Chronic Pain/CRPS

When does my pain become chronic?

CRPS / Pain Management

More than 11% of all adults live with daily chronic pain, while many others develop ongoing physical pain due to their mental health disorders.

At Palo Alto Mind Body, we routinely collaborate with pain specialists to provide ketamine as an adjunct treatment for their pain patients. We find ketamine to be a helpful option when other treatments for chronic pain, particularly Complex Regional Pain Syndrome (CRPS), are not effective.

Although the mechanism by which Ketamine improves pain is still being researched, here are some things we do understand:

How Ketamine Works in Pain Management

NMDA Receptor Blocker (Antagonism)

Ketamine blocks N-methyl-D-aspartate (NMDA) receptors. These receptors are involved in the amplification of pain signals and are overactive in patients with chronic pain.

By inhibiting NMDA receptors, ketamine reduces abnormal pain signaling and may help “reset” dysfunctional pain pathways.

Other Mechanisms:

• Increases dopamine and serotonin levels, potentially improving mood and pain perception.
• Reduces neuroinflammation and glial cell activation, which are implicated in the development of chronic pain conditions.

Effectiveness of Ketamine in CRPS (Types 1 and 2)

CRPS is notoriously difficult to treat. Ketamine is used for patients who are unresponsive to conventional treatments like NSAIDs, anticonvulsants, physical therapy, or nerve blocks.

Clinical Evidence:

Ketamine Infusions:

• Low-dose infusions (e.g., over several hours/days) have shown significant, sometimes long-lasting pain relief.
• Studies report up to 50–80% pain reduction in some patients with CRPS, though results vary.

Duration of Effect:

• Relief may sometimes last days to weeks or even months after treatment.
• Repeated infusions or booster sessions are often needed for sustained benefit.

Severity-Based Outcomes:

• More effective in early-stage CRPS.
• There is less benefit in patients with long-standing or more severe disease, although it may still reduce pain and improve function.

Potential Risks and Side Effects of Ketamine in the treatment of pain

• Psychomimetic effects: hallucinations, dissociation (usually mitigated with benzodiazepines).
• Cardiovascular stimulation: increased heart rate and blood pressure.
• Nausea and vomiting
• Liver enzyme changes and bladder issues (with long-term use).
• Tolerance and variable response among patients.

Clinical Use

• Typically used off-label, often in specialized pain clinics.
• Administered via IV infusion, sometimes as an inpatient procedure for high doses.
• Oral, intranasal, and IM routes exist, but IV is most common in CRPS management.

When does my pain become chronic?

Chronic pain is generally defined as ongoing or recurrent pain that lasts longer than twelve weeks or beyond the time it takes tissues to normally heal. Although chronic pain has many causes, the top three causes are lower back pain, severe headaches, and neck pain.

Why is it hard to treat my pain?

The truth is that most pain relievers aren’t very effective against chronic pain syndromes. The relief they provide is temporary at best, which doesn’t help when your pain is chronic.

Chronic pain also leads to a condition known as central sensitization, which exacerbates the pain cycle. Biochemical changes occur in your central nervous system when your nerves constantly carry pain messages to your brain. As a result, you become overly sensitive and experience pain from non-painful stimuli, like the touch of soft clothing.

What type of pain is caused by mental health disorders?

Mental health disorders like anxiety, depression, and PTSD can cause physical pain and may also intensify pain from other physical causes.

This connection between mental health and pain is not “all in your head.” Psychiatric disorders and pain conditions share some of the same nervous system pathways.

The shared overlap is so significant that primary care physicians often prescribe tricyclic antidepressants to relieve neuropathic pain, and with recent treatment advancements, mind-body expert Dr. Ghorieshi utilizes evidence-based psychotherapies and advanced treatments such as IV Ketamine infusions to relieve chronic pain disorders, even complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy (RSD).

What is complex regional pain syndrome (CRPS)?

CRPS, also sometimes referred to as chronic regional pain syndrome, is a chronic pain condition that typically affects one limb, whether an arm, hand, leg, or foot. In about 90% of all cases, CRPS is triggered by trauma or injury, then one of two types of CRPS develops afterward, type 1 or type 2:

CRPS type 1

Formerly known as reflex sympathetic dystrophy syndrome (RSD). Type 1 causes chronic pain without nerve damage in the affected limb.

CRPS type 2

Formerly known as causalgia, this type has the same symptoms as type 1, though with specific nerve damage.

What symptoms will I develop with CRPS?

Persistent, severe pain is the primary symptom of complex regional pain syndrome. It may spread to the entire arm or leg even when the injury and pain began in your hand or foot. The affected area may be so hypersensitive that the gentlest touch feels painful.

You may also experience:

• Changes in skin temperature, color, or texture
• Swelling of the affected limb
• Changes in hair or nail growth
• Stiff joints in the affected area
• Decreased movement in the affected limb
• Tremors or jerking in the affected limb

When CRPS goes untreated, it can worsen, causing tissue deterioration or muscles that tighten and freeze into a fixed position.

Let's do a graphic at some point. Some examples -