You have a rheumatology follow-up in three weeks. Somewhere between the last visit and this one, you read about ketamine, and now a question is sitting in your notes app: should I ask about it? Plenty of women in their forties and early fifties with fibromyalgia end up exactly here, a little hopeful and a little embarrassed, worried the doctor will think they have been chasing internet cures. Asking is reasonable. Here is how to do it so you leave with a real answer instead of a shrug.
Know what you are asking about before you walk in
The word ketamine covers more than one thing, and doctors will want to know which one you mean.
- Ketamine for pain. Usually given by IV infusion at a pain or infusion clinic. For fibromyalgia, this is off-label: the drug's labeling is for anesthesia, and using it for fibromyalgia rests on a prescriber's judgment, not on an approved indication. The research is small and mixed, and pain relief, when people report it, has often been short-lived.
- Spravato (esketamine) for depression. A nasal spray used in certified clinics. Its approval is for depression in adults, specifically depression that has not lifted after two or more antidepressants, and major depression with suicidal thoughts or actions. It is not used to treat pain.
If your main concern is the pain, you are asking about the first. If what worries you most is a mood that has stayed low through several medicines, you are asking about the second, and the right next step may be a depression evaluation rather than a pain procedure. Some women have both concerns, and that is worth saying out loud. A doctor who hears only about pain will answer only about pain.
A short script you can adapt
Doctors respond well to clear, specific openings. Try something like this, in your own words:
"I have been reading about ketamine and I want your honest opinion. My pain is still bad most days even with what we are doing, and my mood has been low for a long time. I know ketamine for fibromyalgia is off-label and the evidence is limited. Is it something you would ever consider for someone like me, and if not, why not? And separately, do you think my mood needs its own evaluation?"
That framing does three things. It shows you already understand the limits, so the conversation can skip the warnings and get to substance. It invites a reason, not just a yes or no. And it splits the pain question from the mood question, which keeps one from swallowing the other.
Bring the facts that make the conversation useful
Ten minutes goes fast. Type these onto a single sheet and give the doctor a copy at check-in:
- Every medicine you have taken for fibromyalgia, sleep or mood, with rough dates and why each one stopped.
- What you are doing now beyond medicine: walking, water exercise at the Y, physical therapy, counseling, sleep changes.
- Your worst symptoms this month, ranked, and how they affect work and home.
- Blood pressure history and any heart, liver, bladder or substance use concerns, since those matter for any ketamine decision.
- Where you are with perimenopause or menopause, because hormone changes can blur the picture for pain, sleep and mood alike.
Questions to ask before you leave
- What would you want me to try first before anything off-label?
- If I did pursue ketamine for pain, who would you trust to do it, and how would you stay in the loop?
- What would we measure to decide whether something is working?
- Does my insurance usually pay for this, or would it be out of pocket?
- Should I see someone about depression, and can you refer me?
Write the answers down while you are still in the room, or ask if you can record the conversation on your phone. Then read them back that evening, when the fog of a long appointment day has lifted, and note what still needs a follow-up call or a message through the patient portal.
If the answer is no
A no is not a dismissal if it comes with a reason and a plan. Many rheumatologists will steer you back toward the core of fibromyalgia care: graded activity, sleep, therapy that helps with pain coping, and medicines chosen for your situation. That is a legitimate answer. If what you hear is only "that is not a real thing," without explanation, you are allowed to ask for a second opinion. Large health systems around the region, including BJC, Mercy and SSM Health, each have rheumatology practices.
If the real issue is depression
Sometimes the conversation reveals that the bigger burden is not the pain at all but a depression that has never fully lifted. In greater St. Louis, Brain Recovery Centers focuses on that kind of depression and offers a free 30-minute consultation. Consults happen in person at its Chesterfield location, 18118 Chesterfield Airport Road, Suite G, or its South County location, 3934 Union Rd. The clinic does not sell medication and does not do telemedicine. It treats depression, not fibromyalgia, so your rheumatologist stays in charge of your pain care.
If thoughts of suicide show up at any point, skip the waiting room entirely. The national crisis line at 988 takes calls and texts any time of day.
Informational only, and no substitute for your rheumatologist or primary care doctor, who know your history and can weigh your options.