Can Psychedelics Help Treat Chronic Pain Disorders?

Up to 20% of adults across the globe live with some form of chronic pain disorder, which can have a huge impact on well-being and quality of life.

Traditional treatment options for chronic pain consist of painkiller medications, surgery, physiotherapy and psychotherapy. However, some people do not respond to conventional treatments, and medications may come with unwanted side effects such as addiction.

Now, increasing studies suggest that psychedelic medicines - such as psilocybin - could potentially offer an alternative therapy route for those who have exhausted current options and failed to find relief.

Understanding Chronic Pain

Chronic pain is defined as lasting for three to six months or more, and can be caused by a number of different health conditions, such as fibromyalgia, endometriosis, migraines, neuropathic pain, and inflammatory and degenerative joint diseases.

Both physical and psychological issues can stem from chronic pain. These can include muscle and joint stiffness, numbness, tingling, chronic fatigue, brain fog, and physical stress responses such as increased heart rate and cortisol levels.

These symptoms can hugely impact quality of life, disrupting day-to-day activities, sleep, and relationships, and can potentially lead to a decreased ability to exercise, less productivity at work or job loss, social isolation, and physical health problems.

Living with chronic pain and its associated symptoms for a long time can also lead to the development of mental health conditions.

Research shows that:

• 45% of people with chronic pain experience depression.
• One-fourth of primary care patients with chronic pain meet the criteria for major depression.
• There is overlap between the brain circuits involved in both chronic pain and major depression.
• The relationship between physical and mental symptoms of chronic pain can be bidirectional.

Further mental health complications from chronic pain can include emotional distress, anxiety, post-traumatic stress disorder (PTSD), fear of movement and feelings of grief over the loss of identity, independence or physical abilities.

Why Researchers Are Exploring Psychedelics for Pain

While many people are able to manage symptoms with traditional treatments, chronic pain therapies and medications can often be limited in their effectiveness.

Increasing research is now exploring alternative and emerging treatments including gene therapy, neuromodulation, and therapies that address perception and cognition, such as psychedelics.

Psychedelics were studied through the 50s and 60s for mental health until the 1971 UN Convention on Psychotropic Substances brought research to a halt. In recent years, however, psychedelic research has demonstrated their potential as innovative treatments for conditions that overlap with chronic pain such as depression, anxiety and PTSD.

Research shows:

• 40% of people do not respond to analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs)
• 12% of people who use opioids end up dependent.
• 30% of individuals with depression do not respond to traditional antidepressants.

When medications fail, non-pharmacological interventions for chronic pain, such as physical therapy and psychological care, are often used as alternative treatment options.

However, while studies show that 77% of people report success with physical therapy for treating pain symptoms, over 20% fail to find relief. Further, more than half of depression patients do not respond to psychotherapy.

Given these rates of failure, there is an urgent need for innovative and alternative, non-addictive treatment options in chronic pain management.

What the Research Says So Far

Research shows that psilocybin improves mental health symptoms by inducing network-level brain changes. The compound has been found to increase Brain-Derived Neurotrophic Factor (BDNF) and induce neuroplasticity and neurogenesis, which work together to alleviate symptoms of depression by enabling the growth of new neural pathways and neurons in the brain.

Due to the overlapping of brain networks affecting depression and chronic pain, and as psilocybin is similar to serotonin - a neurotransmitter that helps modulate mood and pain - studies and early-stage clinical trials are now investigating psilocybin for the management of chronic pain conditions such as headaches, cancer-related pain and phantom limb pain.

Studies show:

• 91% of participants with headache disorders across five studies reported extended breaks between headaches when psilocybin was taken during a remission period.
• 26% of cancer patients in a phase 2, open‐label trial treated with psilocybin reported reduced pain severity.
• 79% of amputees that took part in a controlled clinical trial saw a reduction in residual phantom limb pain two-weeks following psilocybin treatment.
• Psilocybin treatment for psychological distress in cancer patients saw improvements in symptoms of pain, depression, anxiety symptoms, demoralization, disability and psycho-social-spiritual wellbeing in a systematic review and meta-analysis of clinical trials.

Currently, an ongoing clinical trial led by the University of Alabama, Birmingham, is investigating the effectiveness of psilocybin for fibromyalgia, a condition that causes widespread chronic pain throughout the body. In the trial, researchers will assess psilocybin’s efficacy for pain, fatigue and other fibromyalgia symptoms, as well as quality of life - currently hypothesizing that psilocybin will significantly reduce symptom severity.

How Psychedelics May Affect Pain Perception

Psychedelics may help to improve symptoms of chronic pain by affecting pain perception and helping individuals to reframe their relationship with pain.

In an Exploration of Neuroscience article, researchers suggest that the altered states induced by psychedelics “may lead to profound shifts in perception, cognition, and emotional processing” enabling patients to “perceive their pain differently, potentially reducing its intensity or emotional impact”.

They suggest this may work through the activation of serotonin receptors, the exertion of anti-inflammatory effects, enhancing descending inhibition, opening a window of neuroplasticity, and facilitating synaptic remodeling. Studies show this neuroplasticity disrupts dysfunctional connectivity related to pain processing to “reset” pain-related brain networks.

Plasticity is also thought to contribute to psilocybin’s ability to improve mental health symptoms, enabling maladaptive neural pathways to be replaced with new neurons and pathways that create healthier patterns of thinking and behavior.

Additionally, psilocybin works on the 5-HT2A receptor, which induces altered states of consciousness that are associated with deep emotional insights and processing that predict long-term mental health outcomes.

This psychological flexibility has been suggested to help reduce distress in people living with chronic pain, as well as supporting with reframing personal narratives surrounding trauma or pain.

What We Still Don’t Know

Emerging studies on psychedelics for chronic pain suggest that the compounds could hold promise for the treatment and management of related symptoms, but more research is needed to fully understand their safety and effectiveness.

Experts say that while psilocybin shows promise as a “multidimensional therapy” for chronic pain that could address both “sensory and affective components”, robust randomized controlled trials should be carried out to confirm efficacy and guide clinical translation.

Additionally, more research will be needed to fully understand other properties of psychedelic compounds that could target chronic pain. For example, some studies suggest that psilocybin may have anti-inflammatory properties, signaling a potential to address inflammation-related diseases such as arthritis that can cause chronic pain.

Importantly, psychedelics, including psilocybin, remain largely illegal across the globe.

While there are a small number of exceptions to this, an increasing number of countries such as Canada, the US, and Australia, are now beginning to enable select patient access to these therapies under specialized access schemes for specific conditions.

As psychedelics are placed in the highest scheduling category, regulatory reforms will be needed to enable large-scale healthcare access to psychedelic therapies.

Frequently Asked Questions

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