Low-Dose Ketamine for Chronic Pain: A Biopsychosocial Approach with Michelle Weiner, DO, MPH

In this episode, Michelle Weiner, DO, MPH returns to share her expertise on low-dose ketamine for chronic pain. Dr. Weiner is double board-certified in Interventional Pain Medicine, Physical Medicine, and Rehabilitation. She is founder of Neuropain Health delivering personalized integrative care treating the root cause of pain and suffering, both physical and emotional, using a multidisciplinary biopsychosocial approach with many years of clinical experience with ketamine-assisted therapy. In this conversation, Dr. Weiner reframes chronic pain as more than a symptom of tissue damage, describing it instead as a complex sensory and emotional experience shaped by the brain, nervous system, and a person's broader life context. She explains how chronic pain can become entrenched through maladaptive neural network patterns, fear, stress, and identity-level beliefs, and argues that effective treatment must move beyond symptom suppression toward a biopsychosocial model that addresses suffering, function, and quality of life. Drawing on her clinical work, Dr. Weiner discusses how low-dose ketamine, when paired with preparation, integration, pain reprocessing therapy, somatic work, and functional movement, may help create a window of neuroplasticity that allows patients to interrupt rigid pain patterns and reconnect with their own capacity for healing.   In this episode, you'll hear: How Dr. Weiner understands chronic pain The "triple network model" of neuropsychiatric conditions and how Dr. Weiner applies this to thinking about chronic pain Why imaging, injections, and medications often fall short once pain has become chronic and centrally mediated The gate control theory of pain and how this relates to possible mechanisms of ketamine treatments of pain How ketamine may support chronic pain treatment by creating a temporary window of neuroplasticity that can be used for deeper therapeutic change What pain reprocessing therapy is and why Dr. Weiner sees it as a first-line intervention for many chronic pain conditions Patient stories from Dr. Weiner's practice where belief change was a key component of healing pain   Quotes: "Over time, when [pain] becomes chronic, it's no longer trying to alter the physical body, it's actually trying to reprocess what's happening in the brain." [3:47] "Ketamine for me started to become more interesting because I realized that this wind-up phenomenon that is so responsible for a lot of people's chronic pain can actually start to be reversed when we start using medications [like ketamine] that can change the balance of glutamate and GABA [neurotransmitters]." [14:26] "So I just started to think, how can we use the lowest dose of ketamine to create neuroplasticity, guide them in a way that they're able to move and shift the story, and then that's how you can create long term change.  [18:51]  "The key is to understand that we are our own healers. If we're not involved in actively participating in our treatment, then we're relying on someone else outside of us and that's not really a long term plan." [29:20] "More with ketamine is definitely not better. When people feel so disconnected and so separate from themselves, they can experience more fear. And I think that's important to have that sweet spot where they're able to get that time out. They're not really feeling their pain, they're not in their ordinary mind and their conscious thoughts and they're able to have the brain connect in a different way and experience things differently, which then creates hope and allows them to really wake up and say, 'oh, there there are other options out here for me.'" [30:11]   Links: Dr. Weiner's recent article "Treating chronic pain with low dose ketamine and adjunct therapies within a biopsychosocial approach: a case series" Dr. Weiner's website: Neuropain Health Dr. Weiner on Instagram Dr. Weiner on LinkedIn Previous episode: Ketamine-Assisted Psychotherapy for Chronic Pain with Michelle Weiner, DO, MPH Psychedelic Medicine Association Porangui