Self-Medication for Chronic Pain Using Classic Psychedelics: A Qualitative Investigation to Inform Future Research

Abstract

Background: Chronic Pain is among the leading causes of disability worldwide with up to 60% of patients suffering from comorbid depression. Psychedelic-assisted therapy has recently been found effective in treating a host of mental health issues including depression and has historically been found to be useful in treating pain. Reports of self-medication for chronic pain using psychedelic drugs have been widely documented, with anecdotal evidence indicating widespread success in a range of pathologies.Aims: In preparation for an upcoming trial, to better understand how those with lived experience of chronic pain self-medicate with psychedelic drugs, and to establish, in detail, their therapeutic protocols and practices for success.Methods: As part of patient-involvement (PI) for an upcoming trial in this population, 11 individuals who reported self-medicating with psychedelic drugs took part in a 1-h semi-structured discussion, which was then transcribed and thematically analyzed.Results: Across a range of psychedelic substances and doses, reported pain scores improved substantially during and after psychedelic experiences. Two processes, Positive Reframing and Somatic Presence, were reliably identified as playing a role in improvements in mental wellbeing, relationship with pain, and physical (dis)comfort. Inclusion of other strategies such as mindfulness, breathwork, and movement were also widely reported. Due to the data's subjective nature, this paper is vulnerable to bias and makes no claims on causality or generalisability. Together, these results have been used to inform study design for a forthcoming trial.Conclusion: This pre-trial PI work gives us confidence to test psychedelic therapy for chronic pain in a forthcoming controlled trial. The results presented here will be instrumental in improving our ability to meet the needs of future study participants.

Psychedelic Therapy's Transdiagnostic Effects: A Research Domain Criteria (RDoC) Perspective

“…Psychedelics modulate the immune system via 5-HT1, 5-HT2, and sigma-1 receptor activity (18, 233, 241-248). Altered immune system function, mainly characterized by chronic lowgrade inflammation is associated with a range of psychiatric disorders (57,(249)(250)(251) and it remains an open question whether the potential anti-inflammatory activity of psychedelics will play a role in autoimmune disorders (252) or chronic pain (253,254).…”

Psychedelics: Their Limited Understanding and Future in the Treatment of Chronic Pain

“…Recent studies found that psychedelic-assisted therapy can effectively treat pain and mental health disorders [ 6 ]. Various reports of self-medication using psychedelics are documented, with anecdotal evidence of practical successes [ 7 ]. Suppose we consider our current pain medication regime, including non-steroidal anti-inflammatory drugs (NSAIDs), weak opioids, anti-depressants, and anticonvulsants.…”

“…Suppose we consider our current pain medication regime, including non-steroidal anti-inflammatory drugs (NSAIDs), weak opioids, anti-depressants, and anticonvulsants. Most pain medication regime has various side effects if used for an extended period; for example, opioid use is linked chiefly with drug dependence and has contributed to the ongoing international opioid crisis [ 7 ]. Hence there are several problems with current treatments for pain management.…”

“…Hence there are several problems with current treatments for pain management. Early studies in the 1960s and 1970s suggest that psychedelic drugs may help treat specific cancer pain and phantom limb pain [ 7 ]. The brain's activity under the influence of psychedelics affects the cerebral cortex, where sensory fibres terminate or motor fibres originate.…”

“…A recent survey of patients with chronic pain when self-medicated has shown a positive change in patients with chronic pain and toward the perspective of hope, empowerment, and optimism. Somatic presence fostered increased embodiment and was associated with prolonged analgesia [ 7 ]. Such studies in the field of psychedelics need to be researched and understood to bring effective changes in pain management.…”