Ketamine is known to offer short-term relief for chronic neuropathic pain — but those benefits typically fade within days to weeks. Now, a University of Toronto pilot study published in Med suggests that pairing ketamine with psychotherapy could extend and amplify those gains, potentially offering a new treatment model for one of medicine's most stubborn problems.

The randomized trial enrolled 30 adults with moderate-to-severe chronic neuropathic pain, splitting them into three groups: ketamine only, psychotherapy only, and a combined approach. Ketamine was given as three IV infusions over 16 weeks, while psychotherapy consisted of weekly cognitive behavioral therapy and mindfulness-based meditation sessions. Researchers believe ketamine's ability to promote neuroplasticity creates a window during which patients may be more receptive to behavioral interventions.

By the Numbers:

• 78% of patients in the combined arm achieved a clinically meaningful reduction (≥2.5 points) in pain interference scores at 20 weeks
• 63% in the ketamine-only arm and 56% in the psychotherapy-only arm reached the same threshold
• Depression scores dropped by 3.9 points in both the combined and psychotherapy arms
• 95% of adverse events occurred in the ketamine arms; most were mild (dizziness, nausea)

Why it matters: Chronic neuropathic pain is notoriously difficult to treat, and current options often fall short. This study hints that timing psychotherapy to coincide with ketamine's neuroplasticity window could be a meaningful step forward — and a larger, seven-center blinded trial is already in the works to confirm it.