Chronic Pain Is More Than an Injured Body Part

Acute pain serves an important protective function.

When tissue is injured, the nervous system creates pain to help protect that area while healing occurs.

Chronic pain can become more complicated.

As pain persists, the nervous system may become increasingly responsive to sensory input. This process is often described as central sensitization, in which pain-processing pathways become amplified and stimuli that would normally produce little or no discomfort may become painful.

This can contribute to:

• Persistent burning or aching pain

• Hyperalgesia

• Allodynia

• Pain disproportionate to the original injury

• Reduced range of motion

• Muscle guarding

• Fear of movement

• Sleep disruption

• Progressive weakness and deconditioning

• Difficulty participating in rehabilitation

For some patients, treating the original injury alone is no longer enough.

The nervous system itself has become part of the problem.

How Ketamine May Help Chronic Pain

Ketamine has been used in medicine for decades and has several pharmacologic effects.

One of its most important actions in chronic pain management is antagonism of the N-methyl-D-aspartate (NMDA) receptor.

NMDA signaling is involved in pain transmission, synaptic plasticity, and mechanisms associated with central sensitization.

By modulating this pathway, ketamine may temporarily reduce abnormal amplification of pain signaling in selected patients with neuropathic and centralized pain conditions.

Ketamine is not appropriate for every type of chronic pain, and response varies between patients. That is why treatment begins with a medical evaluation rather than automatically progressing to infusion therapy.

Complex Regional Pain Syndrome

When Pain Becomes a Nervous-System Disorder

Complex Regional Pain Syndrome is a chronic pain condition that most commonly develops after an injury, surgery, or other event involving an arm or leg.

The severity of pain may become substantially greater than would normally be expected from the original injury.

Patients may experience combinations of:

• Severe burning pain

• Extreme sensitivity to touch

• Allodynia

• Hyperalgesia

• Swelling

• Changes in skin temperature

• Changes in skin color

• Altered sweating

• Weakness

• Tremor or abnormal movement

• Joint stiffness

• Loss of range of motion

• Difficulty tolerating weight bearing

• Progressive avoidance of the affected limb

CRPS is generally diagnosed clinically using the overall history, examination, and established diagnostic criteria rather than through one single laboratory or imaging test.

The CRPS Rehabilitation Problem

There is a difficult paradox in CRPS treatment.

Movement Is Important.

But Movement May Be Extremely Painful.

When simply touching, loading, stretching, or moving an affected extremity produces severe pain, conventional physical therapy can become extraordinarily difficult.

The patient protects the extremity.

Movement decreases.

Strength decreases.

Joint mobility worsens.

Sensitivity can increase further.

A cycle begins:

Pain

↓

Movement Avoidance

↓

Loss of Mobility

↓

Weakness & Deconditioning

↓

Greater Sensitivity

↓

More Pain

Breaking this cycle can become one of the primary objectives of treatment.

Ketamine-Assisted Physical Therapy

Creating a Window for Rehabilitation

One of the ways we utilize ketamine at PRO Sports Medicine is by connecting pain management directly with functional rehabilitation.

For appropriately selected patients with conditions such as CRPS, we may perform medically supervised ketamine infusion therapy before physical therapy.

The concept is straightforward:

Reduce the intensity of abnormal pain signaling.

Then use that opportunity to restore movement.

Once the patient has appropriately recovered from the infusion and can safely participate, physical therapy may focus on:

• Range of motion

• Progressive loading

• Desensitization

• Normal movement patterns

• Strength

• Weight bearing

• Functional activity

• Confidence with movement

• Gradual return to normal use of the affected extremity

Rather than viewing ketamine as the entire treatment, we may use it as a tool to help make rehabilitation possible.

Ketamine Creates the Window. Physical Therapy Uses It.

Ketamine may change the pain experience.

Physical therapy determines what we do with that opportunity.

If pain decreases temporarily but the patient continues avoiding movement, the long-term functional benefit may be limited.

Our goal is to strategically use periods of improved pain tolerance to progress rehabilitation.

This is why our model is different from simply providing an infusion and sending the patient home.

Pain Management and Rehabilitation Work Together.

What Ketamine-Assisted Physical Therapy May Look Like

1. Medical Evaluation

We review the diagnosis, pain history, previous treatments, medications, medical conditions, functional limitations, and rehabilitation history.

2. Individualized Treatment Plan

We determine whether ketamine is appropriate and whether pairing treatment with physical therapy makes sense for the patient's condition.

3. Ketamine Infusion

Ketamine is administered in a medically supervised clinical environment with appropriate monitoring.

4. Recovery & Reassessment

After the infusion, we evaluate the patient's pain response, alertness, coordination, motor function, and overall recovery.

5. Physical Therapy

When the patient is sufficiently recovered and it is clinically safe to proceed, structured rehabilitation can begin.

6. Functional Progression

Therapy may focus on progressively restoring movement, loading, desensitization, strength, weight bearing, and normal use.

7. Ongoing Reassessment

We evaluate both pain response and functional progress to determine whether the treatment strategy should continue, change, or advance.

This Is Not Sedated Physical Therapy

This distinction is important.

Our objective is not to heavily sedate a patient and then aggressively manipulate or exercise an extremity while the patient cannot appropriately respond.

Physical therapy requires awareness, communication, coordination, and patient feedback.

Ketamine treatment and rehabilitation therefore need to be appropriately timed.

Patients must be sufficiently recovered from the infusion to safely and meaningfully participate in therapy.

Safety and functional participation take priority over forcing movement.

Why Ketamine Is Used in CRPS

Ketamine has received particular attention in CRPS because NMDA-receptor activity is believed to contribute to central sensitization and abnormal pain amplification.

Clinical studies and systematic reviews have reported reductions in pain among some patients with treatment-resistant CRPS following ketamine infusion therapy.

However, results vary, treatment protocols differ considerably, and pain reduction does not necessarily mean restoration of function.

That distinction is important to our approach.

Pain Relief Creates an Opportunity.

Functional Improvement Is the Objective.

We Measure More Than Pain Scores

Chronic pain treatment should ideally accomplish more than changing a pain score from an 8/10 to a 5/10.

We also want to know:

Can you move farther?

Can you tolerate touch?

Can you bear weight?

Can you use the affected extremity more normally?

Can you participate in physical therapy?

Are you regaining strength?

Can you perform activities of daily living?

Can you return to exercise, work, or recreation?

Pain scores matter.

Function matters too.

Conditions We May Evaluate for Ketamine Therapy

Ketamine is not a universal treatment for musculoskeletal pain.

It may be considered in carefully selected patients with chronic pain syndromes involving neuropathic or centralized pain mechanisms.

Potential conditions may include:

• Complex Regional Pain Syndrome

• Refractory neuropathic pain

• Severe central sensitization

• Selected persistent pain syndromes following injury

• Selected persistent postsurgical pain

• Chronic pain that significantly limits rehabilitation

Routine osteoarthritis, uncomplicated tendinopathy, acute muscle injuries, and other common musculoskeletal conditions do not automatically warrant ketamine treatment.

The treatment should match the underlying pain mechanism.

A Multimodal Approach to CRPS

CRPS rarely has a single solution.

Treatment may incorporate several strategies depending on the severity of the condition, disease progression, previous treatments, and functional limitations.

A comprehensive treatment strategy may include:

• Physical therapy

• Progressive desensitization

• Graded movement

• Weight-bearing progression

• Strengthening

• Home rehabilitation

• Medication management

• Ketamine therapy in selected patients

• Pain management consultation

• Psychological support when appropriate

• Sympathetic interventions when appropriate

• Neuromodulation evaluation in refractory cases

• Specialist referral when necessary

At PRO Sports Medicine, ketamine therapy is intended to support the rehabilitation process—not replace it.

What Happens During a Ketamine Infusion?

Before treatment, patients undergo a medical evaluation to determine whether ketamine is appropriate.

During intravenous treatment, ketamine is administered in a controlled clinical environment with appropriate monitoring.

Depending on the individual and treatment protocol, temporary effects can include:

• Altered perception

• Dreamlike sensations

• Lightheadedness

• Dizziness

• Nausea

• Fatigue

• Temporary dissociation

• Changes in blood pressure

• Changes in heart rate

Patients are monitored during treatment and throughout the appropriate recovery period.

Because ketamine can temporarily affect perception, reaction time, coordination, and judgment, patients must follow post-treatment safety instructions and should not drive themselves home following an infusion.

Treatment Is Individualized

There is no universal ketamine protocol appropriate for every chronic pain patient.

Treatment decisions depend on factors including:

• Diagnosis

• Duration of symptoms

• Severity of pain

• Previous treatment response

• Current medications

• Medical history

• Cardiovascular considerations

• Functional limitations

• Physical therapy tolerance

• Response to previous infusions

• Overall treatment goals

The number, duration, and frequency of treatments are determined individually.

Ketamine Is a Tool—Not the Entire Treatment Plan

This philosophy is central to the PRO Sports Medicine approach.

Our objective is not to create dependence on repeated procedures simply because they temporarily reduce symptoms.

We want every intervention to move the patient toward a larger functional objective.

For one patient, that may mean tolerating touch to an affected foot.

For another, it may mean restoring ankle movement.

For another, it may mean progressing from partial to full weight bearing.

And for another, it may mean finally being able to participate meaningfully in physical therapy after months of being unable to tolerate it.

Every treatment should have a purpose.

An Integrated Sports Medicine Approach

Chronic pain often exists at the intersection of several systems.

There may be:

A structural component.

A neurologic component.

A movement component.

A strength component.

A psychological component.

And a pain-processing component.

Treating only one of these may not be enough.

At PRO Sports Medicine, we can integrate chronic pain treatment with broader musculoskeletal care, including:

• Musculoskeletal evaluation

• Diagnostic imaging

• MSK ultrasound

• Physical therapy

• Corrective exercise

• Ketamine therapy

• Regenerative medicine

• Orthobiologics

• Recovery strategies

• Peptide therapy when medically appropriate

• Specialist or surgical referral when necessary

This allows us to build treatment around the patient rather than around one procedure.

Frequently Asked Questions

Is ketamine an opioid?

No. Ketamine is not an opioid. Its pharmacology is different, with NMDA-receptor antagonism being particularly relevant to its use in chronic pain.

Is ketamine therapy appropriate for all chronic pain?

No. Ketamine is generally considered for selected chronic pain conditions, particularly when neuropathic pain or central sensitization is involved.

Why is ketamine used for CRPS?

CRPS can involve abnormal amplification of pain signaling and central sensitization. Ketamine's effects on NMDA-receptor signaling are one reason it has been investigated and used in selected patients with refractory CRPS.

Why combine ketamine with physical therapy?

Some patients experience pain so severe that they cannot meaningfully participate in rehabilitation. When ketamine produces an appropriate reduction in pain sensitivity, we may use that opportunity to progress movement and rehabilitation.

Will I do physical therapy while sedated?

No. Patients must be appropriately recovered and capable of safely participating before active physical therapy is performed.

Does ketamine cure CRPS?

Ketamine should not be presented as a cure for CRPS. Some patients experience meaningful reductions in pain, but responses vary. Treatment generally remains multimodal and emphasizes rehabilitation and restoration of function.

How many infusions will I need?

There is no universal number. Treatment is individualized according to the diagnosis, response, tolerance, functional improvement, and overall treatment strategy.

Can I drive after treatment?

No. Ketamine can temporarily impair coordination, perception, reaction time, and judgment. Patients should arrange appropriate transportation and follow all post-treatment instructions.

Break the Pain Cycle. Restore Function.

When chronic pain prevents movement, simply telling someone to exercise or participate in physical therapy may not be enough.

For selected patients, ketamine therapy may provide an opportunity to reduce abnormal pain signaling and reopen the door to meaningful rehabilitation.

At PRO Sports Medicine, we take the process one step further by asking:

What can we accomplish with that window?

For patients with CRPS and other appropriately selected chronic pain conditions, the answer may be:

Move again.

Load again.

Strengthen again.

Trust the extremity again.

Return to function.

Schedule a Chronic Pain & Ketamine Therapy Evaluation

PRO Sports Medicine

Performance. Recovery. Longevity.