Hello,
This is Dr Justin Yanuck MD and I’ve given myself 10 minutes to answer this patient question. This week’s question centers on how ketamine can help with chronic pain.
Question: “Can ketamine help with my chronic pain?”
Let’s get some terms straight first. I promise at the end of this short article we will talk about ketamine. Chronic pain is pain that persists for more than 3 months or beyond the expected period of healing. Unlike acute pain which signals injury or illness and typically resolves once the underlying cause is treated, chronic pain continues even after the tissues have healed or when no clear cause remains. Now this is the standard definition of chronic pain. In practice, it’s always more nuanced than this. Most people with chronic pain can identify an etiology, for example their “back went out when lifting a box a few years ago,” or “they woke up one morning, and their neck hurt and never recovered.”
When we image (MRI/CT scan) people with chronic pain we will often find pathology (stuff that is wrong), but does that pathology directly explain their pain. In short, no. In a great study that was done on about 50 young healthy runners’ hips, they found that in these runners, with no complaints, no pain, nearly 70% of them had serious MRI findings of their hips. What this tells me is that pain is MUCH more complex than organic or biomechanical sources of pain. So maybe we shouldn’t always target the image when treating pain…maybe we should target the pain sensing system.
The body perceives pain through a complex system of receptors and spinal cord processing up to the brain. We are hard wired to always consciously and unconsciously prioritize pain signals. Evolutionarily pain is a direct threat to life or limb. Not much more important than that. The problem with our day-to-day chronic pain is that our pain sensing system is misfiring or mis-prioritizing signals and without being very intentional about getting out of the pain cycle, it self-perpetuates itself and gets worse and worse.
More pain, more neurons devoted to sensing pain, the pain is sensed more intently, the pain is more bothersome. In fact, if we take 2 people, one who has no chronic pain, one with chronic pain, and give them the same pain stimuli, say a flick on the wrist, the one with chronic pain will typically feel that pain stimulus as more painful. This isn’t because they are psychologically weak, it’s because their pain sensing system is primed to sense pain, because it has been doing it for months or years.
OK, and this finally leads us to ketamine. Sorry, long introduction to get to the actual question. So if it’s our nervous system that is the issue here. Meaning, it is sensing pain too effectively, maybe a way to turn that down is by allowing for new nerve connections to grow and allow for these signals to be processed differently. This same mechanism for how ketamine works for depression and anxiety is how it works for pain. Chronic stress states…pain, depression, anxiety, PTSD, lead to pruning of the neural architecture. This leads to fixed efficient pathways of processing stimuli. This leads to heightened pain, heightened depression, heightened anxiety, and heightened PTSD. You get the point. So, what we need to do is reverse this pruning and open up the neural architecture. We allow for new nerve signals to grow, to allow the pain signals to transmit less effectively, so they can be perceived differently.
That’s it, that’s how it works (among some other ways we won’t get into in this 10 minute blog post). This neuroplasticity (fancy term for nerve growth) functionally makes it so you can’t perceive pain as well. With each dose of ketamine we get about 48-72 hours of this medicine induced neuroplasticity and then using our pain reprogramming protocol (series of daily 20 minutes exercises) we take advantage of this neuroplasticity and help teach the brain and neural system to start processing these pain signals in a different way.
If you have more questions, feel free to email us at info@renewketamineinfuion.com or book a free consultation.
Cheers,
Dr. Justin Yanuck, MD
Renew Ketamine Infusion
Tustin, San Juan Capistrano, Seal Beach
