Are psychedelic medicines the reset for chronic pain? Preliminary findings and research needs
Chronic pain is a leading cause of disability, reduced productivity, healthcare seeking behavior, and a contributor to opioid overdose in the United States. For many people, pain can be satisfactorily managed by existing medicines and comprehensive psychosocial treatments. For others, available trea...
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| Published in: | Neuropharmacology Vol. 233; p. 109528 |
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| Main Authors: | , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Elsevier Ltd
01-08-2023
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Chronic pain is a leading cause of disability, reduced productivity, healthcare seeking behavior, and a contributor to opioid overdose in the United States. For many people, pain can be satisfactorily managed by existing medicines and comprehensive psychosocial treatments. For others, available treatments are either ineffective or not acceptable, due to side effects and concerns about risks. Preliminary evidence suggests that some psychedelics may be effective for certain types of pain and/or improved quality of life with increased functionality and reduced disability and distress in people whose pain may never be completely relieved. Efficacy in these quality-of-life related outcomes would be consistent with the 'reset in thinking' about chronic pain management being increasingly called for as a more realistic goal for some people as compared to complete elimination of pain. This commentary summarizes the rationale for conducting more basic research and clinical trials to further explore the potential for psychedelics in chronic pain management. Additionally, if shown to be effective, to then determine whether the effects of psychedelics are primarily due to direct antinociceptive or anti-inflammatory mechanisms, or via increased tolerability, acceptance, and sense of spirituality, that appear to at least partially mediate the therapeutic effects of psychedelics observed in psychiatric disorders such as major depression. This commentary represents a collaboration of clinical and more basic scientists examining these issues and developing recommendations for research ranging from neuropharmacology to the biopsychosocial treatment factors that appear to be as important in pain management as in depression and other disorders in which psychedelic medicines are under development.
This article is part of the Special Issue on "National Institutes of Health Psilocybin Research Speaker Series".
•Chronic pain frequently involves biological, emotional, and psychosocial factors.•Pain treatment is increasingly focused on improving functionality and quality of life.•Preliminary evidence suggests that some psychedelics may relieve chronic pain.•Psychedelics may improve functionality and quality of life in chronic pain patients.•The therapeutic potential of psychedelics for chronic pain warrants expanded research.
This commentary discusses the possibility that psychedelic substances may be effective in managing key debilitating biopsychosocial dimensions of chronic pain, regardless of whether they have robust effects for reducing pain in acute pain models. It also discusses some of the putative neuropharmacological mechanisms of action and research findings that seem to raise as many questions as answers to the neuropharmacological-based mechanisms of action. We also discuss strategies going forward that include key areas of research that are needed to determine if psychedelics might have a sufficient benefit to warrant approval by regulatory authorities for the treatment of chronic pain. To be clear, this commentary does not contend that psychedelics have been demonstrated as safe and effective in the treatment of chronic pain, but that preliminary evidence suggests they merit consideration for further research from basic neurobiology and neuropharmacology to clinical trials to determine if they could safely and effectively treat at least some categories of chronic pain as discussed in greater detail elsewhere (e.g., Dworkin et al., 2021; Schindler, 2022). |
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| Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
| ISSN: | 0028-3908 1873-7064 |
| DOI: | 10.1016/j.neuropharm.2023.109528 |