Nerve Pain 'Worse Than Death': Can Ketamine Help?

Toronto Star Report Puts a Spotlight on Nerve Pain and Ketamine

A report published by the Toronto Star on September 14, 2026, describes how some people living with nerve pain characterize their condition as "worse than death" and explores whether ketamine can offer relief. Neuropathic pain is pain caused by damage or dysfunction in the nervous system itself, rather than pain from an injury the nerves are simply relaying, and it is notoriously difficult to treat with standard analgesics like opioids or NSAIDs. The Toronto Star piece frames ketamine as a treatment being considered for this population, though the outlet's reporting is the source for this claim and the full clinical detail of that coverage was not available for this analysis. For readers who use or are considering ketamine troches, a lozenge form of the drug dissolved in the cheek, the underlying question the report raises is not new: does an anesthetic developed decades ago have a legitimate place in chronic pain management, and if so, in what form?

Why Ketamine Comes Up for Nerve Pain at All

Ketamine is an NMDA receptor antagonist, meaning it blocks a specific receptor in the nervous system, called the N-methyl-D-aspartate receptor, that plays a central role in how the brain processes and amplifies pain signals over time. That mechanism is different from opioids, which act on opioid receptors, and it is part of why pain specialists have used ketamine off-label for treatment-resistant neuropathic pain for years, typically after other options such as gabapentinoids, tricyclic antidepressants, or opioid therapy have failed. "Off-label" means the drug is being used for a purpose beyond what a specific formulation was originally approved for, a common and legal practice in medicine when a physician determines it is clinically appropriate. In practice, this has most often meant intravenous ketamine infusions delivered in a monitored clinic setting, where dosing can be titrated in real time and vital signs tracked throughout the session.

Ketamine troches are a newer, compounded alternative to infusions. A compounding pharmacy prepares a customized, prescription-only lozenge dosed for an individual patient, intended to be dissolved slowly in the cheek so the drug absorbs through the oral mucosa rather than being swallowed and processed by the liver first. The appeal is convenience: no IV line, no clinic visit for every dose, and a formulation patients can use at home between in-person evaluations. But convenience is not the same as equivalence to infusion therapy, and the two delivery methods are not interchangeable without a prescriber's guidance on dose and frequency.

What This Means for Troche Users and Prospective Patients

If you already use ketamine troches for chronic or nerve pain, this kind of mainstream health reporting is worth noting mainly because it may prompt more patients to ask their doctors about ketamine, which is a reasonable starting point but not a substitute for individualized evaluation. Nerve pain has many underlying causes, including diabetic neuropathy, post-surgical nerve injury, shingles-related nerve damage, and complex regional pain syndrome, and the right treatment plan depends heavily on which of these is driving the symptoms. A prescriber should confirm the diagnosis, review current medications for interactions, and screen for conditions that raise the risk of ketamine side effects, such as uncontrolled high blood pressure or a history of bladder problems, before starting a troche protocol.

Dosing discipline matters more with troches than with a single infusion visit, precisely because the format allows for repeated home use. Patients and prescribers typically track dose, frequency, and effect over weeks, watching for two things: whether pain relief is meaningful enough to justify continued use, and whether tolerance is building, meaning the same dose becomes less effective over time and pushes toward escalation. Escalating home doses without medical oversight is where risk rises fastest, both from dissociative side effects like disorientation or nausea and from the bladder and urinary tract irritation that has been associated with frequent, higher-dose ketamine use in some patients over extended periods. Anyone using troches regularly should also plan periodic check-ins with a prescriber rather than treating an initial prescription as a set-and-forget regimen.

For people comparing delivery options, infusions still offer the tightest clinical control because dosing happens in real time under supervision, which some prescribers prefer for an initial trial before moving a stable patient to a take-home troche. Nasal ketamine sprays, a separate FDA-approved formulation used specifically for depression rather than pain, are sometimes confused with pain-focused troche use; readers should be clear that the approval pathway and intended use differ between these formulations, and a prescriber's guidance should reflect that distinction.

What to Watch Next

The Toronto Star report itself is the primary source for this story, and readers who want the full patient accounts and clinical framing it describes should read it directly at news.google.com. Coverage like this tends to increase patient interest in ketamine faster than it changes formal prescribing guidelines, so the practical shift for most readers in 2026 will be more conversations with pain specialists rather than any new regulatory approval. If you are considering troches for nerve pain, bring the specific type of pain, prior treatments tried, and any bladder or blood pressure history to that conversation, since those details shape whether troches, infusions, or another approach make the most sense for your case.