Integrating Ketamine and Autogenic Training for Chronic Pain: A Case Study at Walter Reed National Military Medical Center.
Abstract
Ketamine has demonstrated efficacy in managing chronic pain and, when combined with psychotherapy, alleviating psychiatric symptoms. However, no published studies have examined the integration of ketamine infusion with autogenic training for chronic pain management. This case study evaluated the feasibility of combining a 24-hour inpatient ketamine infusion with structured autogenic interventions in an active duty service member with neuropathic pain, phantom limb pain, and complex regional pain syndrome following transtibial amputation. The intervention, termed Ketamine and Autogenic Training (KAT), combines ketamine's analgesic and neuroplastic properties with the pain-modulating and stress-reducing benefits of autogenic techniques. The participant completed 2 outpatient preparation sessions prior to infusion and underwent 2 administrations of the autogenic protocol during the infusion. Pain intensity, functional impairment, and anxiety and depressive symptoms were assessed at baseline, immediately post-infusion, and at 1-week, 1-month, and 2-month follow-ups. The participant remained cognitively engaged throughout the infusion and successfully completed the autogenic protocol despite receiving a relatively high subanesthetic dose. Immediate post-infusion assessments demonstrated marked reductions in pain intensity and interference, with continued reductions at 1 week and 1 month. Functional outcomes improved; depressive symptoms showed transient improvement. No adverse effects were observed. These findings support the feasibility of integrating structured psychological interventions during ketamine infusion and demonstrate meaningful reductions in pain-related interference in an active duty service member. This integrative approach shows promise for enhancing functional capacity and operational readiness in military populations with chronic pain.
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