Classic psychedelic substances like magic mushrooms (psilocybin) and lysergic acid diethylamide (LSD) have shown promising results in clinical trials for treating a multitude of mental health disorders, especially when paired with psychotherapy. While the primary focus of psychedelic research has been centered on their antidepressant and antianxiety effects, a new study has found that psychoactive drugs can also be used in the treatment of chronic pain conditions.
Chronic pain and current treatment options
Chronic pain is described as continuous pain that lasts for over three months. The condition is one of the most costly health problems in the country and can interfere with one’s daily life and psychological state. A recent report published by the U.S. Centers for Disease Control and Prevention estimated that over 51 million Americans — more than 20% of U.S. adults experience chronic pain.
Depending on the cause of the chronic pain condition, individuals can be treated with surgery, acupuncture, or physical therapy, but many rely on medications to ease their discomfort. While nonsteroidal anti-inflammatory drugs (NSAIDs) can alleviate symptoms in milder cases of pain, more severe instances require stronger pain medicines, such as opioids. Unfortunately, opioids can cause a variety of unwanted side effects and are highly addictive. An estimated 5 to 8 million Americans rely on opioids for long-term chronic pain management, and of those who take prescription opioids for noncancer pain, one in four struggle with opioid dependence (1).
These pharmacological interventions do not help treat the cause of the pain but instead, block pain receptors and suppress the nervous system, making them a risky and temporary solution for pain management. Though many pain medications may cause relief in some individuals, a large portion of patients do not benefit from them (2). More safe and effective approaches to managing chronic pain are necessary to improve patient’s quality of life and mitigate the risks of opioid addiction or dependency.
Chronic pain is a complex condition that goes beyond physical injury and discomfort. The condition is also linked to psychological and neurobiological causes, which can be difficult to determine in many cases. Over the past few decades, research has examined the use of psychedelics in managing chronic pain due to their ability to provide rapid and sustained symptom reductions in those with underlying psychological conditions.
Prior to the War on Drugs, researchers tested the analgesic effects of hallucinogens and found evidence that they were efficient in treating neuropathic pain, cancer pain, and phantom limb pain (3). Following the criminalization of these substances, studies were put on hold. Still, a more recent 2015 study also found that those suffering from cluster headaches found relief when using a low dose of psilocybin (4).
Among growing evidence of psychedelic’s potential to manage chronic pain, researchers are still unsure how effective the substances are, and the mechanism of action that causes this effect remains unclear. A plausible theory suggests that psychedelics induce the activation of serotonin receptors (5-HT2A) (5). This process could potentially promote neuroplasticity, allowing the brain to adapt while also reducing inflammatory factors. However, these mechanisms have not yet been scientifically proven.
Results of the study
Last year, researchers set up an online survey on 170 self-medicated patients of varying demographics with chronic pain disorders to further understand the apparent analgesic effects of psychedelics. Questions on the survey included information about the patient’s history of psychedelic use and what serotonergic agonists they were most experienced in using for their self-medication (LSD, psilocybin, DMT, 5-MeO-DMT, ayahuasca, mescaline, or other). Non-classical psychedelics like ketamine and MDMA were excluded from the study. The patients were also asked about the amount of pain they experienced from their conditions, along with the relief they had achieved with conventional treatments, cannabis, full doses of psychedelic medicine, and microdoses. The data of the survey included information related to five different conditions with diagnostic similarities: arthritis, migraines, tension-type headaches, fibromyalgia, and sciatica (6).
Following the survey, a new study analyzed the reported findings. Based on the results, participants reported a decrease in self-rated pain scores after using psychedelics compared to traditional pain medications. This improvement was observed for all surveyed pain conditions except for sciatica.
Participants with migraines found greater pain relief when microdosing, while individuals with fibromyalgia and arthritis experienced more relief with full high doses.
Several survey respondents reported that the duration of pain relief lasted after the date of administration for both full and microdoses. The researchers of this study believe that psychedelics could potentially be useful for acute, currently experienced pain and also as a preventative pain treatment (7).
Some limitations of the study include the lack of a placebo and the nature of the survey being completed by a self-selected sample offering retrospective self-ratings. Another limitation is the lack of survey inquiry on the participant’s set and setting or dosing schedule.
The future of psychedelic drugs for chronic pain management
Future research into psychedelic medicine for chronic pain relief should focus on clinical studies that could provide more solidified evidence. Through controlled doses, dosing schedules, and an in-depth analysis of the participant’s biological and psychological states, researchers can better understand the mechanisms that lead to their analgesic effects.
Further studies can also help establish the safety and efficacy of psychedelic medicines for chronic pain management in diverse patient populations. Additionally, clinical trials can examine the long-term effects of psychedelic treatment on pain relief to determine if limited treatments can provide lasting results.
Nonetheless, individuals with chronic pain conditions may finally have a more effective treatment option without the risk of dependency, as seen with addictive opioids. The future of psychedelic medicine in chronic pain management holds great promise, but adequately conducted clinical research is crucial to the understanding and implementation of this potential treatment option.
References
- Boscarino, Joseph A., Margaret Rukstalis, Stuart N. Hoffman, John J. Han, Porat M. Erlich, Glenn S. Gerhard, and Walter F. Stewart. 2010. “Risk Factors for Drug Dependence among Out-Patients on Opioid Therapy in a Large US Health-Care System.” Addiction 105 (10): 1776–82. https://doi.org/10.1111/j.1360-0443.2010.03052.x.
- Johannes, Catherine B., T. Kim Le, Xiaolei Zhou, Joseph A. Johnston, and Robert H. Dworkin. 2010. “The Prevalence of Chronic Pain in United States Adults: Results of an Internet-Based Survey.” The Journal of Pain 11 (11): 1230–39. https://doi.org/10.1016/j.jpain.2010.07.002
- Fanciullacci, M., E. Del Bene, G. Franchi, and F. Sicuteri. 1977. “Phantom Limb Pain: Sub-Hallucinogenic Treatment with Lysergic Acid Diethylamide (LSD-25).” Headache: The Journal of Head and Face Pain 17 (3): 118–19. https://doi.org/10.1111/j.1526-4610.1977.hed1703118.x.
- Schindler, Emmanuelle A. D., R. Andrew Sewell, Christopher H. Gottschalk, Christina Luddy, L. Taylor Flynn, Hayley Lindsey, Brian P. Pittman, Nicholas V. Cozzi, and Deepak C. D’Souza. 2020. “Exploratory Controlled Study of the Migraine-Suppressing Effects of Psilocybin.” Neurotherapeutics, November. https://doi.org/10.1007/s13311-020-00962-y.
- Castellanos, Joel P, Chris Woolley, Kelly Amanda Bruno, Fadel Zeidan, Adam Halberstadt, and Timothy Furnish. 2020a. “Chronic Pain and Psychedelics: A Review and Proposed Mechanism of Action.” Regional Anesthesia & Pain Medicine 45 (7): 486–94. https://doi.org/10.1136/rapm-2020-101273.
- Bonnelle, Valerie, Will J Smith, Natasha L Mason, Mauro Cavarra, Pamela Kryskow, Kim PC Kuypers, Johannes G Ramaekers, and Amanda Feilding. 2022. “Analgesic Potential of Macrodoses and Microdoses of Classical Psychedelics in Chronic Pain Sufferers: A Population Survey.” British Journal of Pain 16 (6): 619–31. https://doi.org/10.1177/20494637221114962.
- Cavarra, Mauro, Natasha L Mason, Kim P.C. Kuypers, Valérie Bonnelle, Will J Smith, Amanda Feilding, Pamela Kryskow, and Johannes G Ramaekers. 2023. “Potential Analgesic Effects of Psychedelics on Select Chronic Pain Conditions: A Survey Study.” European Journal of Pain, August. https://doi.org/10.1002/ejp.2171.
