Pain

What Are Different Types of Chronic Pain?

  1. Nociceptive pain: pain from physical damage to the body e.g. fracture a bone or cut a finger. Usually, specific noxious stimuli is can be identified.
  2. Neuropathic pain: pain from damage or dysfunction in the nervous system.

What Is Neuropathic Pain?

Neuropathic pain is often intractable.

It is an atypical sensation that arises when nerves sustain damage or malfunction, causing a distorted transmission of pain signals to the brain. This type of pain can manifest as burning, aching, shooting, stabbing, or even electric shock-like sensations. It is frequently intense and tends to worsen during nighttime, potentially leading to disability. The altered nerve sensitivity can make the pain trigger even with mild stimuli, such as a gentle touch or a cool breeze.

Example Conditions

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a unique phenomena where extended pain and other symptoms (skin color, temperature, hair and nail changes) develop after an injury to an arm or leg. It was initially discovered during war times in different countries including Frence, Britain and American Civil War.
Patients experience spontaneous, constant, burning, aching, and throbbing pain disproportionate to the initial injury. 
This is a very debilitating condition. Most of the affected individuals lose function due to the extreme pain and weakness. The recovery never happen as it supposed to. Pain spreads to the whole limb (does not follow the distribution of a peripheral nerve). Extremities can also feel hot, cold, blanched, and mottled. It is also associated with swollen, sweating, weakness, trophic hair growth and osteoporosis. 

Postherpetic neuralgia 

It is the most common complication of shingles. The occurrence is ~ 20%. The affected skin area is often burning and extremely painful even after the skin rashes and blisters heal. The risk of postherpetic neuralgia rises with age. It mainly affects people 50  and older.

Trigeminal Neuralgia

It is characterized by sudden and severe electrical-shock like facial pain. The effected area is usually around the jawline, eye, cheek, lip and gums. In some cases, it can spread to the forehead, but only effects one side of the face at a time. It can be triggered by brushing teeth, eating, talking, touching and even a gust of wind. Common causes for this condition include a tumor or lesion that compresses your nerves, oral or sinus surgery and facial trauma. 

Migraine

Migraine is a severe pulsating and ponding headache that affects one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. The attacks can last hours to days. It is debilitating and very difficult to treat. It is related to both genetic and environmental risk factors. Stress is the most common trigger nowadays. It is more common in women than men. 

Refractory Cyclic Vomiting

Cyclic vomiting syndrome (CVS) is a chronic disorder characterized by sudden episodes of nausea and vomiting lasting for 1–5 days followed by asymptomatic periods. The cause is unknown. It is more common in Caucasians. The onset of each episode comprises three phases: a prodromic phase, an emetic phase, and finally, a recovery phase. In between these episodes, patient is usually without symptoms, although not always. Sweating and nausea are prevalent during the prodromic phase, resembling the prodrome experienced by individuals with migraines. The episodes often commence abruptly, particularly in the early morning. 
Read a case report..

Other Possible Treating Conditions

  • Centralized Pain (Post-Stroke Pain)
  • Diabetic Peripheral Polyneuropathy (DPPN)
  • Phantom Limb Pain & Post Amputee Pain
  • Chronic Pelvic Pain
  • Pudendal Neuralgia
  • Peripheral Nerve Injury

F.A.Q

Studies have shown success in treating various forms of neuropathic pain, including conditions like CRPS/RSD (Chronic Regional Pain Syndrome/Reflex Sympathetic Dystrophy), Trigeminal Neuralgia, Phantom Limb Pain,  peripheral nerve damage and chemo-induced neuropathy. The positive impact on the lives of numerous patients has been truly transformative.
Chronic pain can be caused by numerous causes. It is difficult to predict the precise effects of ketamine treatment. While some types of chronic pain may exhibit a more favorable response to ketamine infusions, it is not guaranteed that ketamine will alleviate all forms of pain.
Another unique feature for pain treatment is that the longer exposure is needed. For example, in a randomized placebo (midazolam)-controlled study in fibromyalgia patients IV ketamine, given over 30 min, produced analgesia no longer than 45 min . In contrast, Sigtermans et al showed that 100 h of IV ketamine infusion in CRPS I patients resulted in up to 3 months of pain relief following treatment. Similar observations were made by Schwartzman et al. following a daily 4 h infusion of ketamine for 10 days in CRPS patients 
If you have explored other alternative treatments without finding relief, we strongly encourage you to reach out to us for a consultation.
[1]. Absence of long-term analgesic effect from a short-term S-ketamine infusion on fibromyalgia pain: a randomized, prospective, double blind, active placebo-controlled trial. Eur. J. Pain. 2011 Oct;15(9):942-9. Read more…
[2]. Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1. Pain. 2009;145:304–311. Read more…
[3]. Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study. Pain. 2009;147:107–115. Read more…
The IV Ketamine treatment for chronic neuropathic pain requires higher dosage and longer duration, compared with depression treatment. Be prepared to stay at least three hours for the first two sessions. The dosage will start low. Based on your response, we will customize the treatment regimen. 
Ketamine infusion therapy is not a first-line therapy for chronic pain management. It may be considered after failure of standard treatment. The most well-studied conditions include CRPS, post herpetic neuralgia, traumatic spinal cord injury, cancer induced neuropathy.  
Generally speaking, the duration of infusion is positively correlated with the duration of relief i.e the longer the infusion=the longer the relief. We recommend a minimum of three hours for most pain conditions. For CRPS, at least four hours are required in order to achieve decent results. 

Following a series of infusions, we hope to see a prolonged period of pain relief measured in weeks to months. Most patients will need to return from time to time for a booster infusion to maintain that level of relief.

IV Ketamine infusion is SAFE! This has been proved by studies and clinic practices over the past few decades. Ketamine has been used safely for surgical anesthesia since 1960s. It has been included on the World Health Organization’s Essential Medicines list since 1985. 
Although it is sometimes abused recreationally in high doses as a “club drug,” there is no evidence that ketamine is addictive. 

Is Ketamine Right for You?