Treating chronic pain with low dose ketamine and adjunct therapies within a biopsychosocial approach: a case series

Chronic pain is an individual experience with physical and psychological dimensions. Ketamine is used in sub-anesthetic doses to treat chronic pain. We describe a proposed multidisciplinary approach with combined treatment of low-dose ketamine and pain-focused psychological and somatic therapies to benefit quality of life of disabled chronic pain patients. Beyond pain reduction, within the biopsychosocial approach, the treatment aims to achieve reduced suffering and improved pain management, functionality, and quality of life. Adopting a multidisciplinary approach can minimize exposure to ketamine and maintain a conservative ketamine dosing regimen. In this way, ketamine is not only used for the analgesic effects, but also to facilitate internal psychological processes of body-mind integration related to the pain identity and trauma. We illustrate the presented treatment approach with three cases of patients treated in a private clinic in Florida, United States. We describe the patients' original injury, ketamine and adjunct psychological and somatic therapies regimen, and short and longer-term outcomes from the patient's perspective. These results are preliminary, require replication with validated measures, and represent an opportunity for additional research and hypothesis formation. More clinical research on ketamine and adjunct therapies for chronic pain conditions is warranted to advance treatment options.