Understanding K-Cramps — H23 Foundation

What are k-cramps?

"K-cramps" are a severe pain that can come on with heavy or prolonged ketamine use. They're usually felt in the upper right side of the abdomen — under the ribcage, below the diaphragm — but can spread to the back and shoulders. Alongside the pain, people often feel nauseous, may be sick, and can experience shaking, sweating, and dizziness.

They tend to last a few hours, though tenderness can linger for several days, and they're often worse with dehydration or after certain foods.

What causes them?

Ketamine can affect the bile ducts — the system that moves bile from the liver to the gut — causing them to become inflamed and slowing the flow of bile. When bile backs up, it creates pressure and pain. Research into k-cramps is still limited, and many health professionals aren't yet familiar with them — which is part of why being clear and honest with your GP matters so much.

Why they shouldn't be ignored

Repeated k-cramps can lead to serious longer-term problems, including bile duct scarring, gallbladder problems (sometimes needing surgery), and liver damage, which can be very serious. This is why getting help early matters.

Signs you need immediate medical attention

See a doctor or call 111 straight away — or 999 if severe — if alongside the pain you have any of:

Fever or chills
Jaundice (yellowing of the skin or eyes)
Dark urine
Pale stools

Be honest about ketamine use so you get the right treatment — it's confidential, and you won't be judged.

Managing the pain safely

The only way to prevent k-cramps is to stop using ketamine. It can be tempting to keep using to dull the pain — but this only prolongs and worsens it.

While you're dealing with a flare-up, some things people find help:

Heat — a covered hot water bottle or heat pack (keep it covered to avoid burns)
Hydration — sip water slowly; staying hydrated before, during and after matters, as dehydration makes cramps worse
Breathing — slow breathing exercises can ease both pain and the anxiety that makes pain feel worse
Position — sitting upright or lying on your left side can help bile move; some people find gentle yoga positions like child's pose helpful
Eating — during a flare-up, avoid fatty, spicy or sugary foods. Don't restrict your diet long-term to keep using, though — that risks malnutrition

On painkillers: always check with a pharmacist or GP before taking anything for k-cramps. Some common painkillers — including ibuprofen and other anti-inflammatories, and codeine-based ones like co-codamol — can actually make k-cramps worse, so it's important to get advice rather than self-medicate.

Further reading. The Ketamine Resource Hub has produced a detailed "K-Cramps Survival Guide" with more on causes, long-term effects and pain management. Find it via @ketamineresourcehub.