Beating Pain with Psychedelics: Matter over Mind?
This review (2021) makes the case for using psychedelics to treat pain. Key areas discussed include studies that have directly used psychedelics to treat pain, potential neuro-restorative effects of psychedelics in pain-related states of consciousness, anti-neuroinflammatory and pro-immunomodulatory actions of psychedelics and the safety, legal, and ethical consideration inherent in psychedelics’ pharmacotherapy. Psychedelics could also help to elucidate the mechanism of pain syndromes.
Authors
- Elman, I.
- Borsook, D.
- Pustilink, A.
Published
Abstract
Basic pain research has shed light on key cellular and molecular mechanisms underlying nociceptive and phenomenological aspects of pain. Despite these advances, [we still yearn for] the discovery of novel therapeutic strategies to address the unmet needs of about 70% of chronic neuropathic pain patients whose pain fails to respond to opioids as well as to other conventional analgesic agents. Importantly, a substantial body of clinical observations over the past decade cumulatively suggests that the psychedelic class of drugs may possess heuristic value for understanding and treating chronic pain conditions. The present review presents a theoretical framework for hitherto insufficiently understood neuroscience-based mechanisms of psychedelics’ potential analgesic effects. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain, analgesia, inflammatory, brain connectivity, ketamine, psilocybin, functional imaging, and dendrites. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) studies employing psychedelics for alleviation of physical and emotional pain; (2) potential neuro-restorative effects of psychedelics to remediate the impaired connectivity underlying the dissociation between pain-related conscious states/cognitions and the subcortical activity/function leading to the eventual chronicity through immediate and long-term effects on dendritic plasticity; (3) anti-neuroinflammatory and pro-immunomodulatory actions of psychedelics as the may pertain to the role of these factors in the pathogenesis of neuropathic pain; (4) safety, legal, and ethical consideration inherent in psychedelics’ pharmacotherapy. In addition to direct beneficial effects in terms of reduction of pain and suffering, psychedelics’ inclusion in the analgesic armamentarium will contribute to deeper and more sophisticated insights not only into pain syndromes but also into frequently comorbid psychiatric conditions associated with emotional pain, e.g., depressive and anxiety disorders. Further inquiry is clearly warranted into the above areas that have potential to evolve into further elucidate the mechanisms of chronic pain and affective disorders, and lead to the development of innovative, safe, and more efficacious neurobiologically-based therapeutic approaches.
Research Summary of 'Beating Pain with Psychedelics: Matter over Mind?'
Introduction
Chronic pain involves persistent alterations in peripheral and central nervous system structure and function that affect sensory, emotional and cognitive domains and reduce physical, psychological and social well-being. Elman and colleagues note that pain becomes chronic when it persists or recurs for more than 3 months and estimate prevalence in US adults at around 30%, roughly 100 million people, with societal healthcare costs in the hundreds of billions of dollars. Traditional pharmacological approaches, notably opioids, have important limitations including uncertain long-term benefit, risk of opioid use disorder and adverse endocrine and affective consequences; these shortcomings, combined with a paucity of objective biomarkers for pain, motivate the search for new treatments. This review evaluates the hypothesis that psychedelic drugs could constitute a novel therapeutic avenue for chronic pain. Rather than focusing solely on their psychoactive effects, Elman and colleagues adopt a systems-based perspective that considers rapid and persistent changes in brain connectivity, synaptic plasticity, anti-inflammatory actions and modulation of descending pain pathways as putative mechanisms. The paper surveys preclinical and clinical evidence, highlights ketamine as a model compound, summarises limited clinical reports, and discusses regulatory, legal and ethical issues that bear on research and potential clinical use.
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Study Details
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- APA Citation
Elman, I., Pustilnik, A., & Borsook, D. (2022). Beating Pain with Psychedelics: Matter over Mind?. Neuroscience & Biobehavioral Reviews, 134, 104482. https://doi.org/10.1016/j.neubiorev.2021.12.005
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