Chronic pain is defined as pain that persists for longer than three to six months or, when associated with an injury, beyond the normal healing time. It is often multifactorial and dynamic, meaning chronic pain can wax and wane, frequently recurring and persisting despite treatment. Unsurprisingly, many individuals suffering from chronic pain also experience comorbid depression and high rates of alcohol and substance abuse, often as a means to cope and self-medicate. In addition to negatively affecting the quality of life for those afflicted, chronic pain and the frequently associated depression impose a significant financial burden on the nation, rendering many individuals unable to work. Chronic pain and depression are among the leading causes of long-term disability. Chronic pain accounts for more than 25% of all lost workdays and over 20% of all workers' compensation claims. Depression, on the other hand, costs the global economy an estimated $1 trillion per year in lost productivity, according to the World Health Organization (WHO).
While there is certainly a need for more effective treatments for chronic pain, ketamine presents a promising dual role in addressing both difficult-to-treat pain and mood disorders such as major depressive disorder and anxiety, which often coexist. A new pilot study investigated two different ketamine-assisted psychotherapy (KAP) approaches: one using a higher ketamine dose administered intramuscularly and the other using a lower dose taken orally. Researchers used ketamine to treat individuals who suffer from both chronic pain and major depressive disorder. Here is an in-depth look at the study and its findings.
While there are various ways to practice KAP, this study included two methods: the psychedelic approach and the psycholytic approach. Let’s take a closer look at each:
Ten adults with a prior diagnosis of major depressive disorder and a comorbid chronic pain condition were selected to participate in the study.
Participants were divided into two treatment groups: five in the psychedelic group and five in the psycholytic group.
Routes of ketamine administration were intramuscular (psychedelic group) and oral lozenges (psycholytic group). Those in the psychedelic group received two injections per session with escalating dosages in subsequent sessions, while those in the psycholytic group received oral lozenges with escalating dosages in subsequent sessions.
Participants underwent a total of six medicine sessions. Those treated with a psychedelic dose of ketamine completed psychotherapy sessions 24 hours after ketamine administration, while participants treated with a psycholytic dose of ketamine actively participated in a psychotherapy session immediately upon administration.
Participants completed various surveys throughout their treatment, including the Beck Depression Inventory (BDI), Brief Pain Inventory (BPI) Short Form, Generalized Anxiety Disorder (GAD-7) Scale, and Post-Traumatic Stress Disorder Checklist (PCL-5), to assess the impact on depressive, pain, anxiety, and PTSD symptoms.
Although the results were not statistically significant due to the small sample size, the study suggests that both KAP approaches can decrease symptoms of pain, depression, anxiety, and PTSD. However, the psychedelic approach showed more consistent and marked overall improvement in symptoms. This indicates that higher doses of ketamine administered intramuscularly or intravenously, potentially due to more intense and transformative altered states of consciousness, could be more effective therapeutically through a fully psychedelic experience.
While further research with a larger sample size is needed, the results of this pilot study align with our clinical experience at the Innerbloom ketamine and psychedelic clinic in San Luis Obispo, CA. We have observed that pain patients typically require higher doses and experience improved outcomes when ketamine-assisted psychotherapy is incorporated into their treatment on days separate from medicine sessions. Future high-quality research could enhance our understanding of ketamine therapy for chronic pain and lead to improved treatment protocols. Additionally, increased implementation of ketamine-assisted psychotherapy may improve symptoms and pave the way for greater acceptance and use of other psychedelic-assisted therapies, that include substances such as psilocybin, LSD, and MDMA, which also have potential therapeutic effects for the treatment of mental health and pain.
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