Stanford Pain Medicine

09/10/2025

Ketamine is a medicine often used in anesthesia, but it has also shown promise for people with chronic pain—especially when other treatments have failed.

Ketamine may help “rewire” these pain pathways in the brain, through a process called neuroplasticity—a kind of brain reset. It may also boost the body’s natural pain-relieving system, called the endogenous opioid system. This is different from taking opioids; instead, ketamine helps the body use its own built-in pain control more effectively.

Stanford’s research has demonstrated that ketamine’s neuroplastic effects may be particularly valuable for patients with conditions where traditional treatments have failed. For example, patients suffering from complex regional pain syndrome (CRPS) or neuropathic pain may benefit more from ketamine’s ability to reset the brain’s pain networks. This discovery has contributed to the growing interest in ketamine as an alternative treatment for these difficult-to-treat conditions.

09/08/2025

New study: Chronic pain is different for everyone, but how do we define “mild,” “moderate,” or “high” impact? Researchers worked with patients and clinicians to set clear cutoffs using PROMIS Pain Interference scores, which measure how much pain disrupts daily life.

They created “score stories” showing what life looks like at different levels. Both patients and clinicians mostly agreed on the thresholds, though they differed a bit on the middle range. Applying these new cutoffs to large patient groups showed fewer people meet the “high impact” category compared with older methods.

Why it matters: Using a shared, patient-informed scale helps doctors and patients talk about pain in a common language—and could improve care and research.

Image description: Figure 1 shows how people living with chronic pain (PLwCP) and doctors set their pain level cutoffs. Neither group agreed completely, but most were very close—within one step (about 5 points). One person with chronic pain set the cutoff for high pain 2 steps higher (12 points) than most others. Four people with chronic pain changed their answers, while no doctors did.

Acknowledgements
Published in Journal of Patient-Reported Outcomes (2025).
DOI: 10.1186/s41687-025-00908-y | PMID: 40824460
Authors: Karon F. Cook, Dokyoung Sophia You, Michael Von Korff, Sean C. Mackey

Full paper: https://bit.ly/4m2Q59N

09/05/2025

Managing chronic pain often takes more than one approach. Medications can be an important part of care, but other tools can also support your body and mind. These strategies typically work best as part of a whole-person plan.

•Ways to Help Your Body
Physical therapy, heat or cold, and massage can retrain muscles, ease tension, and make movement more comfortable. These approaches focus on restoring function and reducing day-to-day discomfort.

•Ways to Help Your Mind
Yoga and other mind–body practices lower stress and help the nervous system calm down, which can reduce the experience of pain.

•Procedures
Some treatments, like acupuncture, TENS devices, or even Botox injections for specific conditions, may be recommended by your doctor as part of a comprehensive plan.

•Measuring Progress in Your Pain Plan
You and your doctor will set goals—like walking farther, sitting longer, or sleeping better. Over time, your care team will check in to see how things are going and make changes if needed. If a treatment isn’t helping or is causing side effects, your provider can explore other options. Pain treatment is personalized, and adjustments are part of ensuring you get the most effective care possible.

09/04/2025

Chronic pain affects millions, yet many proven treatments remain out of reach. As Dr. Sean Mackey explains, the barrier isn’t a lack of knowledge—it’s ensuring access and support so patients can benefit from what we already know works.

09/03/2025

At Stanford, pain doctors are an important part of the team helping manage pain before, during, and after surgery, especially when the pain is expected to be severe.

•When pain doctors are needed: Pain specialists are often called in when surgery is complicated or when doctors need help managing pain that could be intense. For example, after surgeries like chest surgery (thoracotomy), pain specialists are called in to set up pain relief before the surgery starts.

•Why it's important to involve pain specialists early: Some surgeries, like thoracotomies, can cause very severe pain. It's important to manage this pain early to make recovery easier. Pain specialists can put in a pain-relieving catheter before surgery, which helps reduce pain right after the operation.

•Team-based care: Today, doctors work together more than ever. Surgeons, pain doctors, anesthesiologists, nurses, and physical therapists all team up to create a plan for pain management before and after surgery. This helps patients recover faster and feel less pain.

•Pain relief methods: Pain specialists also use methods like nerve catheters to deliver pain relief directly to the area that needs it. This helps reduce pain during the healing process.

08/28/2025

The brain can either amplify or dampen pain—and people can learn skills to help shift this process, says Dr. Beth Darnall. Brain imaging shows this process:

•Focusing on pain causes brain activity tied to pain to amplify.

•Using skills such as mindfulness or cognitive behavioral strategies helps that activity quiet down.

•These are not skills we’re born with—they can be learned and practiced.

With practice, people often report less pain, and brain scans confirm changes in regions linked to pain control.

08/27/2025

Social factors play a crucial role in the experience of chronic pain. Research shows that disruption of social relationships can be a stronger predictor of emotional well-being than physical functioning. In fact, two-thirds of patients in a chronic pain survey ranked social outcomes as extremely important. Dr. Claire Ashton James explains why addressing social aspects—like relationships and social roles—is key to improving pain management outcomes.

The Stanford Pain Relief Innovations Lab presents Dr. Claire Ashton-James, "Addressing Social Aspects of Pain in Practice: Challenges and Opportunities".Dr. ...

08/26/2025

Treatment for complex regional pain syndrome often requires many clinicians working together. A care plan for CRPS may include medications, nerve blocks, stimulation devices, and therapy to restore function. Read the full article for the latest in CRPS diagnosis and treatment:

Complex regional pain syndrome (CRPS) is a severely disabling condition, usually affecting the limbs, after injury or surgery.

08/21/2025

Invisible pain is real. As Dr. Meredith Barad notes, migraine patients often face stigma because others can’t see what they’re going through.

08/20/2025

Stanford researchers tested psilocybin in mouse models of acute and chronic pain — and found no direct pain-relieving effects.

Why it matters:
•Psilocybin is being studied as a possible treatment for depression and chronic pain.

•Some early reports suggested psychedelics might directly reduce pain.

•This study found that across multiple doses and pain models, psilocybin did not act as an analgesic.

The takeaway:
While psilocybin doesn’t directly block pain signals, it may still support patients by changing mood, beliefs, or acceptance of pain — factors that play a powerful role in how pain is experienced.

https://bit.ly/3JjaZEh

08/19/2025

Cognitive functional therapy (CFT), a program that teaches people skills to manage chronic low back pain, showed long-term benefits at 3 years. Dr. Sean Mackey says the findings support adopting CFT as a practical, patient-centered approach.

Personalized cognitive functional therapy provides sustained symptom improvement at 3 years for patients with chronic low back pain, a phase 3 follow-up study suggests.

08/15/2025

Chronic pain treatment requires a whole person approach that addresses the body, mind, and daily life. Our latest blog takes a broad and deep dive into treatment options—from medications and physical therapies to psychological support and advanced interventions—showing how combining these approaches helps manage pain more effectively.

Understanding the full spectrum of care is essential for better pain management.
https://stanford.io/45uxRI7

Discover the full range of chronic pain treatments—from medications and mind-body therapies to advanced procedures