Psychedelics and Chronic Pain

Aug 13

Chronic pain is one of the most prevalent ailments and disabilities worldwide - some estimates put it at 20% of the population (that could mean more than a billion people worldwide suffer from some sort of chronic pain). Do psychedelics have anything to offer this issue?

Yes, I believe they do.

It is becoming more challenging to ignore the therapeutic potential of psychedelics for chronic pain challenges. This may also be true of phantom limb pain, disorders of central sensitivity including chronic fatigue and irritable bowel syndromes, post viral syndromes, and even complex regional pain syndrome.

Ok, that seems a little too optimistic, right? Let me be clear: the varying ailments that can be labeled chronic pain and the potential for psychedelics to be of impact need more study. We are in a sea of uncertainty. However, in this sea of uncertainty, all of the compasses are pointing toward a whole new way of thinking about chronic pain and how psychedelics might be helpful.

To break this down, let's talk about four things: (1) what pain really is, (2) how psychological factors influence pain, (3) how neuroplasticity impacts pain, and (4) the inflammation part of the story. Spoiler: all of these relate to why it is likely that psychedelics have something therapeutic to offer the chronic pain challenge.

Pain is an output of the brain. When we’re hurting, our experience suggests the pain is occurring at the site of injury. But this is an illusion - all pain is entirely created by the brain. Sure, various nerve types originating from the site of injury are involved in this process. But make no mistake, pain is generated by the brain; it is not occurring at the site of injury. Dr. Lorimer Moseley has a wonderful talk on this : https://www.youtube.com/watch?v=gwd-wLdIHjs.

Well if the above is true, it suggests that many contextual factors can influence the experience of pain, including our psychological processes. A simple way to understand this is danger vs safety. You might think of pain as a danger alarm that can actually signal trouble when there is no danger (ever experienced a smoke detector go off when there's no fire? A similar thing can happen with our pain systems). Consider this research that demonstrated a significant reduction in back pain by helping patients understand and then experience their pain as a false alarm. https://pubmed.ncbi.nlm.nih.gov/34586357/ . In simple terms, relief was found by reinterpreting these painful experiences as danger alarms gone awry. Let’s pair with this the understanding that psychedelics help us revise stuck belief systems: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588209/ . Perhaps psychedelics can help revise a stuck belief system about what our pain experience really is.

So if the brain creates pain, and psychological processes are a part of it, it might be useful to think of chronic pain as a neural network that has become too ingrained. Our brain has become too good at creating this pain experience. Thank goodness for “neuroplasticity” - the well understood capability of our nervous system to change throughout our lives. Ingrained neural networks can be changed through the process of neuroplasticity. Well more good news, psychedelics increase the neuroplastic tendency of neurons on a broad scale: https://pubmed.ncbi.nlm.nih.gov/36795823/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082376/.

Now while we have emphasized that the brain creates the pain experience, it does have support. Say you cut your finger - nociceptive neurons will communicate this tissue damage experience to the brain, but there will also be immediate responses at the injury site that promote inflammation. Inflammation is a major part of the pain experience as well - when inflammation occurs, varying compounds (including pro inflammatory cytokines) will perpetually set off a cascade that sends danger alarms to the brain. Without getting into the weeds, inflammation can contribute to states of sustained pain and disease. Indeed there is support that psychedelics contribute to an inflammation reduction many times stronger than ibuprofen! https://pubmed.ncbi.nlm.nih.gov/30102081/

All combined: all pain is generated in the brain - the same brain that is involved in our psychology and made up of neurons that are capable of neuroplasticity. Inflammation in the body influences whether the brain generates pain. There is evidence that psychedelics can help change psychological belief systems, can enhance neuroplasticity, and operate as a powerful inflammation reducer.

Make no mistake, while chronic pain is quite widespread, the individual ways in which it manifests are vast and varied. There will undoubtedly be nuance and variation on how each specific ailment/ individual can best treat their condition with psychedelics. The most effective protocols are still being researched.

But the compass seems to be strongly pointing towards psychedelics having something to offer many of the millions of chronic pain sufferers.

Sources:

Reduced inflammation: https://pubmed.ncbi.nlm.nih.gov/30102081/

Increased neuroplasticity: https://pubmed.ncbi.nlm.nih.gov/36795823/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082376/

Gut brain axis: https://www.sciencedirect.com/science/article/pii/S1697260022000576

Immune function: https://pubmed.ncbi.nlm.nih.gov/33035575/

Revision of stuck belief systems: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588209/