Frontiers in Psychiatry (Jun 2024)

Ketamine in the effective management of chronic pain, depression, and posttraumatic stress disorder for Veterans: A meta-analysis and systematic review

  • Jenny J.W. Liu,
  • Natalie Ein,
  • Natalie Ein,
  • Julia Gervasio,
  • Clara Baker,
  • Rachel Plouffe,
  • Rachel Plouffe,
  • Sonya Wanklyn,
  • Sonya Wanklyn,
  • Amer M. Burhan,
  • Amer M. Burhan,
  • Amer M. Burhan,
  • Brenda Lau,
  • Brenda Lau,
  • Emmanuel Abreu,
  • Emmanuel Abreu,
  • Thomas Wasiuta,
  • Thomas Wasiuta,
  • Thomas Wasiuta,
  • Anthony Nazarov,
  • Anthony Nazarov,
  • Anthony Nazarov,
  • J. Don Richardson,
  • J. Don Richardson,
  • J. Don Richardson,
  • J. Don Richardson

DOI
https://doi.org/10.3389/fpsyt.2024.1338581
Journal volume & issue
Vol. 15

Abstract

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IntroductionKetamine has emerged as a promising treatment alternative for the management of chronic pain. Despite encouraging findings in civilian populations, and favourable results from trials examining its efficacy in military populations, there is still a dearth of information pointing to optimal specifications related to ketamine administration for pain, depression, and posttraumatic stress disorder (PTSD) in military populations. This meta-analysis and systematic review synthesised available evidence on the effectiveness, tolerability, and feasibility of ketamine in the management of chronic pain and mental health conditions in military populations.MethodsThis review followed the Cochrane’s Guide for systematic reviews of interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) as frameworks for data collection and synthesis.ResultsA total of 11 studies and 22 independent samples were retained for data analyses. Across samples, improvements in pain, depression, and PTSD outcomes were evident, with the use of ketamine leading to significant reductions, g = 1.76, SE = 0.19, 95% CI (1.39, 2.13), Z = 9.26, p <.001. These effect sizes were robust with moderate-to-large effects. In addition, the reductions in symptoms were observed in both active-duty and Veteran groups, and for different routes of ketamine administration, frequencies of ketamine administration, duration of ketamine treatments, dosage, study design, and allowance for concurrent treatments.DiscussionThis review provides a preliminary synthesis of available evidence which suggests that ketamine may be a potential option for the treatment of depression, PTSD, and chronic pain in military populations. The viability of ketamine as an alternative treatment may be particularly impactful for those who are treatment resistant, experience chronic symptoms, and/or have exhausted conventional treatments. More research is warranted in order verify the findings presented in this review.

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