Ketamine Assisted Psychotherapy for Chronic Pain with Michelle Weiner, DO MPH

In this episode of the Psychedelic Medicine Podcast, Dr. Michelle Weiner joins to discuss the research on ketamine assisted psychotherapy for chronic pain conditions. Dr. Weiner is Double board-certified in Interventional Pain Medicine, Physical Medicine and Rehabilitation and the Director of Integrative Pain Management at Spine and Wellness Centers of America. She uses a unique personalized approach to treat the root cause of one's pain using a biopsychosocial model including lifestyle and plant medicine to empower her patients to cultivate health, optimize quality of life and decrease pharmaceuticals.

In this conversation, Dr. Weiner discusses her recent research into ketamine therapy for chronic pain and comorbid depression, which compared psychedelic and psycholytic doses of the dissociative. She emphasizes the importance of a biopsychosocial approach to pain treatment and sees the psychotherapy aspect of the ketamine treatments as crucial to their efficacy, as this approach allows doctors to have a better understanding of the complex etiology of the patients pain beyond just what shows up on imaging and empowers patients to actively take ownership of their pain management. While the results from Dr. Weiner's study were very encouraging, she mentions that ketamine therapies typically require maintenance and that more longitudinal research is needed to further understand how durable these changes are.

In this episode:

• The issue of central sensitization in chronic pain
• The difference between psychedelic and psycholytic doses
• What led Dr. Weiner to study chronic pain and comorbid depression
• Neuropathic, nociceptive, and nociplastic forms of pain
• The influence of trauma and stress on chronic pain
• The intersection of pain and identity
• Dr. Weiner's biopsychosocial approach to pain treatment
• The differences between cannabis and ketamine as pain treatment medications

Quotes:

"A lot of [patients'] pain is really similar to fear—fear in the brain—and… if we're not able to understand where this fear is coming from we're not able to extinguish their pain. So I really changed the way I practice and use ketamine because I started to think more about how the psychiatrists are using it, in terms of preparation and integration." [6:59]

"What I've seen is that ketamine does require maintenance in the sense that even if we do six sessions, a lot of patients do need to come back after a few weeks or a few months for maintenance treatment with ketamine as well as therapy." [20:09]

"Pain doctors [should try to] be a little bit more aware of the set, setting, and preparation and integration so that we don't need to use benzos and [patients] can actually have this dissociative experience to allow them to have hope or get out of that fight or flight." [33:04]

Links:

Dr. Weiner's study: Ketamine-assisted psychotherapy treatment of chronic pain and comorbid depression: a pilot study of two approaches

Dr. Weiner's website

Dr. Weiner on Instagram

PMA webinar with Dr. Weiner: Treating Pain and Functional Neurologic Disorders with Psychedelics

Spine and Wellness Centers of America

Psychedelic Medicine Association

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