Chronic pain is real. It can continue long after an injury was expected to heal, develop alongside an ongoing medical condition, or appear without one clear source.
When pain lasts longer than three months, the original injury or disease may no longer explain the full experience. Changes in the nerves, spinal cord, and brain can make the pain system more responsive. Signals that were once protective may become amplified, and sensations that should not hurt may begin to feel painful.
That does not mean every chronic pain condition is “in the brain,” nor does it mean ongoing tissue damage, inflammation, or nerve injury should be ignored. Chronic pain is rarely that simple.
At Mend The Mind in Livingston, Montana, we look at the whole pain pattern before discussing treatment. For some adults whose pain has not responded adequately to conventional care, that includes evaluating whether a nervous-system component may make off-label ketamine worth considering.
Chronic Pain Is More Than an Injury That Lasted Too Long
Acute pain usually serves a protective purpose. It alerts you to an injury, infection, inflammation, or another problem requiring attention. As healing occurs, the pain should generally decrease.
Chronic pain behaves differently. It may continue beyond the expected healing period, remain after the original cause has resolved, or develop as part of a long-term neurological or medical condition.
There are several broad pain mechanisms:
- Nociceptive pain arises from tissue damage or inflammation.
- Neuropathic pain results from damage or disease affecting the nerves.
- Nociplastic pain involves changes in how the nervous system processes pain without clear evidence that ongoing tissue damage or nerve injury fully explains it.
These mechanisms can overlap. Someone with chronic back pain may have structural changes, irritated nerves, muscle guarding, and altered central pain processing at the same time. A person with complex regional pain syndrome may experience inflammatory, neuropathic, and sensitization-related features.
That is why we avoid assuming that every person with the same diagnosis has the same pain mechanism—or should receive the same treatment.
Our chronic pain treatment overview explains more about the conditions we evaluate at our Livingston clinic.
When the Nervous System Becomes More Sensitive
Central sensitization describes changes in the brain and spinal cord that increase sensitivity to pain and other sensations.
This heightened responsiveness may contribute to:
- Hyperalgesia: A painful stimulus feels more intense than expected.
- Allodynia: A sensation that would not ordinarily hurt, such as light touch, becomes painful.
- Pain that spreads beyond the original area
- Symptoms that continue after an injury has healed
- Greater sensitivity to movement, pressure, temperature, sound, or other sensory input
Fibromyalgia is commonly discussed as a nociplastic pain condition involving altered pain processing. If you are considering your options, our fibromyalgia treatment page outlines how we approach this diagnosis at Mend The Mind. Central sensitization may also contribute to some cases of chronic back pain, complex regional pain syndrome, and other persistent pain presentations.
Neuropathic pain is different because it begins with damage or disease affecting the nervous system itself. However, ongoing nerve activity may also contribute to sensitization over time.
None of this means that pain is imagined or caused by a lack of resilience. The brain and spinal cord are physical parts of the body. Changes in how they process pain are biological, even when a scan does not reveal a simple injury that explains the severity of the symptoms.
Why Treating Only the Painful Area May Not Be Enough
When pain has a clear peripheral cause, treatment directed at that cause can be essential. Surgery, anti-inflammatory medication, physical rehabilitation, injections, or treatment of an underlying disease may improve pain when used appropriately.
But an intervention aimed at one joint, muscle, or injured structure may provide incomplete relief when several pain mechanisms are involved.
That does not make the original treatment wrong. It may mean the pain picture has changed or was more complex from the beginning.
Long-term pain care often works best when it addresses several parts of the experience. Depending on the diagnosis, that may involve:
- Treatment of an underlying injury or medical condition
- Physical or occupational therapy
- Gradual movement and functional rehabilitation
- Medications matched to the pain mechanism
- Sleep and stress support
- Psychological care for the emotional burden of persistent pain
- Interventional procedures
- Treatment of co-occurring depression, anxiety, or trauma symptoms
- Carefully selected centrally acting treatments
At Mend The Mind, we do not position ketamine as a replacement for comprehensive pain care. We evaluate whether it may serve as one component of a broader plan when conventional approaches have not provided enough relief.
Our related article offers a closer look at ketamine for chronic pain in Montana.
Where IV Ketamine May Fit
Ketamine affects several systems involved in pain, including glutamate signaling at NMDA receptors.
NMDA-receptor activity contributes to pain transmission and sensitization. By reducing that activity, ketamine may temporarily decrease amplified pain signaling in some people with refractory chronic pain.
That mechanism makes ketamine clinically interesting, but a plausible mechanism does not guarantee a meaningful outcome. We need to consider the specific condition, the evidence supporting treatment, your previous responses, and the risks involved.
IV ketamine for chronic pain is an off-label use. It is generally considered only after more established treatments have been tried or determined to be inappropriate.
Clinical research has reported short-term pain reduction in some people with refractory pain. The strength of the evidence varies considerably by condition. Consensus guidance has found the clearest condition-specific support for complex regional pain syndrome, while evidence for fibromyalgia, mixed neuropathic pain, spinal pain, and several other conditions has been more limited or inconsistent.
More recent reviews continue to describe ketamine as a possible option for carefully selected refractory pain cases while emphasizing the lack of strong long-term data.
For us, that means the evidence supports a careful conversation—not a promise.
Our complete guide to IV ketamine therapy explains how the medication is administered and medically monitored.
Short-Term Relief and Long-Term Outcomes Are Different Questions
One of the most important distinctions in chronic pain research is the difference between an immediate change in pain and a durable improvement in daily life.
A treatment may reduce pain during or shortly after an infusion without producing lasting benefit. Another person may experience enough relief to move more comfortably, sleep better, or participate more fully in rehabilitation. Those functional changes may matter even when pain does not disappear.
When we discuss a possible ketamine trial, we talk about what improvement would realistically mean for you. That could include:
- Lower pain intensity
- Fewer severe pain flares
- Improved sleep
- Greater mobility
- Better tolerance for physical therapy or daily activity
- Reduced interference with work or relationships
- A meaningful change in quality of life
We also discuss what the treatment cannot promise. Ketamine does not repair structural damage, cure an autoimmune disease, reverse every nerve injury, or guarantee lasting relief.
Long-term benefit, optimal treatment frequency, and the effects of repeated courses remain areas where more research is needed.
What We Review Before Recommending Treatment
A diagnosis by itself is not enough to determine whether ketamine is appropriate.
Before making a recommendation, we need to understand your full pain history and how the condition affects your life. Our evaluation may include:
- When and how the pain began
- The diagnoses you have received
- Whether ongoing injury, inflammation, or disease is still present
- The location, quality, intensity, and pattern of the pain
- Signs of neuropathic or nociplastic pain
- Previous medications, procedures, surgeries, and rehabilitation
- What helped, what did not, and what caused unacceptable side effects
- Current medications and prescribing providers
- Cardiovascular health and blood-pressure control
- Psychiatric history, including mania, psychosis, and current safety concerns
- Substance-use history
- Current function, sleep, and treatment goals
- Transportation and support after an infusion
We also consider whether you are receiving appropriate care for the underlying condition. Ketamine should not delay a needed medical evaluation, surgery, neurological assessment, rheumatology care, rehabilitation, or another established treatment.
Our goal is not to fit every pain history into a ketamine protocol. It is to determine whether the treatment has a reasonable role in your specific situation. If you are unsure whether ketamine may be right for you, our guide on Am I a Candidate for Ketamine Therapy? walks through the key considerations.
Medical Monitoring Is Part of the Treatment
Ketamine can affect blood pressure, heart rate, perception, coordination, and alertness. Some people experience nausea, dizziness, anxiety, sedation, or dissociation during treatment.
That is why IV ketamine should be administered within a structured clinical setting by appropriately trained professionals with monitoring and emergency preparedness.
At Mend The Mind, we review your health history and medications before treatment. During an infusion, we monitor vital signs and remain available to respond if you experience discomfort or an unexpected reaction.
You also need a responsible adult to drive you home after treatment. You cannot drive yourself.
Our article on what to expect during your first ketamine infusion walks through the process in more detail.
Where Ketamine Troches May Fit
Ketamine troches are compounded lozenges that dissolve in the mouth and are used at home under medical direction.
For selected patients, we may consider troches as part of a longer-term plan, including maintenance after a meaningful response to IV treatment. They are not interchangeable with an infusion. Absorption is less predictable, the setting is different, and the evidence for non-IV routes in chronic pain is less developed.
Troches are also not a self-directed treatment for pain. Ketamine is a prescription controlled substance, and home use requires:
- A full clinical evaluation
- Individualized prescribing
- Clear preparation and safety instructions
- A responsible treatment environment
- Restrictions on driving and other activities
- Ongoing follow-up and monitoring
- Honest reporting about benefits, adverse effects, and use
We recommend troches only when we believe the potential benefits and practical advantages justify the risks and limitations.
You can learn more about how we use ketamine troches in Montana.
Chronic Pain Deserves Care Without Stigma
Living with pain that other people cannot see can be isolating.
You may have been told that your symptoms are exaggerated, that normal imaging means nothing is wrong, or that the emotional effects of pain make the condition less legitimate. You may also have encountered suspicion because you have tried several medications or seen multiple specialists.
We take chronic pain seriously. At the same time, taking pain seriously means being honest about uncertainty.
We will not tell you that every chronic pain condition is caused by central sensitization. We will not assume that ketamine is appropriate because other treatments have been frustrating. We will not promise that one intervention will restore everything pain has taken from you.
We will listen to the history, evaluate what we can responsibly offer, and explain the evidence and its limits.
Pain can affect mood, sleep, movement, work, relationships, identity, and the ability to take part in the life you value. In Montana, that may include hiking in the Absaroka Range, fishing the Yellowstone River, working outdoors, caring for animals, or simply moving through the day with greater independence.
Seeking thoughtful care is not a failure of self-reliance. It is a practical response to a condition that deserves attention.
Questions We Hear About Chronic Pain and Ketamine
Is chronic pain always caused by central sensitization?
No. Chronic pain is a broad category, and different mechanisms may be involved.
Some pain is driven primarily by ongoing tissue damage or inflammation. Neuropathic pain arises from nerve damage or disease. Nociplastic pain involves altered nervous-system processing without a clear tissue or nerve injury that fully explains the symptoms.
Central sensitization may contribute to several conditions, but it should not be assumed in every case. A clinical evaluation should look for the likely mechanism or combination of mechanisms before treatment is recommended.
Why might ketamine help when other pain medications have not?
Ketamine affects NMDA receptors and glutamate-related signaling involved in pain transmission and sensitization. This mechanism differs from those of anti-inflammatory medications, opioids, and many commonly prescribed neuropathic pain treatments.
That difference may be useful for some people with refractory pain, but it does not mean ketamine is inherently better or appropriate for every diagnosis. The evidence varies by condition, and any benefit may be short-lived.
Is ketamine used for fibromyalgia?
Ketamine has been studied as an off-label treatment for fibromyalgia, but the evidence remains limited and mixed. Small studies have reported short-term changes in pain, while durable benefit has not been consistently demonstrated.
We do not recommend ketamine for fibromyalgia based on the diagnosis alone. We review your symptoms, prior treatment, medical history, function, and goals before determining whether a treatment trial is reasonable.
What does our chronic pain evaluation involve?
We review your diagnoses, pain characteristics, previous treatment, current medications, health history, level of function, and treatment goals.
We also consider whether the pain appears nociceptive, neuropathic, nociplastic, or mixed—and whether another provider should evaluate an unresolved medical or structural cause.
If we believe ketamine is unlikely to help or would create unnecessary risk, we will tell you directly.
Does Mend The Mind take insurance for chronic pain treatment?
Mend The Mind is an out-of-network provider. We may provide a superbill that you can submit to your insurance plan for possible out-of-network reimbursement.
Coverage depends on your individual policy, and reimbursement is not guaranteed. We discuss expected costs before you begin treatment so that you can make an informed decision.
What Matters When Pain Persists
- Chronic pain lasts longer than three months and may involve several overlapping mechanisms.
- The brain and spinal cord can amplify pain, but central sensitization does not explain every chronic pain condition.
- Pain related to altered nervous-system processing is biologically real and is not a character flaw or a product of imagination.
- Treatment should address ongoing tissue injury, inflammation, nerve damage, function, sleep, mental health, and nervous-system sensitization when relevant.
- IV ketamine for chronic pain is off-label and is generally considered only after conventional options have not provided adequate relief.
- Research suggests possible short-term benefit for some refractory pain conditions, but evidence and durability vary substantially.
- Ketamine troches require individualized prescribing and ongoing clinical oversight.
- Results vary, and no pain treatment can guarantee long-term relief.
A Careful Next Step in Livingston
The brain and nervous system matter in chronic pain, but they are only part of a larger clinical picture. Effective care begins by understanding what may be maintaining your pain—not by forcing every experience into one explanation.
At Mend The Mind, we evaluate whether off-label ketamine may have a responsible role after conventional treatment has not been enough. We review your history, likely pain mechanisms, medical risks, prior responses, and practical goals before recommending anything.
When ketamine is not appropriate, we will tell you. When it may be reasonable to consider, we will explain the potential benefits, limitations, risks, and treatment commitment clearly.
Results vary, and no outcome is guaranteed. When you are ready to explore whether ketamine may fit your care plan, you can request a consultation with our Livingston clinic. You are also welcome to schedule a consultation directly through our contact page.
About Cassidy Boyer, CRNA
Cassidy Boyer, CRNA, founded Mend The Mind in Livingston, Montana. She is a board-certified Certified Registered Nurse Anesthesiologist, a Montana native, and a U.S. Air Force veteran with more than a decade of clinical experience using ketamine in monitored medical settings.
Cassidy is currently completing post-master’s Psychiatric-Mental Health Nurse Practitioner training through Montana State University. At Mend The Mind, we combine anesthesia-informed medical oversight with a trauma-informed, whole-person approach to ketamine evaluation and treatment.
Every recommendation begins with a detailed review of your medical history, pain history, current medications, previous treatment, individual risks, and goals.
Works Cited
American Society of Anesthesiologists. (2023, October 19). Statement on ketamine for the treatment of chronic pain.
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.
National Institute of Neurological Disorders and Stroke. (2026, March 13). Pain. National Institutes of Health.
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.
Pickering, G., Morel, V., & Voute, M. (2026). Managing chronic pain: The ketamine option. CNS Drugs, 40(1), 19–41.
Medical Disclaimer
This content is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not intended to replace care from a qualified healthcare professional familiar with your medical history and pain condition.
IV ketamine and ketamine troches used for chronic pain are off-label treatments. Individual results vary, and no outcome is guaranteed. Do not begin, stop, or change a pain medication without consulting the clinician responsible for prescribing it.
If you are experiencing a mental health crisis or thoughts of suicide or self-harm, call or text 988 to reach the Suicide & Crisis Lifeline, call 911, or go to the nearest emergency department.