2 New Studies: Ketamine for Fibromyalgia & Chronic Nerve Pain: Repeat Infusions VS Ketamine with Psychotherapy
Two new (August 2026) published studies: repeat high-dose ketamine infusions gave a third of fibromyalgia patients 2-year relief, while ketamine plus psychotherapy beat ketamine alone
Two ketamine studies for chronic pain came out within a week of each other this August, and each takes a different path towards the same goal: lasting relief.
In the first, published in the Journal of Pain Research, 92 women with fibromyalgia received single-day, high-dose ketamine infusions repeated roughly every six months. A third of them still had more than 50% pain relief two full years later.
In the second, published in Med, a Toronto team randomized 30 patients with chronic nerve pain to ketamine infusions alone, psychotherapy alone, or the two combined. The patients who received both did best. Nearly 80% of patients who received ketamine plus therapy had a clinically meaningful drop in how much pain interfered with their daily lives, compared with 50 to 60% of patients who received either one by itself.
Ketamine's ability to quiet chronic pain has been documented for years. The not-yet-fully-established and not-yet-comprehensively-researched concern is durability: relief from an infusion tends to fade over weeks to months.
These two studies offer two different answers to that problem:
Keep returning for more medicine, indefinitely. Or:
Pair the medicine with psychotherapy and use it to change how the brain processes pain while the drug has the brain temporarily more open to change.
In my practice, I pair ketamine with preparation and integration work, so the Toronto protocol is close to how we practice at NeuroPain Health. Both papers add published data where there has been very little, and each gives physicians and patients one more documented option.
Below, I walk through each study in detail, then put them side by side and explore what each route means for patients and for the physicians treating them.
Single-day, high-dose ketamine infusions for fibromyalgia: the 2026 Journal of Pain Research study
Researchers at the Carolinas Pain Institute reviewed the records of 92 consecutive women with fibromyalgia, ages 24 to 78, treated between 2018 and 2024.
Every patient received the same protocol:
a single-day intravenous infusion of 300 to 500 mg of ketamine over three hours
given under monitored sedation
starting with three loading infusions spaced about a week apart
and then repeated whenever pain crept back, which turned out to be every 3 to 10 months with a median of 6 months.
These patients started at a median pain score of 8 out of 10. By three months it had dropped to 5, and it stayed there through two years of follow-up.
At the two-year mark, 33% still reported more than 50% pain relief, 58% reported at least 30% relief, and 75% had improved by at least two points, the threshold usually treated as clinically meaningful.
The number of patients using opioids fell from 33 to 27.
About one in five patients had side effects during or after infusions, mostly nausea and transient hallucinations, with nothing serious reported.
For a condition where the FDA-approved medications help only a minority of patients, two years of sustained relief in a third of a real-world clinic population deserves attention.
The study's main weakness is in its design: a retrospective chart review with no control group cannot rule out placebo response or natural fluctuation, and the authors themselves close the published research by calling for a randomized trial.
Ketamine plus psychotherapy for chronic neuropathic pain: the 2026 randomized trial in Med
A team at St. Michael's Hospital and the University of Toronto, led by pain physician Dr. Akash Goel, ran the randomized trial the field has been asking for, published in Med, a Cell Press journal: thirty adults with specialist-confirmed chronic neuropathic pain were randomized to one of three arms for 16 weeks:
ketamine infusions alone
weekly psychotherapy alone
or both together
The ketamine dosing was modest by pain-medicine standards: three infusions of 1 mg/kg, capped at 100 mg, each delivered over two hours at weeks 2, 7, and 12.
The psychotherapy was cognitive behavioral therapy blended with mindfulness training, 16 hours in total, delivered mostly virtually, with in-person sessions timed around the infusion weeks.
At 20 weeks, all three groups improved on pain intensity, depression, and anxiety.
The combined (ketamine + psychotherapy) group stood out on one measure: pain interference, meaning how much pain disrupts work, sleep, relationships, and daily function:
Nearly 80% of patients in the combined group reached a clinically meaningful reduction, against 50 to 60% in each single-treatment group. Retention and adherence were high and no serious adverse events occurred.
This was a pilot trial of 30 people, designed primarily to prove the approach is safe and feasible, and the authors are careful to say it cannot conclusively prove superiority. They are now planning a multi-centre, placebo-controlled trial across Canada. But the direction of the signal, from a randomized comparison, points the same way my clinical experience does.
Is ketamine with psychotherapy more effective than ketamine alone for chronic pain?
The Toronto trial gives the first randomized answer in chronic pain, and it is a qualified yes. Patients who did the therapy work alongside their infusions were meaningfully more likely to reclaim daily function than patients who received identical infusions without it.
The pattern echoes what ketamine research in depression has suggested for years: the drug produces a window, and what happens during the window shapes how long the benefit lasts. Dr. Goel describes maladaptive thought patterns in chronic pain as weeds, and puts it this way:
"Ketamine allows us to basically remove those weeds and plant new seeds for new flowers to grow."
There is biology behind the metaphor: ketamine transiently increases neuroplasticity, the brain's capacity to form new connections, for days after an infusion. Chronic pain lives partly in learned circuits: the nervous system rehearses pain until pain becomes the default. Psychotherapy delivered inside that plastic window may rewrite some of that learning in a way that either treatment alone cannot.
Some of what gets rewritten is simply habit. Treatment sessions surface patterns: how you brace against pain, how you sleep, what a flare does to your thinking. What you learn about yourself and your habits during a course of ketamine may reduce how many sessions you need down the road. The medicine opens a window; what you build inside it stays with you after the drug is gone.
Ketamine infusions for fibromyalgia vs ketamine with psychotherapy: how the two 2026 studies compare
Read side by side, these papers could potentially be framed as competing methods. They should not be. They studied different patients with different pain types, used very different doses, and measured different outcomes on different timelines. What can be compared is the approach itself: one protocol relies on repeating the medicine, and the other pairs the medicine with therapy.
Two new ketamine studies for chronic pain, side by side
How the 2026 fibromyalgia infusion study and the Toronto ketamine plus psychotherapy trial differ
| Study detail |
Fibromyalgia study (Journal of Pain Research) |
Toronto trial (Med) |
|---|---|---|
| Condition | Fibromyalgia study Fibromyalgia, 92 women | Toronto trial Chronic neuropathic pain, 30 adults |
| Design | Fibromyalgia study Retrospective chart review, no control group | Toronto trial Randomized controlled pilot, 3 arms |
| Ketamine per session | Fibromyalgia study 300 to 500 mg over 3 hours | Toronto trial 1 mg/kg, capped at 100 mg, over 2 hours |
| Schedule | Fibromyalgia study Repeated indefinitely, median every 6 months | Toronto trial 3 infusions across 16 weeks |
| Psychotherapy | Fibromyalgia study None | Toronto trial 16 hours of CBT with mindfulness |
| Main outcome | Fibromyalgia study Pain intensity | Toronto trial Pain interference with daily life |
| Follow-up | Fibromyalgia study 24 months | Toronto trial 20 weeks |
| Result | Fibromyalgia study 33% maintained more than 50% pain relief at 2 years | Toronto trial Approximately 80% of the combined-treatment group improved meaningfully, compared with 50% to 60% in the single-treatment groups |
Sources: Journal of Pain Research, 2026 and Med, 2026 .
Neuropathic pain traces back to damaged or malfunctioning nerves, while fibromyalgia is classified as nociplastic pain, where the nervous system amplifies pain signals without clear tissue or nerve damage.
In real patients, the line is blurrier than the textbook version: many people have features of more than one type, and the same nervous system is processing all of it.
The Toronto trial excluded fibromyalgia patients, so nobody has yet run the study I most want to see: ketamine plus psychotherapy, randomized, in fibromyalgia.
All chronic pain, whether neuropathic, nociceptive, or nociplastic, is neuroplastic: the nervous system has learned and reinforced it over months or years. Any treatment that shifts nervous system state and delivers a stretch of relief, even temporary relief, interrupts that loop and gives the system a chance to relearn. Both of these protocols do that, but they differ in what happens long-term.
The fibromyalgia study earned something the Toronto trial cannot claim yet, and I want to give it full credit: two years of real-world durability data.
Higher doses and longer infusions may also mean less loading up front, fewer visits before a patient feels traction. What that protocol leaves unused is the highly neuroplastic stretch after each infusion, which came and went twice a year for these patients without any tools paired to it.
Personalizing ketamine treatment for chronic pain: choosing between infusion-only and therapy-paired protocols
Every published protocol becomes an option another physician can offer. Neither of these teams proved the other wrong, and neither claimed to.
Some patients need the pharmacologic anchor of a high-dose infusion they can count on twice a year. Some will get further with lower doses, fewer infusions, and structured work during the window.
Many, I suspect, need different combinations at different points in their course. Physicians reading both papers now have two documented styles to draw from and can match the protocol to the patient in front of them and to the kind of medicine they practice.
For patients, the studies sharpen the questions to ask any clinic:
Ask what the plan is for durability.
Ask whether the protocol includes preparation, integration, or formal psychotherapy, and who provides it.
Ask how the clinic decides dose and frequency for you specifically, rather than running everyone through the same schedule.
In my practice in South Florida, ketamine has never been a standalone drug appointment. I combine it with intention setting beforehand and integration afterward, because the infusion opens a window that closes again, and because what a patient learns about themselves inside that window is often what lets us stretch the interval between sessions.
The Toronto data is early, small, and needs replication in larger placebo-controlled trials, and it is the first randomized evidence in chronic pain for that model: medicine and tools, delivered together.
The two 2026 ketamine studies for chronic pain, summarized:
High-dose route: 92 women with fibromyalgia, 300 to 500 mg infusions repeated about every 6 months. 75% improved meaningfully, and 33% held onto more than 50% relief for two years.
Combined route: 30 patients with nerve pain, randomized. Three low-dose infusions plus 16 hours of psychotherapy outperformed either treatment alone, with nearly 80% reaching meaningful improvement in pain interference.
The two studies covered different conditions, doses, outcomes, and timelines, so they cannot be ranked against each other. The randomized comparison inside the Toronto trial is the real evidence that adding therapy helps.
All chronic pain is neuroplastic, so a shift in nervous system state and a stretch of relief can benefit patients with any pain type.
Neither protocol is right or wrong. They are documented options physicians can now personalize around the patient and their own style of practice.
Ketamine remains an off-label treatment for chronic pain and fibromyalgia, and it requires proper screening, monitoring, and an experienced clinician. If you have fibromyalgia or nerve pain that has not responded to standard care and you want to understand which of these approaches could fit your situation, my team and I can help you evaluate that.
This article is for educational purposes and is not medical advice. Talk with your physician before starting, stopping, or combining any pain treatment.