Loneliness, Depression, Chronic Pain: Relief with Ketamine and Stellate Ganglion Blocks

Loneliness has reached epidemic levels in the United States, with roughly half of adults reporting loneliness. Loneliness isn't experienced the same way in different people, because you can have few friends but not feel lonely. Instead, we'll look at "unmet social needs" and how ketamine and the Stellate Ganglion Block can restore our mood and address the underlying causes of chronic pain, depression, and anxiety in these cases.

Physical Effects of Loneliness on the Brain

Loneliness can cause several key changes to the brain that have ripple effects:

• Increased strength of the default mode network (DMN) of the brain
• This increased DMN strength is associated with nostalgic reminiscing and hypothetical conversations
• These are both related to the ruminations and perseverations that underlie depression and anxiety
• Loneliness-induced ruminative and perseverative thoughts fuel cognitive distortions, in particular, catastrophizing
• Higher levels of catastrophizing in the setting of social isolation are associated with worse pain, more pain medication use, and worse depression and anxiety

Indeed, a recent, and very large, study from the UK showed an association between loneliness, social exclusion, and chronic pain.

Ketamine, a powerful antidepressant, rapidly normalizes connectivity in the brain's default mode network (DMN). This DMN normalization occurs within 1-2 days.

In patients specifically afflicted with PTSD, it is known that the default mode network (DMN) is disrupted. The Stellate Ganglion Block's potent ability to treat PTSD is believed to have a normalizing effect on the DMN by reducing fight-flight hyperarousal. Research in ongoing specifical

Why is Loneliness so Painful to the Brain and Body?

Unmet social needs tap into ancient brain regions related to pain perception. Social pain can increase pain perception, or numb our pain sensitivity, in both adults and adolescents. There are several key connections between social pain and physical pain perception:

• Extraverts are less sensitive to physical pain. "Extraverts" are less afraid of being rejected or hurt in social settings, contributing to greater outgoingness and sociability.
• Physical pain increases introversion, social anxiety, and leads to avoidance of social experiences
• Less social support makes people more prone to physical pain
• Increased social support reduces pain sensitivity
• Fear of abandonment increases the distress of physical pain

It is noteworthy that physical retaliation is often used (unjustifiably) in reaction to social rejection. Additionally, in the English language, the word "hurt" is used to describe both chronic physical pain and "hurt" feelings. Therefore, holistically treating chronic physical pain should always include addressing social isolation.

Patients struggling with fight-flight overactivation, as seen in PTSD, have dysregulated pain perception. This pain dysregulation appears connected to social pain, such as that seen in fibromyalgia, which is associated with social pain and early life trauma. We believe that the Stellate Ganglion Block's normalization of the sympathetic nervous system ("fight-flight response") promotes a healthy path to enhanced social connection.

Ketamine and SGB Ripple Effects: Improved Mood Promotes Greater Social Connection

Ketamine's ability to reduce depression and uplift mood has been shown to enhance social connection. This is also accompanied by increased motivation and significant changes to quality of life. The reduction in PTSD symptoms from the Stellate Ganglion Block also result in ripple effects that promote increase social connection to reduce unmet social needs and loneliness.

The Neurobiology of Ketamine and SGB in Healing Social Isolation

Ketamine and Stellate Ganglion Blocks (SGB) both affect the same brain regions and neurochemicals that are affected by social isolation.

Ketamine and the Anterior Cingulate Cortex

The anterior cingulate cortex (ACC) connects emotional valence with social and physical pain. Additionally, social isolation activates the ACC. Unsurprisingly, the ACC also affects pain sensitivity, to the point where long-time meditators develop a thicker ACC and decreased pain sensitivity.

Ketamine has powerful effects in the ACC, where it stimulates nerve growth through the gene c-Fos. Importantly, ketamine has been shown to have a healing effect in social isolation. Ketamine's potent anti-pain and anti-depressant effects are certainly multifactorial and likely include improvements in the effects of loneliness.

Stellate Ganglion Block (SGB) and the Anterior Cingulate Cortex

The Stellate Ganglion Block also affects the anterior cingulate cortex (ACC). Part of the ACC is heavily involved with hyperarousal and fear, as seen in PTSD. Blood flow is increased to the ACC after the bock and we await future research to demonstrate how resolution of PTSD symptoms can promote greater social connectivity, possibly mediated through the ACC and the limbic system.

Ketamine in the Periaqueductal Grey (Brain Stem)

The Periaqueductal Grey portion of the human brainstem responds to social bonding and separation, as well as physical pain. Ketamine affects the communication between the default mode network (DMN, which governs our intrinsic attention to pain) and the "descending antinociceptive pathway" (which governs our endogenous anti-pain mechanisms). Again, it is not surprising that these brain regions so heavily involved with physical pain processing are also influenced by social pain. Once again, ketamine can play a powerful role in pain reduction in both emotional and physical pain.

Opioids and Oxytocin: Social Pain Mediators

Opioids

Opioids are well known to reduce physical pain. They also have curious effects on social connection, with the general theme being that increased opioid activity promotes feelings of social connection while decreased opioid activity (eg with naloxone) erodes feelings of social connectiveness. However, there is great variability in studies.

Oxytocin

Oxytocin is best known as the "connection" hormone because it may facilitate social connection. It also has multiple anti-pain properties. While oxytocin is not a powerful pain reliever, its shared properties demonstrate the tight link between social connection and pain.

Restore Your Social Connection and Heal Your Pain

Unmet social needs can have significant impacts on our physical and psychological health. IV Ketamine therapy and the Stellate Ganglion Block can have a powerful effect in our healing from emotional and physical pain. You deserve to find relief and take back control of your healing. Schedule a free consultation with Clarus Health to learn if IV Ketamine Therapy or the Stellate Ganglion Block may be effective in treating your chronic pain, depression, or anxiety.