longer or more intensive initial series, particularly those with severe or long-standing central sensitization. Cassidy designs the protocol based on each patient’s individual clinical picture rather than applying a fixed standard.
Can ketamine troches be used for chronic pain maintenance?
Yes. For patients who achieve meaningful pain relief from IV ketamine, troches can be used as a maintenance strategy to sustain the benefit achieved during the infusion series. This approach may reduce the frequency of IV sessions needed over time. Cassidy evaluates whether the troche modality is appropriate and safe for each chronic pain patient individually.
Does chronic pain from an injury qualify for ketamine at Mend the Mind?
It depends on the nature of the injury and how the pain has evolved. Injuries that have produced persistent neuropathic or centrally sensitized pain — where the pain has outlasted the healing timeline and cannot be fully explained by peripheral tissue damage — are more likely candidates for ketamine evaluation than pain from active or ongoing tissue injury. Cassidy will review your history and provide her honest clinical assessment.
Can I still take my current pain medications while receiving ketamine?
In most cases, yes. Certain medications may require dosage adjustments or specific scheduling considerations, and Cassidy reviews your current medications before treatment begins. Do not make any changes to your current pain medication regimen without discussing them with Cassidy and your prescribing providers.
Key Takeaways
- Fibromyalgia, neuropathic pain, and restless legs syndrome involve central sensitization — NMDA receptor-mediated pain amplification that ketamine can directly address.
- Ketamine for chronic pain is an off-label application supported by clinical research but requires honest evaluation of individual candidacy.
- Cassidy Boyer’s evaluation process reviews full pain history, prior treatment responses, and realistic outcome expectations before recommending IV ketamine.
- Ketamine troches may be used as a maintenance strategy after the initial IV series to sustain pain relief.
- Results vary by individual; Mend the Mind is an out-of-network provider and superbills are provided for potential insurance reimbursement.
Conclusion
Chronic pain that has not responded to conventional treatment is not a final verdict — it is a clinical signal that a different mechanism needs to be addressed. At Mend the Mind in Livingston, Cassidy Boyer brings the clinical depth to evaluate that mechanism honestly and the treatment tools to address it when ketamine is the right fit. For patients across Montana who are managing fibromyalgia, neuropathic pain, or other centrally sensitized conditions, we encourage you to reach out and begin an honest conversation about what may be possible. Schedule a consultation with Cassidy at our Livingston office to take the first step.
About Cassidy Boyer, CRNA
Cassidy Boyer, CRNA, is the lead clinician at Mend The Mind in Livingston, MT, offering IV ketamine therapy and ketamine troches for adults with treatment-resistant depression, anxiety, PTSD, OCD, bipolar disorder, suicidal ideation, and chronic pain conditions including fibromyalgia, neuropathic pain, and restless legs syndrome. Boyer’s evaluation process is built on honest, detailed clinical assessment — reviewing each patient’s full prior treatment history, including medications tried, doses, duration, and response, before making any recommendation. As an out-of-network provider using the Osmind care management platform, Mend The Mind provides patients with superbills for potential insurance reimbursement after each session, combining rigorous clinical standards with direct, transparent communication about what ketamine therapy is and who it is actually appropriate for.
Medical Disclaimer
This content is provided by Mend the Mind for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. IV ketamine for chronic pain is an off-label use of an approved medication. Only a qualified medical provider can determine whether ketamine therapy is appropriate for your specific situation. Results vary by individual, and no outcomes are guaranteed. Please discuss all treatment options with your provider before making any decisions about your care.
References
National Institute of Neurological Disorders and Stroke. Fibromyalgia Fact Sheet. https://www.ninds.nih.gov/health-information/disorders/fibromyalgia
American Chronic Pain Association. Central Sensitization. https://theacpa.org/condition/central-sensitization/
Orhurhu VJ, Orhurhu MS, Bhatia A, Cohen SP. Ketamine infusions for chronic pain: a systematic review and meta-analysis of randomized controlled trials. Anesthesia & Analgesia. 2019;129(1):241–254. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602119/
American Society of Regional Anesthesia and Pain Medicine. Consensus guidelines on ketamine for chronic pain. https://www.asra.com/