Ketamine Therapy for Chronic Pain Provides Added Benefits for Substance Misuse Therapy

Abstract

Background: Chronic pain is complicated by comorbid substance misuse. This multifaceted problem increases the risks of polypharmacy, overdose, impaired driving, and avoidable emergency care. Methods: This is an observational study of a convenience sample of twenty adult chronic pain patients who underwent regular monthly intramuscular ketamine for multimodal pain therapy. Ketamine was administered at 0.25 mg/kg per treatment session. Each treatment also involved lidocaine plus magnesium nerve blocks. The cohort was profiled by gender and substance misuse category (benzodiazepine, cocaine, kratom, opioid). Numeric pain score, Severity of Dependence Scale (SDS), and PHQ-9 scores were analyzed. Results: Females comprised 55% (11/20) and males 45% (9/20). Opioids were the most frequent misuse category (45%; 9/20), followed by benzodiazepines (25%; 5/20), cocaine (20%; 4/20), and kratom (10%; 2/20). After repeated treatments, substance misuse improved in all patients, with concordant improvements in mood, pain, and dependence severity. PHQ-9 improved from moderately severe to mild mood disorder, pain improved from severe to moderate, and SDS improved to satisfactory levels. Conclusion: These outcomes indicate that ketamine-based chronic pain therapy is a potential system for integrated substance-misuse therapy within value-based healthcare, highlighting measurable outcomes, risk mitigation, and public safety. Future studies should include larger prospective studies and collaboration with clinical pharmacists and public safety professionals.