Studies suggest that chronic pain impacts one out of every three individuals in the United States, and the problem is also prevalent worldwide. Living with pain – both chronic and acute – can greatly impact a person’s quality of life and ability to engage in previously enjoyed activities, which can also affect their mental health and lead to – or worsen – mental health issues such as depression.

In recent years, the use of ketamine as a novel medication for both pain management and treatment of certain mental health conditions has become increasingly popular. In this article, we will discuss the difference between acute and chronic pain, the link between pain and mental health issues, and how ketamine can be used to help patients suffering from pain and depression achieve relief.

What Is the Difference Between Chronic and Acute Pain?

Pain is a complex and multifaceted experience that serves as a warning signal to the body, indicating potential injury or harm. It can be broadly categorized into two main types: acute pain and chronic pain.

Acute pain is a type of pain that results from a specific type of injury or disease and is defined as being self-limited in duration, meaning it usually resolves as the underlying injury or condition heals. It serves a protective biological purpose – in other words, it alerts the individual to potential tissue damage or danger.

Simply put, acute pain typically arises suddenly and is often caused by an identifiable injury or trauma to the body. It is short-lived and typically lasts for a relatively brief period, ranging from a few seconds to a few months, depending on the severity and nature of the injury. It is usually triggered by specific events such as surgery, broken bones, burns, cuts, strains, or other types of physical trauma. Acute pain is often characterized as sharp, intense, and localized to the area of injury, sometimes accompanied by other symptoms, such as swelling, redness, and inflammation. Other common examples of situations that can lead to acute pain include limb injuries such as a sprained ankle or broken bones, toothaches, surgical incision pain, and burning pain from touching a hot surface.

Chronic pain, on the other hand, persists for an extended period, typically lasting for three months or more beyond the normal healing time for an injury or underlying condition. Unlike acute pain, chronic pain may not serve a clear protective function and can significantly impact an individual’s quality of life.

Chronic pain is persistent and can last for months or even years. It may fluctuate in intensity but generally persists beyond the expected healing time for the condition that caused pain initially.

Chronic pain can result from various factors, including underlying medical conditions (e.g., arthritis, fibromyalgia, neuropathy), nerve damage, inflammation, or unresolved injuries. This type of pain is often described as dull, aching, or throbbing, and it may be accompanied by other symptoms such as fatigue, sleep disturbances, mood changes, and decreased mobility. Common examples of conditions that result in chronic pain include back injuries, migraine headaches, rheumatoid arthritis, neuropathic conditions (such as diabetic neuropathy), and fibromyalgia.

It’s important to note that chronic pain is not just prolonged acute pain but involves complex changes in the nervous system that can alter pain processing and perception over time. Chronic pain may be regarded as a disease state that often does not have a recognizable endpoint.

How Does Pain Impact Someone’s Mental Health?

The relationship between chronic pain and mental health issues, particularly depression, is complex and bidirectional. Chronic pain can significantly impact an individual’s psychological well-being, and conversely, pre-existing mental health conditions can exacerbate the experience of chronic pain.

Living with chronic pain can lead to heightened levels of stress and anxiety. The constant discomfort and uncertainty about the future can contribute to a sense of helplessness and fear, triggering the body’s stress response. In addition, chronic pain often disrupts daily activities, limits social interactions, and impairs overall quality of life. This can result in feelings of sadness, hopelessness, and despair, which are hallmark symptoms of depression.

Pain-related sleep disturbances are common among individuals with chronic pain. Poor sleep quality and insomnia can exacerbate both pain perception and emotional distress, creating a vicious cycle of pain and sleep disturbance. Furthermore, chronic pain can interfere with social activities and relationships, leading to social withdrawal and isolation. This can further exacerbate feelings of loneliness, depression, and a perceived lack of support.

While healthcare professionals may still find it challenging to diagnose and treat patients with both pain and depression, studies suggest that the prevalence estimates for depression are substantially inflated among patients with chronic pain and vice versa. Simply put, many patients who suffer from chronic pain also suffer from depression, and the opposite is also true. Patients with pain and depression may struggle with various aspects, such as pain perception and coping.

Depression can alter the brain’s processing of pain signals. Individuals with depression may experience pain more intensely, making it even more challenging to cope with chronic pain. Additionally, depression can impair an individual’s ability to manage pain effectively. This may lead to increased reliance on harmful coping behaviors such as avoidance, substance use, or self-isolation. Depression can also affect a person’s motivation, concentration, and decision-making abilities, which can make it difficult for individuals to adhere to pain management strategies such as medication regimens, physical therapy, or lifestyle modifications.

On a biological level, it is important to mention that both chronic pain and depression involve alterations in neurotransmitter systems such as serotonin, norepinephrine, and dopamine, which play key roles in mood regulation and pain processing. Specialists suggest that the relationship between pain and depression is likely a result of common factors that result in their neurophysiological overlap.

Can Ketamine Be Used to Control Pain?

Ketamine, first developed as an anesthetic agent, gained attention for its potential therapeutic effects in managing chronic and acute pain and certain mental health conditions.

Ketamine acts on a key pain receptor in the brain called the NMDA receptor, which is a mechanism responsible for the transmission and modulation of pain signals within the central nervous system. Chronic pain conditions often involve heightened responsiveness of neurons in the central nervous system to pain stimuli. Ketamine can help modulate this process and reduce pain sensitization.

Ketamine infusions or oral administration have been shown to provide significant pain relief in various chronic pain conditions, including neuropathic pain, complex regional pain syndrome (CRPS), fibromyalgia, and chronic migraine. The effects of ketamine can be long-lasting, with some patients experiencing relief for weeks to months after treatment.

Ketamine’s ability to modulate pain perception also makes it valuable in managing acute pain, particularly in settings where traditional analgesics may be insufficient or contraindicated, such as when a patient is opioid-resistant or has a history of opioid addiction. Ketamine infusion therapy has been used as part of pain management regimens for procedures like major surgeries and trauma care. Because ketamine can target different pain pathways, it reduces the need for high doses of opioids and minimizes their adverse effects.

Recently, consensus guidelines published by a group of major medical organizations point to the fact that there is moderate certainty of evidence supporting the use of ketamine infusions for pain management in patients with chronic regional pain syndromes (a type of long-lasting pain and inflammation that can happen after an injury or a medical event). For these patients, ketamine has been shown to provide up to 12 weeks of pain relief.

While ketamine is generally well-tolerated when administered at appropriate doses, it can cause side effects such as dissociation, hallucinations, dizziness, and nausea. Additionally, the response to ketamine therapy can vary among patients, and not all individuals may experience significant pain relief depending on the nature of their condition.

How Does Ketamine Help Patients With Mental Health Issues?

Ketamine has also attracted significant attention for its potential therapeutic effects in treating various mental health conditions, particularly depression and other mood disorders. One of the most well-studied and promising applications of ketamine in mental health is its use for treatment-resistant depression (TRD), which refers to depression that has not responded adequately to standard antidepressant medications.

Ketamine has been shown to produce rapid and robust antidepressant effects, often within hours to days, in individuals with TRD. It acts faster than most traditional antidepressants,

which may take weeks to months to exert their full therapeutic effects. Furthermore, ketamine has demonstrated the potential to rapidly reduce suicidal ideation and behaviors in individuals with depression, including those at imminent risk of self-harm or suicide.

Studies have shown that a single dose of ketamine can lead to significant reductions in suicidal thoughts and behaviors, often within one day of administration, and the effects continued for up to one week for most patients. This rapid effect is critical in emergency situations where immediate intervention is needed to mitigate suicide risk.

Preliminary evidence suggests that ketamine may also have therapeutic potential in the treatment of post-traumatic stress disorder (PTSD), a debilitating condition characterized by intrusive memories, avoidance behaviors, hyperarousal, and negative mood disturbances. Ketamine’s ability to modulate fear-related memory processes, enhance emotional processing, and reduce avoidance behaviors may contribute to its efficacy in PTSD treatment. However, further research is needed to establish its safety and efficacy in treating patients with PTSD.

Ketamine has also shown promise in the treatment of bipolar depression, a subtype of bipolar disorder characterized by episodes of depression interspersed with periods of mania or hypomania. While ketamine’s primary focus in mental health research has been on depression, there is growing interest in its potential efficacy in treating various anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), and obsessive-compulsive disorder (OCD).

While ketamine shows promise as a novel and rapidly acting treatment for various mental health conditions, including depression and PTSD, it is not without risks and limitations. Side effects such as dissociation, hallucinations, elevated blood pressure, and potential for abuse and dependence mean healthcare professionals must exercise careful patient selection, monitoring, and administration in a controlled clinical setting. Additionally, the long-term safety and efficacy of ketamine therapy, particularly with repeated or maintenance dosing, remain areas of active investigation in psychiatry.

Is Ketamine Therapy the Right Choice for You?

If you suffer from chronic pain and depression or another mental health condition, it may be worth consulting your doctor and discussing whether ketamine therapy may be a feasible choice for your situation. At APN, our experienced mental health professionals have helped many depression patients achieve symptom relief and remission through the safe use of ketamine along with therapy as a part of an integrated treatment approach.

If you would like to learn more about ketamine therapy or other treatments to support the management of mental health conditions associated with chronic pain, All Points North can help you discover integrated treatment approaches that can help you find the relief you need. Call 424.644.6486 or fill out our online contact form to learn more.

References

  • Chopra, Kanwaljit, and Vipin Arora. “An intricate relationship between pain and depression: clinical correlates, coactivation factors and therapeutic targets.” Expert opinion on therapeutic targets vol. 18,2 (2014): 159-76. doi:10.1517/14728222.2014.855720
  • “Complex Regional Pain Syndrome.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome. Accessed 6 Apr. 2024.
  • Global Burden of Disease Study 2013 Collaborators. “Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.” Lancet (London, England) vol. 386,9995 (2015): 743-800. doi:10.1016/S0140-6736(15)60692-4
  • Liriano, Felix et al. “Ketamine as treatment for post-traumatic stress disorder: a review.” Drugs in context vol. 8 212305. 8 Apr. 2019, doi:10.7573/dic.212305
  • Matveychuk, Dmitriy et al. “Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers.” Therapeutic advances in psychopharmacology vol. 10 2045125320916657. 11 May. 2020, doi:10.1177/2045125320916657
  • Orhurhu VJ, Roberts JS, Ly N, et al. Ketamine in Acute and Chronic Pain Management. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539824/
  • Schwenk, Eric S et al. “Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists.” Regional anesthesia and pain medicine vol. 43,5 (2018): 456-466. doi:10.1097/AAP.0000000000000806
  • Wilkinson, Samuel T et al. “The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis.” The American journal of psychiatry vol. 175,2 (2018): 150-158. doi:10.1176/appi.ajp.2017.17040472