Chronic Pain and Psychedelics
Research has suggested psychedelic therapy can have profound positive impacts on people’s quality of life. With chronic pain disorders impacting daily function and often leading to various mental health problems, what might psychedelic therapy offer these individuals?
Whether or not psychedelics decrease ongoing pain remains unclear. Yet, there’s a possibility that psychedelic therapy could aid in transforming the day-to-day living of people with pain, looking beyond just their pain levels and shifting the narrow focus of “does the treatment reduce the pain” to “how does the treatment affect overall wellbeing.”
Treating and Managing Chronic Pain
Pain is a vital function of our survival, warning the body about potential danger and preventing disease or injury. But when pain persists beyond its purpose, it becomes dysfunctional and can have severe negative consequences on the person experiencing the pain’s life. Chronic pain is estimated to affect over 20% of the population and is one of the leading causes of disability worldwide. As such finding effective treatments is essential.
There are several elements to current chronic pain treatment. Outside of pharmaceuticals, pain management programs are standard in chronic pain treatment and include things like physical therapy, cognitive-behavioural therapies, and diet. However, the human fixation, particularly in Western medicine, on “magic-bullet” cures can often lead to the neglection of lifestyle changes in pursuit of a one-treatment-solves-all approach. Treatment of which being some sort of medication.
Medication is undoubtedly a valuable tool. When people suffer intense and extreme ongoing pain, their top priority is reducing the pain to a bearable level. By managing the pain levels, medication can support those with persistent pain to make healthier choices that can aid quality of life. Yet, in practice, people often use medications as stand-alone treatments, which creates the possibility for more harm than good.
Cycle highlighting how physical symptoms of chronic pain affect lifestyle and psychological health, hence the need for pain management therapy that aims to improve broader aspects of chronic pain suffering.
Pain-relief medications causing more harm than good
Modern medicine has made significant accomplishments in pain relief, with an extensive medical library of prescription drugs effective at reducing pain. However, with high addiction potential and a mile-long list of unwanted physical and mental side effects, it’s apparent these medications come at a price.
Some of the severe health consequences of commonly prescribed pain medications include increased risk for kidney failure and heart disease. Mental health is also at risk with widespread substance abuse of opioids, and alarming evidence to suggest some medications go as far as increasing suicidality.
Managing and listening to the body
Yossi Burland, MS Patient and Psychedelics advocate
I spoke with a chronic pain patient, Yossi Burland, who suffers ongoing pain linked to multiple sclerosis. Like many, he relied purely on medication to treat his pain. However, he stopped due to their unwanted side effects, including feelings of being disconnected from his sense of self and body, a dampening effect prevalent in many people using these drugs. Yossi quoted:
“I was hooked on opioids like codeine, tramadol, and eventually morphine which nearly ended me… I had no relation to my pain so I suffered horrible depression...From my experience with pain medication like opioids, benzodiazepines, and others the aim of killing pain can occasionally be achieved but at the cost of my mental and also my physical health too. Pain meds allowed me to function but caused me to lose contact with my body.”
While there is clearly a necessity for pain relief - it shouldn’t be offered as the foremost treatment nor approached as a long-term solution. Emphasis should be made on helping patients better cope with their pain, and psychedelics may be a means to aid this process.
Pain medications often come with an extensive list of negative side effects on health and mood
A Future Role of Psychedelics?
Cognitive behavioral therapies in chronic pain such as CBT and ACT focus on changing patients’ thoughts and behaviours around living with their condition. It can lead to sustained improvements in a patient’s physical, emotional, social, and occupational functioning. And most importantly, it’s free from all the side effects that medications bear.
Yet, unfortunately, for some patients, their thought and behavior patterns are so ingrained they become difficult to shift, and talking therapies alone is not enough. Not to mention that therapy is an extremely long and ongoing process. However, years of research into psychedelics highlights how psychedelic therapy could catalyze this therapeutic process.
Psychedelics can increase psychological flexibility, the ease with which thoughts and behaviors can shift. Evidence from imaging studies suggests psychedelics make the brain’s wiring more malleable, making it easier for communication patterns between nerves in the brain to change.
In chronic pain treatment, this means psychedelics could help rapidly transform a person’s relationship to their pain and jumpstart the process of them making healthier lifestyle choices.
Psychedelics may be able to increase nerve communication between different areas of the brain, allowing new connectivity patterns and nerve patterns to replace old ones, leading to new thoughts and behaviours.
How people respond to their pain can create a negative cycle. Relating to one’s pain in fearful and catastrophic ways causes stress and negative emotions. These can further increase perceived pain levels, creating more negative feelings and distress. By increasing stuck thought patterns to change, psychedelics could offer a means to break this cycle.
Some theories even suggest that psychedelics could change nerve communication patterns involved in creating ongoing painful sensations and, by doing so, could decrease or get rid of chronic pain altogether. However, the evidence supporting these theories remains minimal, and the varied nature of chronic pain means this would likely only work for a small subselection of patients.
Nonetheless, it is not a pain-decreasing effect that psychedelic research for chronic pain is chasing. For Yossi, psychedelics have helped him manage his pain, encouraged him to lead a healthier lifestyle, and learn to listen to his pain as a guide. He quoted:
“Pain is a signal, a communication and to manage my MS and chronic pain I need to listen to these messages and rest or alter my diet or supplements accordingly.
Psychedelics allow me to feel the pain but not be overwhelmed by it. I can stretch through yoga positions and work through any issues without the blinding pain. I also know my limits using these substances. Pain meds caused me injury as I was impervious to even severe pain causing me to overdo it.”
Psychedelic therapy could help patients change thoughts around their pain and aid patients to process traumas relating to their pain
Imagining a future of psychedelic therapy
Psychedelics remain largely illegal. But with increasing research around psilocybin therapy for depression and other mental health disorders, the likelihood of this treatment becoming legalised and medically available is becoming increasingly realistic. If and once licenced, “off-label” psilocybin therapy could become an “off-label” treatment for chronic pain patients, similar to how SSRI antidepressants are used in pain medicine today.
Psychedelics could be incorporated into pain management programs, combining psychedelic therapy with psychological support, holistic therapies, and mind-body exercises.
With a massive value in chronic pain peer-support groups, a future therapeutic model of psychedelic therapy could consider integrating group psychedelic sessions as a means to build a powerful community through shared experience.
It’s important to remember that there is still very limited evidence in the field of psychedelic therapy and chronic pain. However, scientific researchers are increasingly beginning to build evidence to support a vision,
James Close, a physiotherapist and pain management researcher based in London, is one of these researchers. He believes that the future of psychedelic therapy in chronic pain should be informed by the patients who will be affected by the researchers and not just the scientists.
His work with the Imperial College London’s Psychedelic Research team has involved speaking to patients with chronic pain, hearing what they might hope to get out of, and how they would ideally experience psychedelic therapy. In doing so, future studies investigating the usefulness of psychedelic therapy for chronic pain will be more aligned with needs of the patient.
Psychedelics and Chronic Pain: The Bottom Line
Whether or not psychedelic therapy aligns with the question “does it decrease the pain” remains largely unknown. Theoretically, they may be able to decrease or even alleviate physical pain. But where psychedelic therapy is of significance is its potential to ease psychological pain - the depression and negative thought loops that accompany chronic pain disorders.
As more light shines on the long-term health hazards, and as the epidemic of addiction to pain relief drugs grow, the need for new models of treatment in chronic pain is becoming ever more apparent. Shifting the focus from “does it decrease the pain” to “does their quality of life improve” psychedelic therapy could provide valuable lessons in shaping the future of chronic pain research..
