Psychedelics and Chronic Pain
This article by Oshan Jarow on Vox discusses the emerging potential of psychedelics, like psilocybin and LSD, to treat chronic pain conditions, based on anecdotal evidence and early clinical trials. There is a growing underground movement and scientific interest in their pain-relieving properties. A significant milestone is the National Institutes of Health’s recent $22 million grant for research into psychedelic-assisted therapy for chronic pain. The article underscores the need for further research and regulatory approval while balancing immediate patient needs and the slow pace of official validation.
Most chronic pain lasts long after the underlying tissue damage is already healed. At that point, pain may no longer be a signal stemming from damage in the body, but a stubborn prediction that the mind has learned to make about the body. In this view, chronic pain is like a haunting memory that the mind recasts into the present.
We already have one solution that might be overlooked in this discussion, however. Ketamine has a long-standing history as an analgesic, predating its recent applications in psychotherapy. Discovered in the 1960s, ketamine was initially developed as an anesthetic to provide pain relief and sedation without the severe side effects associated with other anesthetics like halothane and ether. It was first approved for use in the United States in 1970 and quickly became a staple in medical settings, particularly in battlefield and emergency medicine due to its rapid onset, effective pain relief, and ability to maintain cardiovascular stability.
1. Emergency and Military Medicine: Ketamine's analgesic properties made it invaluable in situations where rapid and effective pain relief was crucial. It was widely used in the Vietnam War to treat injured soldiers because it could be administered in the field and did not require advanced medical facilities.
2. Pediatric Anesthesia: Ketamine became a preferred anesthetic in pediatric cases due to its safety profile. Unlike other anesthetics, it does not depress the respiratory system, making it safer for children who are more susceptible to respiratory complications.
3. Chronic Pain Management: In the decades following its introduction, ketamine began to be used off-label for chronic pain management. Conditions such as complex regional pain syndrome (CRPS), fibromyalgia, and cancer pain saw significant relief with ketamine infusions, leading to its incorporation into pain management protocols.
Ketamine is known for its relatively safe profile, especially compared to other anesthetics. Some key aspects include:
1. Cardiovascular Stability: Unlike many anesthetics that can cause significant drops in blood pressure and heart rate, ketamine typically maintains cardiovascular stability. This makes it safer for patients with unstable cardiovascular conditions.
2. Respiratory Function: Ketamine is unique in that it does not depress the respiratory system. This makes it safer for use in various settings, including pre-hospital environments and in patients at risk of respiratory complications.
3. Side Effects: While ketamine is generally safe, it can cause side effects, particularly at higher doses. These include:
Psychotomimetic Effects: Hallucinations and vivid dreams can occur, which is why ketamine is often combined with benzodiazepines to mitigate these effects.
Increased Intracranial Pressure: Caution is required in patients with head injuries or elevated intracranial pressure.
Nausea and Vomiting: Common side effects, usually managed with antiemetic medications.
The psychotherapeutic applications of ketamine, particularly for treatment-resistant depression and PTSD, are relatively recent developments. Research in the early 2000s began to explore the rapid antidepressant effects of ketamine, leading to its FDA approval in 2019 as a nasal spray (esketamine) for treatment-resistant depression.
Ketamine's use as an analgesic has a robust history, underscoring its effectiveness and safety in pain management long before its psychiatric benefits were discovered. Its role in emergency medicine, pediatric anesthesia, and chronic pain treatment highlights its versatility and safety, making it a valuable tool in both historical and modern medical practice. The transition to psychotherapeutic uses has further expanded its applications, offering hope for conditions that are often resistant to traditional treatments.
