I did a short trial of Ketamine infusions in a clinic where they administered it for depression. The doctors running the clinic thought pain management would be novel application, so they took me as a patient. It was not covered by insurance, but I have given all the alternative treatments out-of-pocket trials. Anyway, the ketamine infusions were interesting. The clinic nurse had a lot of problems hitting my veins, so that was always an adventure. Ultimately, we would get the IV placed and Ketamine administered. I didn't have any pain during the treatment, but it would return soon after I got home. I've heard about the nasal spray, lozenges and the wafers, but I've never tried them. I think I could find them with some research. Probably still not covered by Medicare, but it would probably depend on the source.

I remember when my Mom was on Memantine for several years when she had alzheimers. I have not tried it, nor have any doctors mentioned it to me.

How does your son find these doctors? In my experience, pain doctors mostly do procedures. It is rare to find a doctor who will do medication management, and still they want to try the same procedures over and over again, when they haven't worked previously. I let them do the procedures, because they are covered by insurance.

I found the idea to try high dose buprenorphine thru an addiction management clinic that also claimed to treat pain. Most of the addiction management clinics don't want to touch pain patients, and the low dose buprenorphine medications that are approved for pain (like Belbuca) don't provide a high enough dose to help long term opioid patients. So, it was really hard to find a doctor who would prescribe high-dose buprenorphine off-label for pain.

I live in Colorado, where it's pretty easy to find ketamine, cannabis and other things. Not sure about Memantine, but that sounds like something my primary care doctor might prescribe. I tried Cymbalta and Lyrica, but they made me crazy.

I take a pretty high daily dose of Gabapentin with my other pain medications. It just makes me tired. I think the Gabapentin helps, but I'm not sure.

I am always looking for alternatives to the old-school opioids, because they are really hard to get, and they don't lead to a good place. They work for a few hours, and then you have to take more in a higher dose. Then the doctors and pharmacies are afraid of accidental overdose and losing their licenses. I would love to find something else that works.

I will add ketamine wafers / lozenges and Memantine to the list of things I haven't tried. Haven't tried a spinal cord stimulator either, because my sister is bedridden after a failed SCS implant procedure, so I crossed that off my list. Ketamine and Memantine seem much safer, with little downside.

These are good ideas, and I appreciate you sharing these medications that have helped your son. I will see if I can find reliable sources for these medications. Thanks.