Ketamine has gained popularity as we seek effective options for the treatment of chronic pain. Chronic pain and depression are both leading causes of disability worldwide as they are sometimes refractory to conventional treatments. Systematic and evidence based reviews suggest ketamine is effective for acute pain, chronic pain, depression and PTSD. We will focus on the use of ketamine for chronic pain in this post.
Various neurochemical processes lie at the basis of the complex transition from nerve damage to chronic neuropathic pain causing peripheral and central sensitization which manifests itself as severe pain. Ketamine was first synthesized in the early 1960s as a safer alternative to phencyclidine. In 1965, its anesthetic properties were identified. Ketamine is a dissociative anesthetic that produces profound analgesia (pain relief) and amnesia (loss of recollection). At anesthetic doses ketamine depresses the protective airway reflexes and is therefore recommended to be used only by anesthesiologists under fully monitored settings. The effects and side effects of ketamine are dose dependent however, and based on the dose, it can be extended to several other settings outside of the operating room.
Ketamine produces strong analgesia for neuropathic pain states by inhibition of NMDA receptor. The NMDA receptor is an excitatory glutamatergic receptor present at spinal and supraspinal sites and involved in the transmission of painful signals. In chronic pain states, prolonged painful stimulation causes activation and upregulation of the NMDA receptor at the level of the spinal cord resulting in enhanced trafficking of pain signals to the brain ( central sensitization).
NMDA receptor blockers such as ketamine are able to hold the excessive barrage of painful input to the brain and are therefore potential alternatives to existing treatments for chronic pain. Ketamine is also able to activate descending inhibitory pathways. These are the pathways in the central nervous system which can downregulate pain. This has been confirmed using fMRI studies.
It is due to these specific actions that Ketamine may be an effective treatment for your chronic pain. Make an appointment today to discuss your options at Texaspainclinic.com