By Tanya Dall, MD and Justin Yanuck, MD
Let’s start with some foundations. Pain is not solely in your head; however, there are many factors in your brain that contribute to your pain that are not directly related to the painful source. This is where Ketamine can be helpful.
Chronic pain is defined as pain lasting for greater than 3 months and is associated with significant emotional distress and/or functional disability. Over 20% of Americans suffer from chronic pain. However, the vast majority of patients who seek medical help for their pain have their treatments catered towards biomechanical sources (like an arthritic knee or herniated disc) instead of the multiple other factors that contribute to pain.
Chronic pain is much more than a biomechanical/inflammatory source of pain. In fact, studies have shown that if you take 100 healthy adults with no back pain and do an MRI of their lower back, about 30% of them will have severe disease noted on the MRI which would typically be associated with a painful condition. Furthermore, 20-40% of patients with chronic low back pain have no significant imaging findings on MRIs.
This is because chronic pain is a mixture of hyper-sensitized, easily irritated, peripheral (outside of the spinal cord) and central (spinal cord and brain) nerves. Furthermore, chronic pain results from central amplification, which is where the pain signals become heightened as they move towards the parts of the brain that process them, given the months or years of attention and focus to these signals. For example, if you are sitting down right now, it’s unlikely you are thinking about the touch signals coming from the chair to your buttocks, your brain ignores these because you have learned over time these signals are not important. However, if you start to consciously or unconsciously perseverate over a specific painful sensation, your brain will start to devote more and more real estate to processing signals from that location. This is how central amplification occurs, and there are real neurobiological changes that happen because of this. Additionally, chronic pain is often accompanied with other mental health disorders such as depression, anxiety, and PTSD, and all of these can independently influence/amplify one’s perception of pain.
Unlike procedures, opioids, or anti-inflammatories which treat pain purely as something biomechanical, Ketamine acts to treat the actual root causes of chronic pain like those described above. Ketamine does so through its action on the NMDA receptor, triggering several critical downstream reactions that alter’s a patient’s reception and response to the pain. These reactions lead to something called “neuroplasticity,” the development of new neural connections that allows for different ways to process the pain. Infusions are typically done over a 10-14 day period, with 5 infusions stacked together to optimize this neuroplasticity and change the way the brain processes these pain signals. These neurobiological changes combined with an integrative psychotherapy program have been shown to treat many of the most difficult pain disorders including chronic back and neck pain, fibromyalgia, CRPS, trigeminal neuralgia, and neuropathic pain.
We have seen incredible results on patients with years of chronic pain. To learn more about this treatment for chronic pain visit our website at renewketamineinfusion.com