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mr peabody

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Pinwheel flower

A Natural Treatment for Chronic Pain

LIH | Neuroscience News | 3 Jun 2021

Summary: Conolidine, a natural painkiller derived from the pinwheel flower and frequently used in Chinese medicine, interacts with a newly identified opioid receptor that regulates natural opioid peptides produced in the brain.

Building on their previous findings, scientists from the Immuno-Pharmacology and Interactomics group at the Department of Infection and Immunity of the Luxembourg Institute of Health (LIH), in collaboration with the Center for Drug Discovery at RTI International (RTI), a nonprofit research institute, have demonstrated that conolidine, a natural painkiller derived from the pinwheel flower and traditionally used in Chinese medicine, interacts with the newly identified opioid receptor ACKR3/CXCR7 that regulates opioid peptides naturally produced in the brain.

The researchers also developed a synthetic analogue of conolidine, RTI-5152-12, which displays an even greater activity on the receptor.

These findings, which were published on June 3rd in the prestigious international journal Signal Transduction and Targeted Therapy, further advance the understanding of pain regulation and open alternative therapeutic avenues for the treatment of chronic pain.

Opioid peptides are small proteins that mediate pain relief and emotions, including euphoria, anxiety, stress and depression, by interacting with four classical receptors (“molecular switches”) in the brain. Dr Andy Chevigné, Head of Immuno-Pharmacology and Interactomics, and his team had previously identified the chemokine receptor ACKR3 as a novel fifth atypical opioid receptor, with high affinity for various natural opioids.

ACKR3 functions as a ‘scavenger’ that ‘traps’ the secreted opioids and prevents them from binding to the classical receptors, thereby dampening their analgesic activity and acting as a regulator of the opioid system.

In the current study, the researchers identified ACKR3 as the most responsive target for conolidine, an alkaloid with analgesic properties, by screening over 240 receptors for their ability to be activated or inhibited by this molecule.

“We confirmed that conolidine binds to the newly identified opioid receptor ACKR3, while showing no affinity for the other four classical opioid receptors. By doing so, conolidine blocks ACKR3 and prevents it from trapping the naturally secreted opioids, which in turn increases their availability for interacting with classical receptors. We believe that this molecular mechanism is at the basis of the beneficial effects of this traditionally used medicine on pain relief,” said Dr Martyna Szpakowska, first author of the publication and scientist within the LIH Immuno-Pharmacology and Interactomics group.

In parallel to characterising the interaction between conolidine and ACKR3, the two teams went a step further. The scientists developed a modified variant of conolidine — which they called “RTI-5152-12” — which exclusively binds to ACKR3 with an even higher affinity.

Like LIH383, a patented compound previously developed by Dr. Andy Chevigné and his team, RTI-5152-12 is postulated to increase the levels of opioid peptides that bind to classical opioid receptors in the brain, resulting in heightened painkilling activity.

The LIH-RTI research teams established a collaboration agreement and filed a joint patent application in December 2020.

“The discovery of ACKR3 as a target of conolidine further emphasises the role of this newly discovered receptor in modulating the opioid system and, consequently, in regulating our perception of pain,” said Dr. Chevigné, corresponding author of the publication and leader of the LIH Immuno-Pharmacology and Interactomics group.

“Our findings could also mean that conolidine, and potentially also its synthetic analogues, could carry new hope for the treatment of chronic pain and depression, particularly given the fact that conolidine was reported to trigger fewer of the detrimental side-effects — namely addiction, tolerance and respiratory problems — associated with commonly used opioid drugs like morphine and fentanyl.”

“Our work could therefore set the basis for the development of a new class of drugs with alternative mechanism of action, thereby contributing to tackling the public health crisis linked to the increasing misuse of and addiction to opioid drugs,”
says Dr. Ojas Namjoshi, co-corresponding author of the publication and lead scientist on the study at RTI.

“Once again, we have built on the findings of our excellent fundamental research and translated them into applications with the potential of tangibly improving clinical outcomes for patients,” said Prof Markus Ollert, Director of the LIH Department of Infection and Immunity.

 

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More than half of people using cannabis for pain experience multiple withdrawal symptoms

University of Michigan | Neuroscience News | 8 Jan 2021

More than half of people who use medical marijuana products to ease pain experience clusters of multiple withdrawal symptoms, a new study finds.

And about 10% of the patients taking part in the study experienced worsening changes to their sleep, mood, mental state, energy and appetite over the next two years as they continued to use cannabis.

Many of them may not recognize that these symptoms come not from their underlying condition, but from their brain and body’s reaction to the absence of substances in the cannabis products they’re smoking, vaping, eating or applying to their skin, says the University of Michigan Addiction Center psychologist who led the study.

When someone experiences more than a few such symptoms, it’s called cannabis withdrawal syndrome – and it can mean a higher risk of developing even more serious issues such as a cannabis use disorder.

In the new research published in the journal Addiction, a team from the U-M Medical School and the VA Ann Arbor Healthcare System reports findings from detailed surveys across two years of 527 Michigan residents. All were participating in the state’s system to certify people with certain conditions for use of medical cannabis, and had non-cancer-related pain.

“Some people report experiencing significant benefits from medical cannabis, but our findings suggest a real need to increase awareness about the signs of withdrawal symptoms developing to decrease the potential downsides of cannabis use, especially among those who experience severe or worsening symptoms over time,” says Lara Coughlin, Ph.D., the addiction psychologist who led the analysis.

Long-term study in medical cannabis use

The researchers asked the patients whether they had experienced any of 15 different symptoms – ranging from trouble sleeping and nausea to irritability and aggression – when they had gone a significant time without using cannabis.

The researchers used an analytic method to empirically group the patients into those who had no symptoms or mild symptoms at the start of the study, those who had moderate symptoms (meaning they experienced multiple withdrawal symptoms) and those who had severe withdrawal issues that included most or all of the symptoms.

They then looked at how things changed over time, surveying the patients one year and two years after their first survey.

At baseline, 41% of the study participants fell into the mild symptoms group, 34% were in the moderate group and 25% were classed as severe.

Misconceptions about medical cannabis

Many people who turn to medical cannabis for pain do so because other pain relievers haven’t worked, says Coughlin, an assistant professor in the Department of Psychiatry who sees patients as part of U-M Addiction Treatment Services. They may also want to avoid long-term use of opioid pain medications because they pose a risk of misuse and other adverse health consequences.

She notes that people who experience issues related to their cannabis use for pain should talk with their health care providers about receiving other pain treatments including psychosocial treatments such as cognitive behavioral therapy.

The perception of cannabis as “harmless” is not correct, she says. It contains substances called cannabinoids that act on the brain – and that over time can lead the brain to react when those substances are absent.

In addition to a general craving to use cannabis, withdrawal symptoms can include anxiety, sleep difficulties, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger and shakiness.

Previous research has shown that the more symptoms and greater severity of symptoms a person has, the less likely they are to be able to reduce their use of cannabis, quit using it or stay away from it once they quit.

They may mistakenly think that the symptoms happen because of their underlying medical conditions, and may even increase the amount or frequency of their cannabis use to try to counteract the effect – leading to a cycle of increasing use and increasing withdrawal.

Coughlin says people who decide to use a cannabis product for a medical purpose should discuss the amount, route of administration, frequency and type of cannabis product with their regular health provider. They should also familiarize themselves with the symptoms of cannabis withdrawal and tell their provider if they’re experiencing them.

Feeling the urge to use cannabis after a period without use, such as soon after waking up, can be a sign of a withdrawal syndrome, she notes. So can the inability to cut back on use without experiencing craving or other symptoms of withdrawal.

Because there is no medically accepted standard for medical cannabis dosing for different conditions, patients are often faced with a wide array of cannabis products that vary in strength and route of administration. Some products could pose more risk for development of withdrawal symptoms than others, Coughlin says.

For example, people who smoked cannabis tended to have more severe withdrawal symptoms than others, while people who vaped cannabis reported symptoms that tended to stay the same or get worse, but generally did not improve, over time.

As more states legalize cannabis for medical or general use, including several states that will legalize its use based on the results of last November’s election, use is expected to grow.

More about the study

The researchers asked the patients about how they used cannabis products, how often, and how long they’d been using them, as well as about their mental and physical health, their education and employment status.

Over time, those who had started off in the mild withdrawal symptom group were likely to stay there, but some did progress to moderate withdrawal symptoms.

People in the moderate withdrawal group were more likely to go down in symptoms than up, and by the end of the study the number of the people in the severe category had dropped to 17%. In all, 13% of the patients had gone up to the next level of symptoms by the end of the first year, and 8% had transitioned upward by the end of two years.

Sleep problems were the most common symptom across all three groups, and many in the mild group also reported cravings for cannabis. In the moderate group, the most common withdrawal symptoms were sleep problems, depressed mood, decreased appetite, craving, restlessness, anxiety and irritability.

The severe withdrawal symptom group was much more likely to report all the symptoms except sweatiness. Nearly all the participants in this group reported irritability, anxiety, and sleep problems. They were also more likely to be longtime and frequent users of cannabis.

Those in the severe group were more likely to be younger and to have worse mental health. Older adults were less likely to go up in withdrawal symptom severity, while those who vaped cannabis were less likely to transition to a lower withdrawal-severity group.

The study didn’t assess nicotine use, or try to distinguish between symptoms that could also be related to breakthrough pain or diagnosed/undiagnosed mental health conditions during abstinence.

Future directions

Coughlin and her colleagues hope future research can explore cannabis withdrawal symptoms among medical cannabis patients further, including the impact of different attempts to abstain, different types of use and administration routes, and interaction with other physical and mental health factors. Most research on cannabis withdrawal has been in recreational users, or “snapshot” looks at medical cannabis patients at a single point in time.

Further research could help identify those most at risk of developing problems, and reduce the risk of progression to cannabis use disorder, which is when someone uses cannabis repeatedly despite major impacts on their lives and ability to function.

 

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How to use CBD for pain

LA Weekly

The pain-relieving properties of CBD are well recognized in different parts of the world. A large number of people are now using this compound for dealing with pain. CBD is now replacing the prescription medicines that are commonly used for pain. This hemp-derived compound can be useful for avoiding the side effects associated with opioids and other medicines which are prescribed for controlling chronic pain. We are listing some of the important pain-relieving properties of CBD that can help you to find out whether you can also use CBD for pain.​

Can you use CBD for chronic pain?

CBD can be used for reducing chronic pain that is associated with many diseases. Our body has a system called the endocannabinoid system (ECS), which manages different functions in the body. It can regulate pain, immune responses, appetite, mood changes, etc.

Researchers suggest that CBD interacts with the endocannabinoid receptors that are distributed all across your body. Receptors are tiny proteins that are attached to the cells in your body. These receptors have the ability to receive signals from different stimuli and will help your cells to respond.

These responses can create pain-relieving and anti-inflammatory effects that are useful for pain management. Hence, using CBD oil or other CBD products can help people to deal with chronic pain. Studies suggest that CBD can be useful in dealing with neuropathic pain, cancer pain and pain associated with fibromyalgia. Therefore, CBD can be effective for overall pain management without causing much side effects.​

How can CBD help with arthritis pain?

Arthritis, which is a common autoimmune disease, can result in severe pain and inflammation in your joints. Arthritis cannot be cured, but controlling its symptoms can be helpful in preventing this disease from getting worse.

A study conducted in 2019 for finding out the effectiveness of CBD for arthritis showed promising results. This study used rats with arthritis as subjects and administered different doses of CBD for each rat. The researchers noted that there was a considerable reduction in pain and inflammation in the joints of affected rats. Hence, it was concluded that CBD can be useful for reducing pain, inflammation, and swelling associated with arthritis in humans too.​

Can you use CBD for cancer pain?

Cancer and its treatments can often result in severe pain in patients. Patients who have undergone cancer treatments like chemotherapy and radiation suffer from different side effects including pain, inflammation, nausea, etc. Even though there are a lot of prescribed medicines available for controlling them, they all come with a large number of side effects. But now CBD can be a great relief for cancer patients for reducing the pain associated with cancer and its treatments.

Most of the studies used THC along with CBD for controlling pain associated with cancer. THC is the psychoactive compound in cannabis that is known across the world for its intoxicating effects. Hence, more studies are needed to find out the effectiveness of CBD alone for controlling the pain associated with cancer.​

Can CBD help with migraine?

A lot of people are using CBD for controlling migraines. This is a neurological condition that can result in a large number of symptoms including headache, vomiting, nausea, sensitivity to light, etc. This is a condition that affects a large number of people across the world.

Migraine can cause powerful headaches which can be unbearable at times. As CBD is found to be useful for controlling this pain, many people are choosing this natural compound over other prescribed medications.

Studies conducted for finding out the effectiveness of CBD for migraine used a combination of CBD and THC. It is found that this combination was helpful in reducing the pain associated with migraine by a considerable amount. However, more studies are needed in this field for finding out the effect of CBD for pain caused by migraine.​

How to use CBD for pain

You can choose a variety of methods for consuming CBD for pain. If you want immediate results it is better to choose smoking/vaping, where you will get the results in a few minutes itself. The sublingual method can also give you fast relief, but not as fast as vaping/smoking.

If you are not comfortable with these methods, you can choose a product that can be taken orally. There are a lot of CBD pills, capsules and edibles available in the market that can help you to consume CBD easily.

In addition to this, you may also choose CBD topicals that you can apply directly to the infected areas for reducing the pain and inflammation. Different topicals including CBD lotions, creams, salves, ointments, balms, etc. are available in the market that you can use based on your convenience.

The large number of CBD products available in the market helped users to choose a method that is comfortable for them. This compound might also be useful for you, if you are searching for a natural product that does not cause much side effects and can effectively control pain.

 

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Pain and psychedelics – Drug interactions with analgesics

SPIRIT PHARMACIST | 10 Dec 2019

This is the second of two installments on pain and psychedelics. In the first installment or Part I (above), I cover mechanisms of psychedelic action in the context of pain, suffering and philosophy. In this installment I cover drug interactions with different classes of analgesics.

Pain and analgesics: Psychedelic healing, set, and setting

There are many different types of analgesics and pain medications available, each of which has different mechanisms, effects, risks, and interactions with psychedelics. Therefore, we’ll take a class by class approach in this guide. Generally speaking, psychedelic healing works via the heightening of senses, expression or feeling of emotion, and (hopefully) resolution of repressed emotions. Pain relievers or analgesics are drugs that act to suppress pain signals or modulate emotions in a way that suffering is decreased. From this perspective, there is a possibility for counterproductive effects between analgesics and psychedelic-assisted psychotherapy. Counterproductive effects may be further increased by agents that have strong effects in the Central Nervous System (CNS) such as opioids. On the flip side, analgesic agents may increase physical comfort and reduce sympathetic nervous system (fight or flight) arousal due to painful conditions. This could confer beneficial effects on user ‘set’ and the depth of their experience.

When pain conditions are present, the psychedelic user should inquire into and reflect upon any drug or non-drug based modifications that would preserve user ‘set’ or improve user ‘setting’. Adjustments can be made to the physical setting, such as allowing an individual with orthopedic hip and knee injuries to use a comfortable chair to sit in opposed to having them sit on the ground. Many pain medications have the tendency to cause physical or psychological dependence. Discontinuing pain medication may be so damaging to user ‘set’ that they aren’t able to actively participate in their experience. For example, if the user has advanced illness or severe chronic pain (e.g. cancer) it may not be reasonable (due to physical and psychological dependence as well as medical necessity) to discontinue opioid or other pain medication. For others, use of pain medication may be problematic or unwanted. They may be approaching psychedelics in hopes of using less or stopping the use of pain medications. In these cases substance use treatment mind sets may improve outcomes and stopping use of pain medication may be intentional. In most cases (with the exception of ibogaine and ayahuasca which harbor severe physical risks in combination with analgesics), use of pain medication is primarily a risk vs. benefit decision the user can assess based upon their pain condition and goals of analgesic use. A comprehensive assessment of pain conditions as well as their treatments is an essential part of preparing for a therapeutic psychedelic experience.

Over the counter (OTC) analgesics

There are a few different classes of pain relievers that are sold over the counter (OTC) in the United States including acetaminophen/paracetamol (Tylenol), ibuprofen (Motrin, Advil), naproxen (Aleve), and Aspirin. Generally, these medications do not pose any risk of physiological danger in combination with psychedelics, including psychedelics that contain MAOIs such as ayahuasca.

Acetaminophen (Tylenol, paracetamol)

Interestingly, there is an emerging body of research, particularly with acetaminophen (Tylenol) demonstrating that OTC pain relievers can have effects on emotional processing and behavior. It was demonstrated that acetaminophen (Tylenol) has the ability to blunt emotional processing to both positive and negative stimuli. It can also reduce effects of pain secondary to things like social rejection. It appears that it can interfere with our judgement of errors and make us more apathetic to mistakes. The site of interference in error evaluation appears to be in the cortex, which is a site in the brain targeted by psychedelics via their stimulation of 5HT2A receptors. Evidence for an effect on emotional processing is less well established with other OTC analgesics, although ibuprofen has also been shown to have a sex specific effect on emotional processing. How strong these effects on the interference of emotional processing are and whether they could influence psychedelic healing processes in a clinically significant manner is unknown. OTC analgesics have been permitted to be used in protocols of clinical trials utilizing psychedelics to date.

Non-steroidal anti-inflammatory drugs (NSAIDS)

Another more theoretical area of drug interaction involves effect on the immune system and inflammatory responses. Non-steroidal Anti-Inflammatory Drugs (NSAIDS) such as ibuprofen, naproxen (and several other prescription agents such as meloxicam, diclofenac etc.) work by blocking the production of pro-inflammatory mediators termed prostaglandins. Psychedelics are known to have immunomodulatory and anti-inflammatory effects, thus there could be an immune system mediated interaction. The significance of this interaction, if any, is unknown.

Aspirin

Aspirin has a similar mechanism of action to NSAIDS, although low daily doses are often used for advanced cardiovascular conditions. Therefore, when use of low-dose or daily aspirin is reported, a contraindicated condition to psychedelic use may be present.

Due to the benign nature of OTC analgesics from a physical perspective when used with psychedelics and lack of perceptual psychoactive effects, their benefits still likely outweigh risks of interference with emotional processing for minor aches and pains before or after psychedelic experiences. For example, OTC analgesic use prior to psychedelics to relieve menstrual cramps may improve ‘set’ of the user enough to be worth the risk of blunted emotional processing. Similarly, a mild-moderate tension headache is a common side effect the day after psilocybin use and if adequately relieved by an OTC analgesic, it may allow for a less distracted period of reflection in the immediate post-use period, creating a compelling benefit. Conversely, for a new pain or a pain that becomes exacerbated by psychedelic use without an explanatory provocation, it may be preferable to attempt working through pain using psychosomatic processing or other non-drug related methods rather than taking analgesics.

Neuropathic analgesics

Nerve pains are often described as stabbing, shooting, tingling, or burning types of pains and are treated with a variety of analgesics. These analgesics are almost universally active in the CNS and many share therapeutic overlap with other psychiatric or neurologic illnesses including depression, anxiety, and seizure disorders. The only neuropathic agents that are not CNS active involve topical remedies.

Antidepressants

I discuss interactions with antidepressants used for nerve pain such as duloxetine (Cymbalta) and amitriptyline (Elavil) elsewhere. Psychedelics, either in macro or micro doses, may be effective agents in pain conditions. It’s a logical hypothesis to test: if antidepressants work for depression, anxiety nerve pain, or fibromyalgaia and psychedelics also work for depression, anxiety, and have anti-inflammatory effects, that they may have potential to impact nerve pain too.

Gabapentinoids

The gabapentinoids include the agents gabapentin (Neurontin) and pregabalin (Lyrica). They are used for neuropathic pain and anxiety disorders primarily, although gabapentin is also an antiepileptic agent. There is likely some mild interaction potential between gabapentin, pregabalin and psychedelics that may blunt the experience, although user anecdotes don’t support a strong interaction and in a clinical study of MDMA for PTSD, they allowed users to remain on gabapentin when used for pain. There is no rationale to believe that gabapentin or pregabalin would have a high risk of serotonin syndrome or other severe adverse reactions if combined with ayahuasca. Speculatively, they may diminish effects of ibogaine or ketamine due to GABAergic activity.

Both gabapentin and pregabalin have dependence when taken for extended periods of time and can cause withdrawal syndromes if not tapered appropriately. Therefore, in persons with neuropathic pain that are getting a beneficial effect from these agents, it is reasonable to simply continue them. For persons using lower doses for anxiety disorders, tapering the medication over a period of a few weeks may be considered instead.

Opioids

Opioids is an umbrella term that encompasses drugs that produce an analgesic effect by binding with μ-opioid receptors. It includes both naturally derived drugs such as codeine, morphine, and heroin (opiates) as well as synthetics such as oxycodone, methadone, buprenorphine, tramadol, and others. Opioids are notorious for leading to dependence, tolerance, and substance use disorders (addiction) and harms associated with opioids are currently epidemic in the US. They are regulated as controlled substances and produce sedative effects on the CNS, which can lead to fatal respiratory depression in overdose. Drugs that depress CNS activity, tend to generally have blunting effects on psychedelics, although how significant this effect is may depend on individual factors such as tolerance, dose, or the agent(s) used. If an underlying opioid use disorder is present, then the psychedelic ibogaine would likely be of most benefit, although is limited by potential for fatal arrhythmia.

Opioids are oftentimes used for the short-term management of severe pains associated with post-surgical pain, acute physical trauma, or pain flares associated with various medical conditions. For these indications they may be offered ‘as needed’ and taken for such a short period of time or so sparingly that physical dependence does not occur. For the opioid user that doesn’t have a physical dependence on opioids, it is likely best and relatively easy to avoid them for at least 72 hours prior to psychedelic use, which is the timeframe that it could be expected that most opioids used on an as needed basis are eliminated from the body. If persons are experiencing an acute pain flare requiring as needed opioids, it may be best for user set and setting to simply postpone the psychedelic session until the individual is no longer in high amounts of pain and using opioids.

In users of opioids for the treatment of chronic pain in which a substance use disorder is not present, then the choice of psychedelic and management approach is important. Some opioids are contraindicated with ayahuasca or ibogaine. For life-threatening illness or illness in which opioids are medically necessary, continuation of long-acting opioids may be necessary for comfort in user ‘set’.

Which opioids can you combine with Ayahuasca?

While opioids all share their activity at μ-opioid receptors, some of them have additional pharmacology at serotonin and norepinephrine reuptake pumps that could introduce serious drug interaction potential with MAOI containing psychedelics such as ayahuasca. The opioids methadone (Dolophine), meperidine (Pethidine), tapentadol (Nucynta), and tramadol (Ultram) and dextromethorphan all have some weak affinity for the serotonin reuptake pump and have been implicated in cases of serotonin syndrome when combined with MAOIs. Therefore, these agents should be either avoided or discontinued at least 5 half-lives ahead of ayahuasca use. The opioids hydrocodone, oxycodone, buprenorphine, morphine, hydromorphone, oxymorphone, heroin and codeine do not have activity at the serotonin reuptake pump and have not been implicated in cases of serotonin syndrome.

Have opioids and psychedelics ever been combined in clinical trials with other psychedelics?

It is relatively common for opioids to be prescribed for pain associated with illnesses such as late stage cancers. In clinical trials of psilocybin assisted psychotherapy for life-threatening illness in which many participants had late stage cancer, the use of long-acting opioid medications (e.g. sustained release morphine or oxycodone) administered every 12 hours were permitted to be used concurrently per the clinical trial protocol. The protocol stipulated that psilocybin administration would be timed 6 hours after the ingestion of their opioid and 6 hours prior to their next dose of opioid. Therefore, it appears their strategy was to time the dose of psychedelic the farthest possible from the previous opioid dose, while still allowing time for the psilocybin experience to unfold prior to the next opioid dose. For serotonergic psychedelics that do not contain an MAOI, such as MDMA, psilocybin, or short-acting inhaled tryptamines (5-MeO-DMT), this strategy would seem to be adaptable. For other serotonergic psychedelics such as LSD or mescaline, the length of the psychedelic effect may present challenges for use of this strategy. Notably, while the trial protocol permitted long-acting opioids, it’s unclear how many trial participants were actually taking them or if their results differed from others in the trial.

How are opioids used with ibogaine?

When ibogaine is used in a person that uses opioids, it is typically with the intention of managing opioid use disorder (OUD) rather than helping mood or having an analgesic effect in a person with chronic pain. Ibogaine is contraindicated to be used in conjunction with long-acting or extended-release formulations as well as the Medication Assisted Treatment (MAT) drugs methadone and buprenorphine. This is because ibogaine is known to sensitize the user to opioids back to pre-opioid use levels, thus opioid use while on ibogaine can be dangerous and increase risks for overdose. Another risk is arrhythmias and cardiotoxicity, which is worsened considerably by methadone. Therefore, ibogaine use should be attempted only in the opioid user that wants to stop using opioids completely and is on a short-acting opioid prior to ibogaine use.

Ketamine

Ketamine is more accurately classified as a dissociative anesthetic rather than a psychedelic. Given anesthetics have sedative properties, there could be additive risks of sedation or respiratory depression when ketamine or opioids are combined. This can become excessively dangerous with high doses, unmonitored environments, or use of other sedatives like GHB, alcohol, or benzodiazepines. Serotonergic psychedelics are likely lower risk psychedelics to use in combination with opioids when it comes to ketamine. Other pain medications such as OTC analgesics possess minimal risk in combination. There may be some theoretical interactions between drugs that interfere with GABA such as the gabapentinoids (gabapentin, pregabalin), although these interactions are not well documented if they are real.

Conclusions

OTC analgesics are low risk with many psychedelics and can be used to help with minor aches and pains that come up around the time of psychedelic use. Prescription agents to manage pain taken on a chronic basis are more complex and should be assessed in the context of user ‘set & setting’ to optimize potential for healing psychedelic experiences. Ketamine has some additional risk with sedative analgesics like opioids, although is combined in clinical practice for opioid-sparing effects. Ayahuasca and ibogaine are special cases in which scrutiny for drug interaction that has physical risks should be assessed, particularly with opioids.

 

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Researchers report 20 micrograms of LSD delivers similar analgesic results
to opioids such as oxycodone and morphine in an acute pain test.

First-of-its-kind LSD microdosing trial for acute pain relief reports remarkable results

by Rich Haridy | NEW ATLAS | 26 Aug 2020

An incredible, first-of-its-kind trial testing the pain-killing properties of LSD microdoses has delivered the compelling suggestion that tiny, non-psychedelic doses of this infamous drug could serve as an effective analgesic.

Back in the 1960s, during the original heyday of psychedelic science, one of the more fascinating research areas for LSD was its unexpected efficacy as an analgesic. Researcher Eric Kast was one of the pioneer investigators on the topic, publishing over a dozen key papers exploring the ways pain perception is influenced by LSD.

Kast’s work was primarily with active psychedelic doses of LSD, and he consistently found the drug produced effective, and protracted, analgesic effects. Unfortunately, Kast’s work with LSD ended, as most psychedelic research did, when access to the drug was restricted in the late 1960s.

Decades later, as the freeze on psychedelic research begins to thaw, the idea of LSD as a pain-reliever still sits on the fringes of psychedelic science. No modern clinical researcher has returned to Kast’s ideas, however, anecdotal cases have begun to emerge highlighting some people self-medicating with LSD microdoses to treat chronic pain.

This new study, led by researchers from Maastricht University with assistance from the Beckley Foundation, is the first clinical trial to revisit this topic in more than 50 years. Unlike Kast’s prior work, this new research focused on microdoses of LSD rather than larger, actively psychedelic doses.

“From a medical point of view, controlled research on the efficacy of LSD in pain management should focus on non-hallucinogenic, low doses of LSD, which are more manageable and thus preferable over treatment with high doses of LSD that produce full-blown psychedelic effects,” the researchers explain in their paper.

The double-blind, placebo-controlled trial recruited 24 healthy subjects, each of whom took part in four separate experimental sessions, separated by at least five days. Three different LSD microdoses were tested (five, 10, and 20 micrograms) alongside a placebo.

During each experimental session, the subjects completed a Cold Pressor Test (CBT) at two time points following dosing: 90 minutes after and five hours after. The test basically involves plunging one’s hand into a tank of water at 3 °C (37.4 °F). Pain tolerance is measured by combining the amount of time one can hold their hand in the cold water, with a series of subjective ratings regarding painfulness.

The researchers described the results of the study as “remarkable”, with the 20-µg-dose group revealing prolonged improvements to pain tolerance compared to both lower doses and placebo. The results were sustained across both time points suggesting the analgesic effect is just as prominent five hours later as it is within the first 90 minutes.

“The current data consistently indicated that LSD 20 µg significantly reduced pain perception as compared with placebo, whereas lower doses of LSD did not,” the researchers write. “LSD 20 µg significantly increased pain tolerance (i.e. immersion time) by about 20%, while decreasing the subjective levels of experienced painfulness and unpleasantness.”

So what exactly is going on here? Is LSD just distracting people from the acute pain, or is it actually inhibiting pain signaling through a more direct pharmacological mechanism?

Kast hypothesized 50 year ago these analgesic effects were the result of LSD reorienting attention away from pain sensations to a more encompassing psychedelic experience. While that hypothesis certainly is reasonable when high LSD doses are administered, it doesn’t really explain the results seen in this new microdose trial.

The researchers do note a small correlation between increasing levels of psychedelic disassociation and greater pain relief in their results, but the association was weak. They estimate it accounting for no more than six percent of the variance in analgesic results.

A variety of possible alternate hypotheses are presented in the new study, from pharmacologically influencing specific brain receptors known to mediate pain sensation, to triggering a condition called hypertension-associated hypoalgesia whereby blood pressure rises can lead to a diminished perception of pain.

“… an extended dose-finding study is needed to determine the dose at which analgesic effects of LSD are optimal, i.e. when efficacy is maximal and mental interference is minimal,” propose the researchers. “Such a study could potentially explore the trade-off between increments in treatment efficacy and psychedelic symptoms in a low to medium dose range (i.e. 20–50 µg LSD).”

Perhaps the most intriguing finding in the study is the observation that the analgesic effect seen in the 20-µg LSD group is comparable to what prior studies have seen with in the same cold water pain test for opioids such as oxycodone and morphine.

Needless to say, a great deal more research is needed before these results can be extrapolated into any real-world clinical treatment. Will these LSD microdose results translate into pain relief for chronic pain sufferers? Or is this kind of analgesic best for certain types of acute pain? What are the safety issues surrounding long-term use?
Does a tolerance eventually build to low-dose LSD?

At the very least these promising results suggest further clinical trials are necessary as modern researchers slowly catch up with where the science was half a century ago.

The new study was published in the Journal of Psychopharmacology.

 

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I Can Live Again!

by Tim Riley | LDN Science | 1 Mar 2017

Low Dose Naltrexone dramatically reduced my severe chronic back pain, making opiates obsolete.

Please tell us a little about your health condition.

In 1998 I had 2 back operations that failed and left me in a lot more pain than ever. We're talking constant pain. Every 3-6 months, I'd see yet another doctor and do another procedure (epidurals, burning of the nerves, steroid injections). They did over 30 procedures on my lower back, but nothing seemed to work. I was in an incredible amount of pain.

What was your pain like before LDN?

It was constant and crippling. I'd wake up in the morning and think, Where is my medication? I'd have to pop a pill and wait 20 minutes for it to take effect in order just to get up out of bed. I had to hang onto things, like the countertop, in order to walk. It took me an hour to get going in the morning. I'm only 63 now but I felt like a very old man.

How did your doctors treat your pain?

The doctors put me on high doses of long-acting morphine, and short-acting and extended-release oxycodone. At one point, I would take 60 mg of long-acting morphine in the morning, another 60 mg again at night, and every 4 hours during the day I would take an oxycodone. Here I was taking all those heavy duty drugs, and my body was depending on them. 3 to 4 four hours after taking oxycodone, the pain would flare up again and Id feel like I needed to take it again.

Why did you want to get off opiate-based medications?

I was on those medications for 12 years. I was able to get off of them, but then eventually had to go back on them for another 5 years. A couple times the pain got so bad, I took more than my usual amount. But if you run out of your medication early and you need more (because you cant do without it), you are looked at like a criminal. It was so depressing. If you do one thing wrong, doctors will throw you out of their practice. First they tell you that you need morphine, and then, a year later, they are locking doors behind you. They are treating you like a criminal, requiring urine tests, and scrutinizing your every move. At one point, I couldn't stand it any longer. I was going to commit suicide. I wanted off those other medications.

How did you come to take LDN?

About 16 months ago, after telling my doctor I wanted to get off all opiates, he told me to go to a detoxification center that deals specifically with people with chronic pain. By giving me various other medications for different periods of time, they were able to help me get off all the opiates. As part of their treatment, they gave me shots of Vivitrol, and I started to feel much better. After a year, though, insurance no longer covered those treatments. So, I needed to find something else. I had been reading about low dose naltrexone and decided to pursue it. I found a doctor willing to prescribe 50 mg naltrexone pills to me that I dissolved in water, and I dosed myself with 4.5 mg of LDN each morning. I've been on LDN for about 3 months. I haven't felt this kind of pain relief in over 20 years.

How successful has LDN been in reducing your pain?

I have 75-80% less pain than when I was taking opiates. LDN is affordable and has virtually no side effects. Even with all that, its infuriating that most doctors aren't interested in it. I asked my doctors about LDN every now and then over the years, and they dismissed it, saying that it didn't work. But it does. Yesterday I forgot to take my LDN, and I started to feel the pain return. I took it this morning, and now the pain is gone.

Has LDN affected you in any other way?

I also have COPD, which is a lung disorder. I usually have 2-3 bouts with it during the wintertime, but this winter (since Ive been on LDN) I haven't had any exacerbations. Also, my mood is better. When I was on all those opiates, although I never allowed myself to get really depressed, I had to really fight becoming depressed. Now, because I'm in so much less pain, I don't have to struggle to stay positive.

You mentioned that you take LDN in the morning. Why?

I tried taking it at night, but I couldn't sleep well. So, I started taking it in the morning instead, and it worked just as well without any side effects at all. I could probably try taking it at night again and see if my body has adjusted to it already.

What's been the biggest change for you since starting LDN?

I can walk freely. I just step out of the bed, and I'm walking right away. Like normal. It's incredible. I could walk right across the street. My spine is like a disaster area, so that's really saying something. I'm not 100% pain free, but I can do a lot more than before. LDN has been amazing for me. I am now doing better than I ever was when taking all those heavy duty opiates. There's a radio commercial that says, When you're living on pain meds, you're not really living. I can live again!

What would you like to tell people in the same position as you once were?

If you're in chronic pain and you want to get off opiates, but you're afraid to, I'd recommend finding a detox program that deals with chronic pain patients. After you get off the opiates, I recommend you try LDN. Hopefully you'll get better pain relief than you ever had before. It might set you free.

https://www.ldnscience.org/resources...onic-back-pain
 
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Ketamine more effective than opioids for acute pain*

by Brandon May | Clinical Pail Advisor | 18 Dec 2020

Ketamine may be a more effective treatment option than opioids for prehospital acute pain, according to findings from a systematic review study published in the BMJ Open. Ketamine likely decreased pain more than opioids, but had a notable higher risk for agitation.

The review included 8 studies comprising a pooled cohort of 2760 adult patients with prehospital acute pain who were treated with either ketamine, opioids, or nitrous oxide. Studies included in this review were 4 randomized controlled trials, 1 cluster randomized trial, 1 prospective cohort study, and 2 retrospective studies.

Across studies, comparisons were made between intravenous (IV) ketamine and IV opioids, IV ketamine with IV morphine vs IV morphine alone, continuous IV ketamine vs single-dose IV ketamine, intranasal ketamine with nitrous oxide vs nitrous oxide alone.

According to the investigators, there were 5 studies in the review that had high risks of bias. In a cluster randomized controlled trial of 308 patients and a retrospective cohort of 158 patients, treatment with ketamine was associated with probable lower pain scores compared with opioids (change in visual analogue scale, prior to hospitalization}.

The researchers also found that treatment with ketamine probably led to less nausea and vomiting compared with opioids, but greater agitation.

A limitation of the study, according to the researchers, was the potential lack of other studies that may have generated more relevant results, including studies not published in English. Also, none of the studies included in the review were powered to assess the safety of ketamine in this patient population.

Based on this review, the researchers concluded that treatment with IV ketamine in analgesic doses of 0.1 to 0.2mg/kg “appears to be at least as effective as opioids administered alone considering pain reduction.”

*From the article here:
 

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Hope for chronic pain sufferers with Fibromyalgia*

by dispensaries.com | 23 Sep 2021

When it comes to the health benefits of cannabis, better pain management always ranks high on the list. It’s the reason many people turned to medical cannabis in the first place (often as a replacement for opioids). But it’s of special importance to those with Fibromyalgia.

Chronic pain is one of the unfortunate characteristics of Fibromyalgia, a condition that also causes fatigue, memory problems, and difficulties sleeping. Patients suffer from the condition without any well-defined, underlying organic disease, and the exact cause of fibromyalgia remains unknown.

A new literature review of 22 scientific papers conducted by the California Institute of Behavioral Neurosciences and Psychology investigated the use of cannabis or synthetic cannabinoids with fibromyalgia patients. They report that the studies “suggest that medical cannabis is a safe and effective treatment for Fibromyalgia pain,” although there are some limitations.

Fibromyalgia impacts between 5 and 7 percent of the population.

Millions of people worldwide suffer from Fibromyalgia. In the United States and Europe, about 4 percent of the population has Fibromyalgia syndrome (FMS), according to the study. About twice as many women as men suffer from the syndrome. FMS can develop at any age, and often happens in connection with rheumatic diseases.

Because so many studies have found that cannabis provides effective treatment for pain - and promotes better sleep - it’s often mentioned as a possible medication for FMS patients. A handful of studies have looked at the issue through the years. They include:​
  • A 2008 study involving 40 fibromyalgia patients that found the synthetic cannabinoid nabilone had significant pain-relieving effects​
  • A 2011 study involving 28 patients who used cannabis for Fibromyalgia and found that 43 percent reported strong pain relief and 43 percent reported mild pain relief​
  • In that same 2011 study, 81 percent of participants reported that cannabis provided strong relief from Fibromyalgia-related sleep issues​
The recent review, however, took a comprehensive look at a wide range of studies over the years.

For FMS suffers, cannabis can provide relief with limited side effects.

Essentially, the researchers found that previous studies make a strong case for further research into the treatment of Fibromyalgia pain with weed. The aim of the study was to explore the potential for cannabis use, and the researchers concluded that potential is high.

They wrote, “Ultimately, we believe that the use of cannabis and cannabinoids for pain relief in Fibromyalgia has shown great potential and may be a source of hope for those suffering from chronic pain associated with this condition, and for the physicians treating them.”

However, they also wrote that the benefits must be weighed against any potential harmful effects, calling for more research conducted for longer periods to assess the long-term efficacy of cannabis for chronic pain.

Authors concluded "cannabis carries limited side effects, and can also improve some common and debilitating symptoms associated with FM, thus making them an adequate potential treatment option, when other treatment lines have been exhausted.”

Interest certainly remains high among those with Fibromyalgia. A survey in Canada found that 24 percent of Fibromyalgia patients reported a history of cannabis use. Of those, 61 percent classified themselves as current marijuana users and many reported substantial symptom relief.

*From the article here :
 
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Iboga saved me from chronic pain

Most people are not aware that Iboga is profoundly effective for treating severe pain caused by nerve damage. The majority of people I've talked to have only heard of it for treating addiction. The reason I am writing this is because I suffered from debilitating pain that made me feel like my life was over. I lost hope. Before my Iboga experience this summer, I had absolutely no idea it would do anything for my damaged nerve. Little did I know. For three whole months after taking a good dose of Iboga, the noribogaine was still flowing in my body, and I was able to do things that I had not been able to do in a long time.

I had got it into my head that my nerve was damaged, and there was nothing I could do. It is hard not to when everything you try doesn't help or only makes it worse. After 3 months, I began to notice my symptoms were coming back because the noribogaine metabolite was finally being flushed from my body. I made a conscious decision to break away from the beliefs I had about myself and my situation.

So for the past month or so I have been taking ~1g of potent Iboga bark per week. It allows me to function on a level I never thought possible. I feel more like myself now than ever before. I can live and be happy and not even think about my nerve. I am doing more than I ever could before with this disability, and I feel like it's exponential, the more I do, the more I can do. It's an exercise. A constant process.

Iboga allowed me to take a step back into my self unadulterated by the constructs of my mind and start working every day to be the better person that I have always wanted to be. It feels odd saying this, but I feel Iboga saved my life. My work with it keeps evolving, too.

I recently gave up an 11 year cannabis addiction, as well as coffee and nicotine overnight with 1g of potent bark, good food, lot of water, and meditation. I did this because I always told myself I never could, or I never wanted to. I just got fed up. I've been perfectly happy, and sober (except for Iboga effects, which are mild), for the first time in my life. I honestly never ever thought this was possible and I am loving it. I am sure I will use cannabis again, but it feels good to take a break and not be dependent.

So, in conclusion, if you are in a country where Iboga is legal, and you suffer from chronic pain that nothing else seems to help, you may want to consider this medicine.

https://www.dmt-nexus.me/forum/defau...=posts&t=27827
 

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Can psychedelics treat pain?*

LSD and psilocybin increasingly show promise as mental health treatments. Now universities and companies are exploring their use in pain management.

by Troy Farah | Scientific American | 30 Sep 2021

When Kevin was just 11 months old, he was diagnosed with type 1 diabetes, which led to other health problems as he grew up: loss of vision in his left eye and peripheral neuropathy, a painful condition caused by nerve damage. Then, in 2019, a colonoscopy revealed he had colon cancer.

Feeling anxious and depressed, Kevin (a pseudonym) decided to try self-medicating with psychedelics, including psilocybin-containing “magic mushrooms.” Twice a week, the now 28-year-old delivery driver takes about half a gram of the outlawed fungi. This amounts to too little psilocybin to induce a full-blown trip, and Kevin says he quickly noticed an improvement in his mental health—a result that is in line with a handful of recent studies about the drug’s clinical potential. And he was pleasantly surprised to find that his physical pain seemed to decrease as well, even on the days he was not taking anything.

“A lot of the anxiety and depression I was dealing with started to fade away—and then the pain in my legs started to go away,” Kevin says. “I’m feeling the lasting effects from the psilocybin on my stomach and colon pretty much all the time.”

Vivid colors, warped textures and sounds, and intense introspection are famously associated with the psychedelic experience—and now, increasingly, so are improvements in mental health conditions such as anxiety and post-traumatic stress disorder. But what about pain relief? That is the question a growing number of researchers are asking, based on anecdotal reports that drugs such as LSD or psilocybin can help with this. Both drugs are currently illegal under federal law, though medical studies on them are now being officially cleared with increasing frequency.

From psychedelic start-ups to university labs, scientists are starting to test such drugs on various types of pain: cluster headaches, chronic pain, fibromyalgia and even phantom limb pain. This May a New York City–based, multimillion-dollar psychedelic start-up called Mind Medicine (MindMed) announced Project Angie—a series of studies using LSD and an undisclosed drug to treat chronic pain.

“We don't really know how psychedelics work to modulate people’s long-term symptoms in any illness, let alone pain disorders, which are less studied than some of the others,” says physician Dan Karlin, MindMed’s chief medical officer. “But there is compelling preclinical evidence that they work ... via psychological mechanisms … but also may have some direct effects on descending pain pathways.”

Tryp Therapeutics, a California-based psychedelic start-up, is exploring chronic pain relief using psilocybin and another, psilocybin-based drug with an undisclosed formulation that is obliquely called TRP-8803. The company has also partnered with the University of Michigan to study how these drugs might treat fibromyalgia, a complex and little understood condition blamed for pain throughout the body. Tryp has added leading psychedelic researcher Robin Carhart-Harris to its scientific advisory board, and the company says he will play a “critical role” in clinical trial design.

Earlier this year Yale University announced a trial using psilocybin for cluster headaches. And in August the Oxford, England–based pharmaceutical start-up Beckley Psytech raised $80 million for psychedelic research. Part of this will fund a phase 1b safety trial investigating low-dose psilocybin to treat a rare kind of headache called a short-lasting unilateral neuralgiform headache attack.

These efforts are in very early stages, and so far any results are far from clear. Some experts argue that the evidence for psychedelics relieving pain is weak and that these drugs are so powerful that they should only be used in psychotherapy—if anywhere. Even if psychedelics can relieve physical pain, they may not be better tools than those that are already widely available.

“Pain is this four-letter word that can mean so many different things,” says Vivianne Tawfik, an assistant professor of anesthesiology, perioperative and pain medicine at the Stanford University School of Medicine. At an outpatient clinic, Tawfik treats rare and refractory types of pain usually associated with surgery or injury, such as chronic neuropathic pain and complex regional pain syndrome. “There’s a role for opioids,” she says. “There might end up being a prescribed role for psychedelics. The jury’s still out.”

Tawfik warns that any off-target effects of psychedelics need to be carefully monitored. “I think abuse liability needs to be really closely considered, making sure that there aren’t unexpected psychiatric effects, certainly in populations at risk,” she says.

History of pain and psychedelics

One of the earliest recorded studies of pain relief from psychedelics was conducted by Eric Kast, an Austrian-born physician who fled the Nazis with his family in 1938 and resettled in the U.S., later becoming an anesthesiologist at Chicago’s Cook County Hospital. Kast had an early interest in how to measure pain responses: in 1962 he designed an elaborate apparatus—a pneumatically operated “mechanical pain-producing device”—that used air pressure to let a subject apply a “pain-producing element” (possibly a needle) to their own leg.

Two years later his attention was drawn to the powerful psychedelic LSD, which he tried giving to 50 “gravely ill” patients afflicted by pain with causes ranging from cancer to gangrene. They first received the synthetic opioids hydromorphone (Dilaudid) and meperidine (Demerol)—and later they were given 100 micrograms of LSD as well. This would be a strongly psychoactive dose for most people.

“When compared with LSD-25, both [other] drugs fell short in their analgesic action,” Kast wrote in 1964. It was a remarkable anecdote but barely investigated further. For decades this remained some of the best research in this area, aside from a few case studies.

“I feel like most of the studies that were done weren’t done well,” says Fadel Zeidan, a neuroscientist who studies the underlying mechanisms of pain and mindfulness at the University of California, San Diego. Zeidan, who is co-leading a study on psilocybin for phantom limb pain, would like to see “higher standards, more rigor” in this area of research. In 2020 he co-authored a review that weighed the evidence of psychedelics relieving chronic pain and proposed a mechanism of action. The review noted that psychedelics act on the body’s serotonin receptors—notably the type known as 5-HT2A—which have been linked in some research to the development of chronic pain.

“Serotonin is also involved in descending modulation of pain, from the brain down to the spinal cord,” Tawfik says. But she and others note there are currently very little data to back up the hypothesis that psychedelic pain relief acts through this mechanism. “Even though we know that some of the receptor systems that underlie pain are probably similar, there’s probably a lot of nuance that we don’t really know yet or appreciate.”

One of the few double-blind, randomized, placebo-controlled studies on this topic was published last year. Researchers at the Netherlands’ Maastricht University and their colleagues trialed 24 people who were given an oral solution of ethanol containing either a low dose of LSD (too low to cause strong effects such as visual disruptions) or a placebo. Then the subjects placed their hands in almost freezing water. The longer they could keep their hands submerged, the better their pain tolerance was determined to be.

Ratings of pain tolerance from subjects who received LSD were comparable to those in studies with the opioids oxycodone and morphine, leading the authors to conclude in the Journal of Psychopharmacology that “low doses of LSD might constitute a novel pharmacological therapy.”

Again, the researchers hypothesized that serotonin receptors had a role in this effect. Two of the scientists who conducted this study, Matthias Liechti of the University of Basel and Kim Kuypers of Maastricht University, are currently working with MindMed on its LSD and pain research. And the paper’s lead author, Johannes Ramaekers of Maastricht University, says he is developing another pain study to look at psychedelics and fibromyalgia.

But Boris Heifets, a Stanford Medicine anesthesiologist who studies pain—as well as “rapid acting psychiatric therapies,” including psychedelics—says the focus on serotonin in pain relief is probably a “red herring.” Heifets (who is beginning a trial looking at psilocybin and chronic lower back pain) argues that the fact that psychedelics can also improve mood should not be overlooked, given neurological connections between pain and depression.

“If these drugs are going to help, it’s going to be much like the way we think they help for depression—[that is], changing your relationship to your pain,” Heifets says, emphasizing that psychotherapy is the core of psychedelics’ apparent effectiveness in mental health. “The revolution with this class of medicines is that it's really not just medication alone.... This whole body of research is emphasizing the importance of therapy, psychological support and connection.”

U.C. San Diego’s Zeidan agrees. What a drug like psilocybin could be doing is helping “treat the whole person,” he says—adding that he believes this should be a greater focus of modern medicine in general.

“Chronic pain is really just this comorbid snowball of shit,” Zeidan says. “It’s not only the sensory abnormalities, but it’s also the depression, the anxiety, the sedentary lifestyle, the self-doubt, learned helplessness—it’s this whole thing.”

If psychedelics are ever prescribed for pain, it would not be the first time a drug developed for another kind of treatment has been co-opted in this way. Gabapentin and pregabalin (Lyrica) are two antiseizure drugs now commonly prescribed for nerve pain, while duloxetine (Cymbalta) is an antidepressant often used to address chronic musculoskeletal pain.

Despite the scarcity of solid evidence that psychedelics can tackle physical pain, some people like Kevin are not waiting. Three others interviewed for this article claim to use LSD to treat different types of pain, from cluster headaches to degenerative disc disease in the neck and lower back.

All say they are willing to risk breaking the law because they have tried everything else, with very little success. The steadily increasing research could shed some light on whether these long-demonized drugs can relieve physical suffering—or if they are simply placebos—while also examining long-term side effects.

“Every individual’s experience of chronic pain is unique,” Tawfik says. “Many of my patients are still looking for better treatment options.... We just always need to have these risk-benefit conversations with any of these medications.”

*From the article here :
 

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Can psychedelics cure chronic pain?*

by Evan Lewis-Healey |PSYCHEDELIC SPOTLIGHT | 30 Nov 2021

Nine out of the 11 chronic pain sufferers interviewed say they experienced some kind of lasting pain reduction while self-medicating with psychedelics.

Psychedelics are proving to be a wonder drug for applications beyond treating anxiety and depression, and chronic pain may be no exception.

A recent publication by Imperial College London has investigated the effects of self-medicating psychedelics for chronic pain. Although the study was not conducted to assess the effectiveness of psychedelics in the treatment of chronic pain, the research opens the door to a number of clinical trials that are planning to be conducted in the next several years.

Chronic pain can come in many forms, but is broadly characterized as lasting pain for more than three months. The condition is more commonplace than you may think — around 20% of the global population has to live with it.

More serious and debilitating chronic pain conditions, such as fibromyalgia, have been causing doctors to scratch their heads for decades now; there is no explicit underlying cause of the condition, which means that treatments are rarely very successful.

Some patients are treated with antidepressants or opioids if the pain is relatively low-level. However, treatment can go as far as invasive neurosurgery — something that many patients would hope to avoid.

Despite the intensity of these more drastic treatments, many chronic pain patients are unable to feel long-lasting relief, which can have a huge impact on their quality of life.

“I just remember feeling really frustrated that I was in this situation. ‘When will it end, when will I feel normal again?'” said one chronic pain sufferer featured in the study. “I felt like my pain was controlling my life. There’s some hopelessness in that… legitimately thought I was probably never going to get better, or that I would never feel true happiness again, or comfort, or any of those things.”

With no known cure for chronic pain, many patients, in this dark sense of hopelessness, turn towards self-medication.

Psychedelics for chronic pain?

The burgeoning interest in the use of psychedelics has been brewing online for years now. There are huge forums that document people’s journey with psychedelics to treat chronic pain, many testifying to its great success.

For example, over 10,000 people have actively participated with “Clusterbusters”, a website and organization dedicated to using psychedelics to treat cluster headaches (a debilitating condition characterized by cycles of excruciating headaches).

While this may seem like there could be strong placebo effects at play here, the science of psychedelics argues otherwise. LSD, and other psychedelics, have been shown to have strong analgesic effects, with research going as far back as 1964. Another study has even investigated the effects of LSD on phantom limb pain, a mysterious condition where patients perceive severe pain in an amputated limb.

Building on this, researchers at Imperial College London decided to conduct a series of interviews on those that self medicate with psychedelics for chronic pain. The aim of the research was to pave the way for future clinical trials, informing them about optimal dosing, and to see how psychedelics may change a patient’s perception of their own debilitating pain.

In the study, PhD student Julia Bornemann, the lead researcher of the study, had an open conversation with 11 chronic pain sufferers who had self-medicated with psychedelics. Each patient was also asked to retrospectively rate how their pain levels had changed after their psychedelic session.

Many patients testified to the analgesic effects of psychedelics, with nine out of 11 saying that they had complete or at least partial analgesia during the experience.

One patient highlighted this sudden and drastic change: “I remember getting up… and just being absolutely painless… I was standing up, perfectly upright, straight. Normally I can’t put any pressure whatsoever on the right side of my body… I use crutches and canes most of the time, but I haven’t for a few days.”

This patient quote also shines a spotlight on another finding from the study — again, nine out of the 11 patients experienced some kind of lasting pain reduction. This is a remarkable finding considering these patients had suffered from pain for an average of around 10 years.

Moving forward with caution

The results here, however, need to be taken with a pinch of salt — the study was not intended to confirm whether psychedelics are effective in the treatment of chronic pain. Rather, it was to lay the groundwork for future clinical trials.

James Close, honorary clinical research fellow at the Psychedelic Research Centre and author of the study, highlights that a new study is to be conducted very soon, which will more rigorously assess the effectiveness of psychedelics for chronic pain. “Julia Bornemann and I are heading the team for a small mechanistic study looking at brain activity in people with fibromyalgia undergoing psilocybin assisted therapy. We’ve passed ethics and are due to start in Q1 of 2022.”

Close also sees promise in the use of psychedelics and is hopeful for the future. “As a specialist pain therapist working with these patients every day in the NHS, I hope this intervention will be able to help some people who’ve run out of treatment options for what can be a horrendous condition.”

*From the article here :
 
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