Integrative Pain Management
What Treatments Might Be Considered for Pain Management?
Potential treatments for chronic pain could include, but are not limited to:
- We specialize in the appropriate use of buprenorphine, an opioid partial agonist, for chronic pain.
- Physical therapy
- Acupuncture and Traditional Chinese Medicine
- Trigger point injections
- Massage, myofascial release, Rolfing
- Mindfulness Training and Biofeedback
- Nutrition and dietary supplements
- Ketamine augmentation (see below)
Additionally, more interventional modalities that may be arranged by referral to specialty centers, such as epidural injections, PRP or stem cell therapies, nerve ablations, implanted nerve stimulators and even in some cases surgery, are sometimes helpful.
Ketamine for Chronic Pain
Ketamine may be administered via intravenous infusion or intramuscular injection as an adjunctive intervention for chronic neuropathic pain, complex regional pain syndromes (CRPS) and treatment-resistant chronic headaches, in addition to other treatments. Chronic pain is often originally related to soft tissue or nerve injury, but over time develops into an interaction between brain and body that results in incorrect signals being sent and interpreted.
Ketamine for pain is an off-label use, and ketamine is not always appropriate for each situation. A careful clinical evaluation is required to determine whether it will likely be safe and effective. Niesters, Martini, and Dahan (2014, British Journal of Clinical Pharmacology) have an excellent review of the research in this area, and recommend ketamine as an intervention only after multiple other lines of treatment have failed.