Scottsdale Ketamine Therapy Clinic

Ketamine for Migraine & Chronic Pain

What is Migraine?

Migraine is a neurological disorder characterized by recurring, intense headaches often accompanied by other disabling symptoms. These symptoms can include nausea, vomiting, sensitivity to light (photophobia), sound (phonophobia), and sometimes even touch or smell (Goadsby et al., 2017). Migraines can last for hours to several days, and their severity often disrupts daily activities. Chronic migraine, defined as headaches occurring on 15 or more days per month for at least three months, significantly impacts quality of life, leading to emotional distress, reduced productivity, and an increased risk of depression and anxiety (Lipton et al., 2015).

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What is Chronic Pain?

Chronic pain is a persistent pain condition lasting longer than three months. Unlike acute pain, which serves as a warning signal for injury, chronic pain persists beyond normal tissue healing and may lack an identifiable cause (Treede et al., 2015). Common symptoms include ongoing discomfort, fatigue, mood disturbances, and cognitive impairments. Chronic pain is now understood to be a condition that involves changes in the central nervous system (CNS), particularly in regions responsible for emotional processing, such as the prefrontal cortex and limbic system (Baliki et al., 2012). These changes often create a feedback loop where the pain itself exacerbates emotional distress, leading to further sensitization and difficulty in managing symptoms.

Evidence for Benefits of Ketamine for Migraine and Other Forms of Headache

Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has shown promise in treating migraine and other forms of headache. Studies suggest that ketamine’s ability to modulate glutamate pathways in the brain helps reduce hyperexcitability, a hallmark of migraine pathophysiology (Cohen et al., 2019). In a clinical setting, intravenous ketamine infusions have been associated with significant reductions in pain severity for patients with refractory migraines, particularly those unresponsive to conventional therapies (McInnis et al., 2021).

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Evidence for Benefits of Ketamine in Chronic Pain

Ketamine’s role in chronic pain management has been extensively studied, particularly for conditions such as complex regional pain syndrome (CRPS), fibromyalgia, and neuropathic pain. Its mechanism involves blocking NMDA receptors, thereby disrupting central sensitization, a key factor in chronic pain maintenance (Schwartzman et al., 2009). Multiple studies report that ketamine infusions provide rapid and sustained pain relief, even in cases where traditional pain medications have failed (Kiefer et al., 2008). Furthermore, ketamine’s ability to modulate mood and reduce anxiety may enhance its effectiveness in addressing the psychological burden of chronic pain (Niesters et al., 2014).

What Happens to the Brain in Chronic Pain Conditions?

Chronic pain induces profound changes in the brain, often referred to as neuroplastic alterations. Functional MRI studies reveal that individuals with chronic pain exhibit altered connectivity in the default mode network (DMN) and hyperactivity in areas such as the anterior cingulate cortex and amygdala, regions involved in emotional regulation and pain perception (Baliki & Apkarian, 2015). Over time, these changes can lead to heightened pain sensitivity and impaired cognitive and emotional processing. This “pain brain” state underscores the need for treatments that address both the physical and psychological aspects of chronic pain.

Ketamine’s Effects on the Brain

Ketamine’s effects on the brain are multifaceted. By antagonizing NMDA receptors, ketamine disrupts the transmission of pain signals and mitigates central sensitization. It also promotes synaptogenesis and neuroplasticity by enhancing brain-derived neurotrophic factor (BDNF) signaling (Duman et al., 2019). These effects help to “reboot” dysfunctional pain pathways and restore normal neural functioning. Additionally, ketamine’s rapid antidepressant effects are particularly beneficial for chronic pain patients, who frequently experience comorbid depression and anxiety (Williams et al., 2018).

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The Benefit of an Integrative Approach to Pain Conditions

While ketamine offers significant potential benefits, its effectiveness is often enhanced when combined with integrative treatment strategies. Physical therapy, psychotherapy, and neurorehabilitation can address the multifaceted nature of pain, targeting both its physical and psychological dimensions. For instance, physical therapy can improve mobility and reduce pain, while psychotherapy helps patients develop healthier coping mechanisms and reduce catastrophizing (Ehde et al., 2014). Neurorehabilitation techniques, such as biofeedback and mindfulness-based stress reduction (MBSR), further complement ketamine’s effects by fostering self-regulation and promoting resilience.

Why Choose Neuregen for Ketamine Therapy?

At Neuregen, we believe ketamine therapy should be integrated into a comprehensive mental health and pain management plan. Our approach involves a full psychiatric assessment to determine the appropriateness of ketamine for each individual’s unique needs. By combining ketamine therapy with advanced physiotherapy and neurorehabilitation techniques, we aim to maximize treatment outcomes while minimizing potential risks. Our multidisciplinary team, trained in psychiatry, pain management, and rehabilitation, ensures that every patient receives personalized, evidence-based care.

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References

Baliki, M. N., & Apkarian, A. V. (2015). Nociception, pain, negative moods, and behavior selection. Neuron, 87(3), 474-491.

Baliki, M. N., Geha, P. Y., Apkarian, A. V., & Chialvo, D. R. (2012). Beyond feeling: chronic pain hurts the brain, disrupting the default-mode network dynamics. Journal of Neuroscience, 28(6), 1398-1403.

Cohen, S. P., Bhatia, A., Buvanendran, A., Schwenk, E. S., Wasan, A. D., Hurley, R. W., & Hooten, W. M. (2019). Consensus guidelines on the use of intravenous ketamine infusions for chronic pain from the American Society of Regional Anesthesia and Pain Medicine. Regional Anesthesia and Pain Medicine, 43(5), 521-546.

Duman, R. S., Sanacora, G., & Krystal, J. H. (2019). Altered connectivity in depression: NMDA receptors, rapid-acting antidepressants, and therapeutic implications. Biological Psychiatry, 65(7), 681-684.

Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain. American Psychologist, 69(2), 153-166.

Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S. (2017). Pathophysiology of migraine: A disorder of sensory processing. Physiological Reviews, 97(2), 553-622.

Kiefer, R. T., Rohr, P., Ploppa, A., & Dieterich, H. J. (2008). Ketamine infusion for the treatment of complex regional pain syndrome: A randomized, double-blind, placebo-controlled trial. Pain, 123(3), 279-290.

Lipton, R. B., Munjal, S., Alam, A., Buse, D. C., Fanning, K. M., Reed, M. L., & Dodick, D. W. (2015). Migraine in America Symptoms and Treatment (MAST) Study: baseline study methods, treatment patterns, and demographic characteristics. Headache, 58(5), 787-799.

McInnis, A. M., Matheson, K. M., & Nakagawa, S. (2021). Intravenous ketamine for treatment-refractory headache: A retrospective review of efficacy and safety. Journal of Pain Research, 14, 233-242.

Niesters, M., Martini, C., & Dahan, A. (2014). Ketamine for chronic pain: risks and benefits. British Journal of Clinical Pharmacology, 77(2), 357-367.

Schwartzman, R. J., Alexander, G. M., Grothusen, J. R., Paylor, T., Reichenberger, E., & Perreault, M. (2009). Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo-controlled study. Pain, 147(1-2), 107-115.

Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., ... & Wang, S. J. (2015). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19-27.

Williams, N. R., Heifets, B. D., Blasey, C., Sudheimer, K., Pannu, J., Pankow, H., ... & Schatzberg, A. F. (2018). Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. American Journal of Psychiatry, 175(12), 1205-1215.