Attending physician; Clinical director Northwell Health Zucker School of Medicine at Hofstra New York, New York
Abstract Title: Unlocking the Brain's Pain Relief Potential: Exploring Psychedelic-Assisted Therapy for Chronic Pain
Background: Chronic pain remains a complex puzzle, defying a single cause and often resisting traditional treatments. It impacts 1.5 billion people and more than 50 million people in the US. Management of chronic pain prioritizes non-opioid medications like acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) to minimize risks. While opioids have a role in acute and cancer pain, their use in chronic pain is debated due to potential addiction. Despite guidelines restricting their use, many patients receive strong opioids for chronic pain, contributing to the opioid crisis. This highlights the urgent need for effective, non-opioid alternatives.
Purpose/Objectives: Considering the shortcomings of available modalities, it is overdue for us to explore new ways to help. With medicine like LSD and psilocybin, there are new frontiers in pain management emerging. The purpose of the current presentation is to review and analyze psychedelic-assisted therapy for chronic pain, and evaluate their efficacy in light of brain neurotransmitter systems.
Methods: Literature searches and personal experience in clinical practice contributed to the knowledge base that led to the review and perspective expressed in this presentation.
Results: Though used for centuries in various cultures for spiritual or recreational purposes, psychedelics also held promise for treating mental health and chronic pain conditions. However, the 1960s saw a surge in recreational use, leading to stigmatization and classification as Schedule 1 drugs under the Controlled Substances Act in the US. This effectively shut down further clinical research for decades.2 Thankfully, recent years have witnessed a resurgence in human studies exploring the potential of psychedelics, despite ongoing hurdles and challenges.
These substances may hold the key to rewiring pain pathways in the brain. While traditionally, the class of medications have focused on mental health, positive surprises were discovered by accidentally resolving chronic pain. Starting from case reports of patients participating in studies for major depressive disorder, addiction, or obsessive-compulsive disorder and then discovering their physical pain has completely resolved. Eventually, these discoveries lead to more formal research as well as advocacy in the area.
The precise mechanisms by which psychedelics, such as lysergic acid diethylamide (LSD) and psilocybin, alleviate chronic pain remain under investigation. However, several potential pathways are explored. Psychedelics primarily act through the 5-HT2A receptor, possibly disrupting established pain pathways and promoting neuroplasticity, the brain's capacity for reorganization. 3 Additionally, they may influence inflammation and blood pressure, both of which can modulate pain perception.
Conclusions/Implications for future research and/or clinical care: While the science behind their pain-relieving effects is still being unraveled, and past research hasn't always been the most robust, psychedelics have a surprisingly long history of easing cancer-related pain. In fact, recent studies are painting a promising picture for their ability to not only manage physical discomfort but also improve emotional well-being in patients with cancer. Additionally, patients with severe headaches like cluster migraines report self-medicating with psychedelics to find relief. 5 Ongoing clinical trials are delving deeper into their efficacy, particularly for cluster headaches. Notably, psychedelics offer a potentially safer alternative to opioids, lacking their addictive properties and exhibiting a favorable safety profile. This research suggests a paradigm shift in chronic pain management. Psychedelic-assisted therapy could offer a much-needed weapon in the fight against chronic pain, empowering patients to find lasting relief.
References: 1. Sarah E.E. Mills, Karen P. Nicolson, Blair H. Smith,Chronic pain: a review of its epidemiology and associated factors in population-based studies,British Journal of Anaesthesia,Volume 123, Issue 2,2019,Pages e273-e283,
2. Kooijman NI, Willegers T, Reuser A, Mulleners WM, Kramers C, Vissers KCP, van der Wal SEI. Are psychedelics the answer to chronic pain: A review of current literature. Pain Pract. 2023 Apr;23(4):447-458. doi: 10.1111/papr.13203. Epub 2023 Jan 11. PMID: 36597700.
3. Castellanos JP, Woolley C, Bruno KA, et al,Chronic pain and psychedelics: a review and proposed mechanism of action,Regional Anesthesia & Pain Medicine 2020;45:486-494
4. Preller, K. H., Herdener, M., Pokorny, T., Planzer, A., Kraehenmann, R., Stämpfli, P., ... & Vollenweider, F. X. (2017). The fabric of meaning and subjective effects in LSD-induced states depend on serotonin 2A receptor activation. Current Biology, 27(3), 451-457.
5. Sewell RA, Halpern JH, Pope HG Jr. Response of cluster headache to psilocybin and LSD. Neurology. 2006 Jun 27;66(12):1920-2. doi: 10.1212/01.wnl.0000219761.05466.43. PMID: 16801660.
