Do You Know Your Pain Type? SGB and Ketamine for the 3 Types of Chronic Pain Explained

Chronic pain affects millions, but most patients and doctors aren't sure what is generating the pain signals. Understanding the different types of chronic pain is important to finding effective pain relief. There is no one-size-fits-all solution for chronic pain, and Clarus Health uses IV Ketamine, the Stellate Ganglion Block (SGB), and NAD+ to provide tailored treatments. Learn how these innovative treatments provide relief so you can advocate for the modality that matches your health needs.

1. Nociceptive Pain: Pain from Tissue Damage

Nociceptive pain is the body’s response to physical injury or tissue damage, triggering pain to protect the body and initiate healing.

• Examples: Osteoarthritis, broken bones, sports injuries, post-surgical pain, etc.
• Symptoms: Aching, throbbing, or sharp pain, usually localized and made worse by movement or pressure.
• Causes: Caused by inflammation or trauma- this is a protective mechanism signaling the body to avoid further damage (think cuts, burns, broken bones).

Nociceptive pain is generally well-understood, and treatments often include anti-inflammatory medications and physical therapy. However, when standard treatments fall short, advanced therapies can provide the relief patients need, including IV Ketamine, Stellate Ganglion Block, and NAD+.

2. Neuropathic Pain: Pain from Nerve Damage

Neuropathic pain originates from damage or dysfunction within the nervous system itself, rather than from an external injury.

• Examples: diabetic neuropathy, sciatica, post-herpetic neuralgia, etc.
• Symptoms: Burning, tingling, shooting, or stabbing, and it can be constant or intermittent.
• Causes: Nerve damage from trauma, infections, or illnesses (like diabetes). In some cases, the cause is unclear, leading to misfires in pain signaling within the nerves.

Neuropathic pain can be challenging to treat since it doesn’t respond well to standard painkillers. Targeted treatments, including IV Ketamine, Stellate Ganglion Block, and NAD+ offer more specialized relief for nerve-related pain.

3. Nociplastic Pain: Pain Without Clear Tissue or Nerve Damage

Nociplastic pain is a recently defined category of pain that does not involve clear evidence of tissue or nerve damage. Instead, it’s thought to be caused by altered pain processing within the central nervous system.

• Examples: fibromyalgia, chronic migraine, and irritable bowel syndrome (IBS).
• Symptoms: May feels diffuse or widespread, with varying intensity that can be influenced by stress, emotions, or external stimuli.
• Causes: believed to stem from “central sensitization,” where the brain and spinal cord amplify pain signals even in the absence of injury or inflammation.

Since nociplastic pain has multiple causes, and is less responsive to typical medications, therapies like IV Ketamine, Stellate Ganglion Block, and NAD+ can provide valuable relief. These modalities can modify central pain modulation, a critical key for many patients.

Nociplastic pain includes conditions that don't have clear causes and are difficult to treat. IV Ketamine, Stellate Ganglion Block, and NAD+ can provide valuable relief to these conditions

IV Ketamine for Chronic Pain

IV Ketamine can provide pain relief for many painful conditions:

• Nociplastic pain: fibromyalgia, complex regional pain syndrome (CRPS or RSD), headache (including migraine)
• Nociceptive pain: even effective in post-surgical pain
• Neuropathic pain: various neuropathies and neuropathic conditions, including phantom-limb syndrome

Ketamine can act as a "reset" to the body's dysregulated pain response. Ketamine acts as an antagonist to the NMDA receptor, thereby reducing the body's “wind-up” phenomenon. "Wind-up" occurs after repeated painful stimuli (conducted by C-fibers, eventually enhancing NMDA receptor spontaneous activity) and appears to sensitize the spinal cord to perceiving and transmitting pain signals. Ketamine can block this "wind-up" to provide appreciable pain relief.

The chronic pain protocol for IV Ketamine is significantly different than the protocol used for mental health. IV Ketamine for chronic pain requires a doctor specialized in anesthesiology or emergency medicine to safely supervise the procedure.

Additionally, stress responses increase the body's "fight-flight" hormones, including adrenaline. This is where the Stellate Ganglion Block plays a role. In fact, successful pain-relief with the Stellate Ganglion Block (and other fight-flight nerve blocks) is a positive predictor for response to IV Ketamine. This is believed to be because of how fight-flight activation sensitizes our nervous system to pain signals.

Stellate Ganglion Block for Chronic Pain

Stellate Ganglion Blocks can provide pain relief for many pain conditions:

• Nociceptive pain: including post-operative pain, especially in the elderly
• Neuropathic pain: including post-mastectomy neuropathy, facial pain, thalamic pain syndrome, postherpetic neuralgia, and neuroinflammatory pain
• Nociplastic pain: such as complex regional pain syndrome (CRPS or RSD), headache (including migraine), fibromyalgia, facial pain, burning mouth syndrome
• Pain conditions associated with PTSD
• Benefits: SGB offers targeted, long-lasting relief by calming the autonomic nervous system, particularly in patients whose pain is amplified by stress

How Does SGB Reduce Chronic Pain?

Your body's stress response to psychological and physical stressors can elevate noradrenaline levels and activate your body's "fight-flight" response (called your sympathetic nervous system). Reducing the fight-flight response can relieve emotional pain (especially suicidality) and cascade to relieving chronic physical pain. Additionally, the fight-flight response (or sympathetic nervous system) can affect pain in many other ways:

• After nerve injury, critical nerve roots (called the dorsal root ganglion, DRG) forms abnormal connections with outbound (or efferent) sympathetic nerve fibers. This means the sympathetic nerves can cause abnormal pain signaling (via "peripheral afferent fibers").
  • The sensory neurons that are invaded by sympathetic nerves can be repeatedly activated by fight-flight activation.
  • Furthermore, injured nerves sometimes fire pain signals sporadically, triggered by the fight-fight response (norepinephrine, specifically).
• Injured nerves express fight-flight receptors (called alpha-2 adrenergic receptors) that are stimulated by stress hormones like norepinephrine.

SGB can block the hyperexcitability and sensitivity of these sympathetic nerves that can exacerbate dysregulated pain transmission. It can also improve blood flow and reduce concentrations of pain signaling molecules, like substance P.

Indeed, the Stellate Ganglion Block may relieve fight-flight pain through its neuroplasticity, where SGB may prevent new, dysregulated fight-flight nerve growth in response to nerve injury.

SGB and Norepinephrine: Relieving Emotional Pain and Inflammation

Increased norepinephrine is associated with posttraumatic stress disorder (PTSD), CRPS, and hot flashes. This can have a cascading effect to also reduce anxiety. The SGB's neuroplasticity travels from the Stellate Ganglion up to the amygdala, hypothalamus, and hippocampus. These brain areas have bi-directional communication with the locus coeruleus, the brain's norepinephrine factory.

Because of the tight linkage of your immune system with your nervous system, it's not surprising that the SB can also regulate inflammation, inhibit the proinflammatory cytokines (IL-1B, TNF, IL6), and promote nerve repair. This may explain the SGB's benefit in patients with long COVID.

NAD+ for Chronic Pain

NAD+ is an emerging solution for chronic pain treatment. We believe NAD+ works by supporting cellular metabolism throughout the central nervous system. This appears to improve mitochondrial function and resilience in the setting of dysregulated pain transmission.

It is believed that when cells in our nervous system are deficient in NAD, they may produce a dysfunctional response to pain. This is specifically believed to contribute to neuropathic pain.

IV NAD+ is safe for use in multiple conditions, including therapies for chronic pain. Furthermore, given NAD's effects on fatigue, cognition, and detoxification, this can be a powerful adjunct to a holistic chronic pain treatment plan.

Start Your Pain Relief Journey Today

Knowing the type of chronic pain you’re dealing with—nociceptive, neuropathic, or nociplastic—is the first step toward effective treatment. Advanced therapies like IV Ketamine, Stellate Ganglion Block, and NAD+ therapy go beyond mere symptom relief and can address underlying causes to provide lasting relief. It is important to speak with your doctor about the benefits and risks of IV Ketamine and SGB. Schedule a free consultation with Clarus Health to learn if IV Ketamine, SGB, or NAD+ may be effective in reducing your chronic pain.