Chronic Pain Involves More Than the Original Injury
Chronic pain affects nearly one in four U.S. adults and can interfere with sleep, work, movement, relationships, and emotional well-being. For some people, pain continues after an injury appears to have healed. For others, it develops alongside arthritis, nerve damage, fibromyalgia, migraine, complex regional pain syndrome, or another ongoing medical condition.
Persistent pain should not be reduced to either a damaged body part or “something in the mind.” Pain is a real sensory and emotional experience produced through interactions among the body, peripheral nerves, spinal cord, and brain.
In some chronic pain conditions, ongoing inflammation, tissue damage, or nerve injury remains important. In others, the nervous system becomes more responsive to pain signals over time. Many patients have a combination of these mechanisms.
At Wholistic Health, we use this broader understanding when speaking with patients from Theodore, Mobile, and surrounding Gulf Coast communities. Rather than assuming that every person needs the same intervention, we consider the type of pain, the suspected mechanism, previous treatments, current medications, medical history, and how pain is affecting daily function.
Our goal is not to promise that one brain-based treatment will resolve every chronic pain condition. It is to determine whether a different treatment target may deserve consideration when standard care has not provided enough relief.
Why Pain Can Continue After Tissues Heal
Pain normally serves a protective purpose. After an injury, the nervous system becomes more sensitive so that the affected area is protected while healing takes place.
Touching a sprained ankle may hurt more than expected. Movement may feel threatening. Nearby tissue may become tender even when it was not directly injured. In many cases, this heightened sensitivity gradually settles as the body recovers.
Sometimes it does not.
A process called central sensitization can develop when neurons in the spinal cord and brain become increasingly responsive to incoming signals. This may contribute to:
- Pain from touch or pressure that would not ordinarily hurt
- An exaggerated response to a painful stimulus
- Pain that spreads beyond the original location
- Symptoms that continue after an injury has healed
- Increased sensitivity to sound, light, temperature, stress, or movement
- Pain flares that seem disproportionate to a new physical trigger
Central sensitization is a neurological process, but it cannot be diagnosed from one symptom or scan. It is also not the explanation for every form of chronic pain.
A person may still have structural disease, inflammation, nerve injury, or another treatable medical cause. Careful evaluation remains necessary before deciding which part of the pain system should be targeted.
“Brain-Based” Does Not Mean the Pain Is Imaginary
Patients with persistent pain are sometimes told that normal imaging means nothing is wrong or that emotional stress proves the pain is psychological. Both conclusions can be misleading and deeply discouraging.
Pain does not require visible damage on an X-ray or MRI to be real. The nervous system can change how strongly it responds to signals, and those changes can influence pain intensity, sensitivity, and duration.
At the same time, identifying nervous-system sensitization should not become another reason to dismiss physical symptoms. New weakness, fever, unexplained weight loss, loss of bladder or bowel control, rapidly worsening pain, or other concerning changes still require prompt medical evaluation.
We believe patients deserve both validation and clinical precision. The pain is real, but understanding its mechanism may help explain why a procedure aimed only at one joint, muscle, or disc did not provide lasting relief. Understanding how pain affects mental health can be an important part of that broader picture.
Why Procedures Do Not Always End Persistent Pain
Surgery, injections, nerve blocks, physical therapy, and other interventions can be highly appropriate when they address a clear source of pain. Many patients benefit from them.
However, correcting a structural problem does not guarantee that every pain signal will disappear. Persistent pain after a procedure may involve several possibilities:
- The original condition is still active.
- Another pain generator was not identified.
- Nerves were damaged or irritated.
- The body developed compensatory movement patterns.
- Sleep, mood, or physical deconditioning is amplifying symptoms.
- The central nervous system remains sensitized.
This does not mean the procedure was unnecessary or that the pain has become purely psychological. It means the next evaluation may need to look beyond the original tissue problem.
That is particularly important in conditions involving widespread pain or abnormal nerve signaling. Our overview of chronic pain treatment near Mobile explains the pain conditions currently represented in our clinic and how we begin the evaluation process.
Different Pain Mechanisms Require Different Plans
“Chronic pain” is not one diagnosis. Two people may both report severe pain while experiencing very different biological processes.
Nociceptive Pain
Nociceptive pain generally begins with actual or threatened tissue injury. Arthritis, a fracture, inflammation, or a surgical wound may activate pain receptors.
Neuropathic Pain
Neuropathic pain results from a lesion or disease affecting the somatosensory nervous system. It may feel burning, electric, shooting, tingling, or numb. Some patients experience pain from light touch or temperature changes.
Our clinic explicitly evaluates selected patients for neuropathic pain treatment, although every pain patient must first have a referral from a pain-management physician.
Nociplastic or Sensitized Pain
Nociplastic pain involves altered pain processing without enough evidence that ongoing tissue damage or a somatosensory lesion fully explains the symptoms. Fibromyalgia is a commonly discussed example, although its biology is complex and remains an active area of research.
Patients can also have mixed pain. Someone may have arthritis-related tissue pain, neuropathy, and central sensitization at the same time. A useful plan should reflect that complexity rather than forcing every symptom into one category.
Fibromyalgia and Nervous-System Sensitivity
Fibromyalgia commonly involves widespread pain, fatigue, disrupted sleep, cognitive symptoms, and increased sensitivity to painful or nonpainful stimuli. Researchers continue to study its causes, but altered pain processing within the nervous system appears to play an important role.
That does not mean every fibromyalgia symptom begins in the brain or that a single neurological treatment will resolve the condition. Fibromyalgia care often includes a combination of movement, sleep support, medications, behavioral strategies, pacing, and attention to co-occurring health concerns.
We discuss the clinic experience more fully in our article on how fibromyalgia therapy may support chronic pain management.
When standard approaches have not provided adequate relief, some patients ask whether IV ketamine belongs in the discussion. The answer depends on the individual, and the research remains limited. Our earlier review of the potential role of ketamine in fibromyalgia care offers additional background, but candidacy still requires a medical evaluation.
Where IV Ketamine May Fit Into Chronic Pain Care
Ketamine affects NMDA receptors within the glutamate system. These receptors participate in pain transmission, spinal “wind-up,” and some of the processes associated with central sensitization.
Because of that mechanism, researchers have evaluated IV ketamine for selected refractory pain conditions, particularly complex regional pain syndrome and certain forms of neuropathic pain.
Clinical trials and consensus guidance suggest that some patients may experience short-term pain reduction. The quality and duration of evidence vary considerably by diagnosis, infusion protocol, and study design. Evidence is more supportive for complex regional pain syndrome than for many other chronic pain conditions, while research involving fibromyalgia and mixed neuropathic pain remains limited.
IV ketamine for chronic pain is an off-label use. It is not FDA-approved as a treatment for chronic pain, fibromyalgia, neuropathy, or complex regional pain syndrome.
At Wholistic Health, we do not describe it as a cure, a guaranteed way to “reset” the nervous system, or a replacement for comprehensive pain management. We consider IV ketamine treatment only after reviewing whether the patient’s diagnosis, referral, treatment history, and medical status support further evaluation.
Pain Infusions Require Different Planning
Ketamine protocols used for chronic pain are not necessarily the same as protocols used for psychiatric conditions.
Our published pain protocol involves monitored infusions lasting approximately two to four hours. The treatment experience, dose, monitoring needs, and number of sessions may differ according to the diagnosis and individual response.
Before recommending treatment, we review factors such as:
- The diagnosed pain condition
- Referral and records from the pain-management physician
- Previous medications, procedures, and rehabilitation
- Cardiovascular history and blood-pressure control
- Psychiatric history
- Substance-use history
- Current medications and possible interactions
- Previous reactions to anesthesia or ketamine
- Treatment goals and expected functional outcomes
Potential adverse effects may include dissociation, dizziness, nausea, sedation, perceptual changes, and temporary increases in blood pressure or heart rate. Longer or repeated treatment also requires thoughtful medical oversight.
Not every patient is an appropriate candidate. Active psychosis, uncontrolled cardiovascular concerns, certain substance-use risks, or other medical factors may affect the decision. We discuss these issues before a patient commits to a treatment plan. For a deeper look at what to expect, our guide on what to know before your ketamine infusion session covers preparation and key questions to ask.
Relief Is Not the Only Outcome That Matters
A lower pain score can be meaningful, but it is not the only way to judge whether treatment is helping.
We also ask whether a patient is able to:
- Sleep more consistently
- Walk or exercise with less limitation
- Participate in physical therapy
- Complete household or work responsibilities
- Spend more time with family
- Reduce avoidance caused by fear of pain
- Improve concentration or mood
- Use fewer rescue interventions under medical guidance
A treatment that temporarily lowers pain but does not improve function may not provide the value the patient needs. Conversely, even a partial reduction in pain may matter if it allows someone to move, sleep, or engage in rehabilitation more effectively.
Realistic goals are especially important with ketamine because responses vary. Some patients do not respond, some experience only temporary improvement, and others may need maintenance treatment after an initial response.
Chronic Pain, Sleep, Depression, and Anxiety Can Reinforce One Another
Living with persistent pain places a significant burden on the nervous system and daily life. Pain can interrupt sleep, reduce movement, limit social activity, and make work more difficult. Over time, those changes can contribute to depression, anxiety, frustration, grief, and isolation.
The relationship also works in the other direction. Poor sleep, fear, stress, and depression may increase pain sensitivity or make symptoms harder to manage. That does not mean the pain is caused by attitude. It means pain and emotional health influence some of the same biological and behavioral systems.
At Wholistic Health, we consider pain, mood, sleep, and function together. Addressing depression or anxiety may support quality of life and participation in pain care, but psychiatric treatment should not be presented as proof that the physical pain is unreal. Our depression treatment in Mobile, AL is one avenue we may discuss when persistent pain and low mood co-occur.
SPRAVATO® Is a Depression Treatment, Not a Pain Treatment
Some people with chronic pain also live with treatment-resistant depression. In that situation, a separate depression treatment may deserve consideration.
SPRAVATO® is an esketamine nasal spray with FDA-approved indications for treatment-resistant depression and certain depressive symptoms in adults with major depressive disorder. It is not FDA-approved for chronic pain and should not be described as a direct treatment for fibromyalgia, neuropathy, or another pain condition.
Treating qualifying depression may improve mood, motivation, and engagement with a broader pain plan. It does not guarantee that the underlying pain will improve.
Our article explaining what SPRAVATO® is and how treatment works provides more information about its depression indications and monitored in-office process.
Questions Patients Ask About Ketamine and Chronic Pain
What is central sensitization?
Central sensitization is an increase in the responsiveness of pain-processing neurons in the spinal cord and brain. It may contribute to allodynia, hyperalgesia, spreading pain, and prolonged sensitivity.
It is one possible pain mechanism, not a diagnosis that explains every chronic condition. A clinician should still evaluate for tissue injury, inflammation, nerve damage, and other medical causes.
Can IV ketamine provide lasting pain relief?
Some studies have reported pain reduction lasting beyond the infusion period, particularly in selected patients with complex regional pain syndrome. Other studies show shorter or less consistent benefits.
No provider can predict the duration of relief for an individual patient. Diagnosis, protocol, previous treatment, health history, and response to the initial course may all matter.
Does ketamine work for fibromyalgia?
Research involving ketamine for fibromyalgia is limited. Small studies suggest possible short-term effects on pain, but there is not enough high-quality evidence to promise sustained relief or define a standard protocol.
We describe ketamine as a possible off-label option for carefully selected patients, not an established cure for fibromyalgia.
Will insurance cover IV ketamine for chronic pain?
Coverage varies by plan and indication. Because IV ketamine for chronic pain is an off-label treatment, patients should not assume that it will be covered.
Our team can explain current clinic pricing and help patients identify which questions to ask their insurer before treatment. Final coverage decisions are made by the insurance company.
Can I continue my current pain medications?
Possibly, but every medication must be reviewed. Opioids, sedatives, blood-pressure medications, psychiatric prescriptions, and other drugs may affect safety, monitoring, or the treatment plan.
Patients should not stop a pain medication abruptly. Any change should be coordinated with the prescribing clinician.
Does Wholistic Health replace my pain-management physician?
No. Our current site states that pain patients must be referred by their pain-management physician.
IV ketamine, when appropriate, is one possible adjunct to a broader pain plan. Ongoing diagnosis, medication management, rehabilitation, procedures, and long-term pain care may still require coordination with the patient’s established specialists.
What to Remember About Brain-Based Pain Care
- Chronic pain is real, even when imaging does not fully explain its intensity.
- The brain and spinal cord influence every pain experience, but central sensitization is not the cause of every chronic pain condition.
- Persistent pain may involve tissue damage, inflammation, nerve injury, altered pain processing, or several mechanisms at once.
- IV ketamine affects NMDA receptors involved in pain signaling, but evidence varies substantially by diagnosis.
- Evidence is more supportive for selected complex regional pain syndrome cases than for fibromyalgia or many mixed pain conditions.
- IV ketamine for chronic pain is off-label and is not FDA-approved for that purpose.
- Treatment should support meaningful goals such as movement, sleep, function, and participation in rehabilitation—not just a lower number on a pain scale.
- Wholistic Health requires pain patients to have a referral from a pain-management physician.
A Different Treatment Target May Open a Different Conversation
When pain continues despite medications, procedures, rehabilitation, or surgery, it does not automatically mean that nothing more can be done. It may mean that the original diagnosis needs review, more than one pain mechanism is present, or the nervous system has become part of what sustains the symptoms.
The brain is not the only key to chronic pain relief, but it is an essential part of how pain is experienced and regulated. Ignoring that part of the system can leave an incomplete treatment plan.
At Wholistic Health, we offer patients from Theodore, Mobile, and nearby Gulf Coast communities a careful conversation about whether monitored IV ketamine may be an appropriate addition to their existing care.
We do not promise a particular result. We review the referral, medical history, previous treatments, potential risks, and functional goals before making a recommendation.
To ask questions about our evaluation process, contact our Wholistic Health team.
How We Approach Chronic Pain at Wholistic Health
At Wholistic Health, we combine traditional medical care with a whole-person perspective. We understand that persistent pain can affect physical health, sleep, mood, relationships, and daily independence.
Our role is not to dismiss the treatments a patient has already tried or to suggest that every chronic pain condition has one neurological solution. We work to understand the full history and determine whether our monitored IV ketamine service fits within the patient’s broader pain-management plan.
When it does, we provide clear information about the off-label status, evidence limitations, potential risks, treatment process, costs, and realistic expectations. When it does not, we believe patients deserve to hear that clearly as well. You can learn more about our clinic and care philosophy on our About Us page.
Works Cited
Cohen, S. P., Bhatia, A., Buvanendran, A., Schwenk, E. S., Wasan, A. D., Hurley, R. W., Viscusi, E. R., Narouze, S., Davis, F. N., Ritchie, E. C., Lubenow, T. R., & Hooten, W. M. (2018). Consensus guidelines on the use of intravenous ketamine infusions for chronic pain. Regional Anesthesia and Pain Medicine, 43(5), 521–546. doi:10.1097/AAP.0000000000000808 https://pmc.ncbi.nlm.nih.gov/articles/PMC6023575/
Curatolo, M., La Bianca, G., & Cosentino, G. (2023). Central sensitization and pain: Pathophysiologic and clinical insights. Journal of Pain Research, 16, 3329–3340. https://pmc.ncbi.nlm.nih.gov/articles/PMC10716881/
Lucas, J. W., Connor, E. M., & Bose, J. (2024). Chronic pain and high-impact chronic pain in U.S. adults, 2023. National Center for Health Statistics Data Brief, 518. https://www.cdc.gov/nchs/products/databriefs/db518.htm
Orhurhu, V., Orhurhu, M. S., Bhatia, A., & Cohen, S. P. (2019). Ketamine infusions for chronic pain: A systematic review and meta-analysis of randomized controlled trials. Anesthesia & Analgesia, 129(1), 241–254. doi:10.1213/ANE.0000000000004185 https://pubmed.ncbi.nlm.nih.gov/31082965/
Sigtermans, M. J., van Hilten, J. J., Bauer, M. C. R., Arbous, M. S., Marinus, J., Sarton, E. Y., & Dahan, A. (2009). Ketamine produces effective and long-term pain relief in patients with complex regional pain syndrome type 1. Pain, 145(3), 304–311. doi:10.1016/j.pain.2009.06.023 https://pubmed.ncbi.nlm.nih.gov/19604642/
U.S. Food and Drug Administration. (2025). SPRAVATO® prescribing information. Center for Drug Evaluation and Research. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s016lbl.pdf
Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl.), S2–S15. doi:10.1016/j.pain.2010.09.030 https://pmc.ncbi.nlm.nih.gov/articles/PMC3268359/
Medical Disclaimer
This content is provided for educational purposes only and does not constitute medical advice. It is not intended to diagnose, treat, cure, or prevent any condition. Chronic pain can have many causes, and symptoms should be evaluated by qualified healthcare professionals.
IV ketamine for chronic pain, fibromyalgia, neuropathic pain, and complex regional pain syndrome is used off-label and is not FDA-approved for these indications. SPRAVATO® has specific FDA-approved depression indications and is not approved as a chronic pain treatment.
Do not start, stop, or change a pain medication, psychiatric medication, or other prescribed treatment without guidance from the prescribing clinician. Seek immediate medical care for new weakness, loss of bladder or bowel control, chest pain, difficulty breathing, severe injury, sudden neurological symptoms, or another possible emergency.