A Potentially Effective New Treatment for Chronic Pain

A recent study, published in the August 2023 issue of Neuropharmacology, examined whether psychedelic medicines (e.g., psilocybin, LSD, mescaline) may reduce chronic pain—and found preliminary evidence in favor of this conclusion.

The paper was authored by F. Z. Zia from the National Institutes of Health, and colleagues across the U.S.

Before discussing the study, an introduction and definitions.

What is Chronic Pain?

Unlike acute pain, which lasts a short time and is associated with tissue damage, chronic pain refers to pain that lasts or recurs for months or even years.

In the U.S., one in five adults has chronic pain. In other words, over 50 million Americans report experiencing symptoms every single day on most days.

Many conditions can cause (or are associated with) chronic pain. Some examples are arthritis, fibromyalgia, foot pain, irritable bowel syndrome (IBS), knee pain, tension headache, hip pain, low back pain, old injuries, and previous surgery.

In addition, a variety of biological, psychological, and social factors may worsen pain. For instance, research has found that feelings of loneliness correlate with increased acute and chronic pain. Guilt, which is common in this patient population, is similarly associated with worse pain and functioning.

Potential Treatments for Chronic Pain

Chronic pain may be managed using different approaches:

• Self-help: Rest, stress management, breathing techniques, meditation, relaxation practices, healthy eating, weight loss, exercise, sleep hygiene, and other techniques.
• Strength-based approaches: Some examples are positive psychology approaches like zest intervention, positive imagery, writing gratitude letters, and humor.
• Psychological therapies: In particular, cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).
• Physical therapy and physical modalities: For instance, massage, heat and cold applications, ultrasound, biofeedback, and electrical nerve stimulation.
• Pharmacological treatments: Over-the-counter medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), steroid injections, opioids, non-opioid medications (e.g., tricyclic antidepressants), gabapentin, etc.
• Surgery: Recommended in rare cases of severe and intractable pain.

Can Psychedelics Help Treat Chronic Pain?

Zia and colleagues, in their recent paper, discussed another potentially effective treatment for chronic pain: psychedelics such as psilocybin (magic mushrooms), lysergic acid diethylamide (LSD), mescaline, and dimethyltryptamine (DMT).

Psychedelics, sometimes also called hallucinogens, are psychoactive substances that induce altered states of consciousness and psychedelic experiences (e.g., mushroom or acid trips). Though commonly used for recreational purposes, recent research on medical uses of psychedelics has been promising. For instance, psilocybin has been shown to reduce depression.

Reviewing the research, Zia et al. conclude that psychedelics appear to be helpful in the treatment of headache disorders (migraines, cluster headaches), cancer pain, phantom limb pain, and neuropathic pain. They note psychedelics might be “effective adjuncts” for the “management of chronic pain and comorbid conditions that frequently involve pain, such as PTSD, and major depression in cancer patients.”

However, there is no consensus on the mechanisms of how these drugs reduce chronic pain. Potential mechanisms may include serotonergic processes (with possible anti-inflammatory effects), dopaminergic processes, neuroplasticity, and changes in brain functional connectivity (e.g., changes to the default mode network).

More research is needed to answer questions about mechanisms but also questions related to safety and efficacy, optimal dosing (e.g., microdosing), the importance of mystical experiences for therapeutic benefits, psychedelics’ effects on quality of life and co-occurring psychiatric disorders, etc.

Multimodal Approach to Chronic Pain

Psychedelics are a promising adjunct treatment—that is, as part of a multimodal approach, meaning an approach providing different modes of interventions at the same time. Why multimodal? Because the experience of pain has many dimensions:

• Biological: The extent of pain-causing illness/injury, genetic predisposition to pain sensitivity, other illnesses, and stress.
• Psychological: Emotions (fear, anxiety, anger, depression, guilt, shame), coping skills, the tendency to worry and catastrophize (e.g., believing the pain is unbearable and will never get better).
• Social: Supportive versus critical attitudes, views, and responses of loved ones (parents, siblings, spouse) to pain, work demands, access to quality medical care, and cultural beliefs and norms.
• Spiritual: The pain patient’s values, sense of meaning and purpose, belief in the possibility of healing (even in the absence of a cure), feelings of connection with all humanity and life, trust in God/other transcendent beings, etc.

As can be seen, one’s perception of pain is affected by many factors. And for a treatment approach to be successful, it must address the various dimensions of pain. We should keep this in mind, as we study medical uses of psychedelics.

Takeaway

Chronic pain refers to pain that is long-lasting or recurrent.

According to preliminary evidence, a number of psychedelics appear to alleviate chronic pain, reduce distress and disability, and improve the quality of life in chronic pain patients.

However, psychedelics are not a panacea for chronic pain. Why? Because chronic pain, though usually described in terms of physical sensations, is affected by many biological, psychological, social, cultural, and spiritual factors: genes, personality traits, psychological states (e.g., guilt, fear of dying, or tendency to catastrophize), coping skills, loneliness, unemployment, cultural attitudes toward pain or disability, and sense of meaning and purpose in life.

Therefore, although psychedelics could have great potential therapeutic value, they are only one element of an effective treatment. To manage chronic pain effectively, one must treat the whole person—body, mind, and spirit. To think otherwise may result in disappointment with this drug, or in psychedelic misuse and abuse.