Background 

Chronic pain, defined as pain persisting for 3 or more months, affects 20% of adults in the US

Despite the variety of existing pain medications, the majority offer only partial symptom relief, resulting in persistent pain and reduced quality of life for affected individuals

Ketamine is commonly used to treat chronic neuropathic pain although its long-term analgesic effects 

Ketamine may enhance the brain’s receptivity to psychotherapy, such as cognitive behavioural therapy (CBT), and combining both has been proposed as a novel treatment for chronic neuropathic pain.

Objectives:

1. Assess the feasibility of conducting a pilot trial designed to compare three interventions for chronic pain 
2. Assess changes in pain interference, pain intensity, pain catastrophizing, depression, and anxiety

Methods:

 1) Pilot, randomized, single-blinded controlled trial with 3 arms: Ketamine, CBT, and Ketamine+CBT

 2) Adults (≥18 years old) with chronic neuropathic pain were followed over a 20-week period

 3) Feasibility assessed through recruitment rate, withdrawal rate, and attendance at sessions

 4) Analyses of secondary outcomes were done descriptively 

Results:

30 participants were recruited after a 20-month period, 13% of which withdrew following randomization

In the Ketamine plus CBT arm, 70% attended all ketamine and CBT sessions. 80% of the ketamine arm attended all ketamine sessions. In the CBT arm, 90% attended all psychotherapy sessions

The combined ketamine plus CBT arm had greater reductions in pain interference at weeks 16 and 20 compared to the ketamine only and CBT only arms (Figure 1)

Discussion: 

Low withdrawal rates and increased protocol adherence among participants suggests trial feasibility 

Although underpowered, these results show support for combined ketamine and CBT as a treatment for chronic neuropathic pain 

The results of this pilot trial demonstrate the need for a larger, sufficiently powered RCT to determine whether the difference observed in pain interference is statistically significant