Chronic Pain Care

How pain, mood, and inflammation connect

Chronic pain is more than a physical symptom. Over time, ongoing pain can:

• Sensitize the nervous system, so the brain “turns up the volume” on pain signals.
• Increase stress, anxiety, and depression, which can further amplify the experience of pain.
• Be associated with chronic inflammation, which can irritate nerves and alter how the brain processes pain.

Because of this, working only on the pain itself is often not enough. Treating co‑occurring depression, anxiety, and inflammation can significantly improve pain and overall quality of life. This is why Dr. Ghelber emphasizes a comprehensive plan that addresses both body and mind.

Ketamine infusion therapy

Many people living with chronic pain also struggle with treatment‑resistant depression. When depression is severe and long‑standing, it can lower pain tolerance, increase suffering, and make pain feel overwhelming.

In carefully selected cases, Dr. Ghelber offers ketamine infusion therapy to treat depression. By targeting mood and the brain circuits involved in emotional processing, ketamine can help lift depressive symptoms, improve sleep and motivation, and reduce emotional reactivity to pain. For many patients whose pain and depression are closely linked, treating the depression with ketamine can also lead to meaningful improvement in the experience of pain, even though the primary goal of ketamine in this setting is relief of depression.

Ketamine is used within a comprehensive treatment plan, with careful assessment, monitoring, and coordination with your other providers.

Transcranial Magnetic Stimulation (TMS)

TMS uses focused magnetic pulses to stimulate specific areas of the brain involved in mood and pain processing. It is FDA‑cleared for treatment‑resistant depression.

In addition, off‑label TMS can be used to target brain regions involved in neuropathic and other neurological pain, with the goal of modulating overactive pain pathways. There is also growing evidence for the role of TMS in conditions such as fibromyalgia, where it may help reduce widespread pain and improve function in some patients. These pain‑focused applications are considered off‑label and are offered only after careful evaluation and discussion of the current evidence and limitations.

By improving depression and, in selected cases, directly modulating pain‑related brain circuits, TMS can be an important part of a comprehensive strategy for patients with chronic pain and significant mood symptoms.

Treating depression and anxiety to help pain

Depression and chronic pain often reinforce each other. Depression can lower pain tolerance, reduce motivation to move or engage in physical therapy, and make coping with pain much harder. When depression and anxiety improve, many people notice that their pain becomes more manageable.

Dr. Ghelber may recommend:

• Targeted medications for depression, anxiety, or sleep problems.
• TMS for treatment‑resistant depression, with the potential added benefit of influencing how the brain processes pain.

By treating mood and emotional health, the goal is to reduce suffering, increase resilience, and create better conditions for pain to improve.

Addressing inflammation carefully

Often, chronic pain and depression are accompanied by increased inflammation. Dr. Ghelber is attentive to:

• Medical conditions and lifestyle factors that can worsen inflammation (for example, poorly controlled medical illnesses, high stress, poor sleep).
• Coordinating with your other physicians to optimize medical care that may indirectly reduce inflammatory burden.
• Using psychiatric and pain‑related treatments that can support healthier brain‑body regulation over time.

This careful, whole‑person view helps ensure that pain care is as comprehensive and safe as possible.

Emerging biological therapies

Researchers are also studying biological therapies for people whose chronic pain and depression do not respond to standard treatments. These approaches include immune‑targeted medications (monoclonal antibody drugs that calm specific inflammatory signals) and experimental “regenerative” options such as stem‑cell–derived products, exosomes, and secretome‑based therapies, which aim to reduce inflammation and support nerve and brain repair.

Early studies suggest these strategies may help a subset of patients who have high inflammation and severe, treatment‑resistant symptoms. Work is ongoing in areas such as chronic pain, fibromyalgia, neuropathic pain, trauma‑related conditions, and some neurodegenerative disorders. At this stage, these biological therapies are considered experimental and are generally being explored in research and highly specialized settings, with a strong focus on safety, informed consent, and realistic expectations.

Taking the next step

If chronic pain and depression are limiting your life and previous treatments have not brought enough relief, you do not have to face this alone. To learn more about individualized options for managing pain and emotional symptoms in a safe, collaborative way, contact the Institute for Advanced Psychiatry in Fort Worth, Texas, to schedule a consultation.

Important disclosure

Our office does not function as a general pain clinic. Not all types of pain and not all pain treatment modalities are evaluated or treated here. Specifically, we do not prescribe opioid medications for pain under any circumstances. Our role is to address chronic pain primarily through the treatment of depression and other psychiatric conditions, as well as selected neuromodulation and related treatments when appropriate.