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Saturday, September 24, 2022

Are Psychedelics the Future of Pain Relief?


A person with magic mushrooms

Image: Nicoletta Belardinelli

For more than 15 years, Ainslie Course suffered from one of the most intense pains known to humans: cluster headaches. Sometimes nicknamed “suicide headaches”, her main symptom was an excruciating pain that suddenly surrounded one eye in debilitating bouts of attacks. These cycles could last for months, and acute sufferers are known to be statistically more likely to take their own lives. But none of the traditional treatment options worked for Course. Instead, psychedelics were her saviour.

“My experiences with psilocybin therapy were life-saving,” says 55-year-old Course, now the vice-president of a non-profit organisation called Clusterbusters. “Not only did psilocybin help to control the acute nature of the attacks, but it greatly lengthened remission times between cycles.” On pharmaceutical medicines, she would rarely be migraine free for a few months. “But with psilocybin, my remission periods are up to two years.”

In fact, it increasingly seems that pain – one of the most universal experiences in the human condition – is now the next frontier for psychedelics after mental health. And the use of psilocybin to ease cluster headaches is not the only line of investigation. LSD is now being investigated by startups and universities around the world for its treatment of chronic pain and fibromyalgia (a debilitating condition which causes, among many other symptoms, excruciating stiffness).

High quality evidence remains scarce, but dozens of emerging trials go some way towards validating widespread anecdotal reports that psychedelics can play this role. “There’s a case for cautious optimism and continuing to push the cause,” says James Close, a doctoral student at the Centre for Psychedelic Research at Imperial College London and pain management therapist at Imperial College Healthcare NHS Trust.

Early and preclinical evidence suggests that psychedelics might have a positive effect on the psychological mechanisms and neural pathways associated with persistent pain. “Looking at the depression and PTSD studies, you can see quite conceivably how psychedelics might help people change the relationship they have with their chronic pain,” says Close.

Why is that so? A key advantage of psychedelics over prescribed drugs is that they can work holistically to free the brain from deep-rooted habits, thus opening people to new states of mind. Among those experiencing serious and persistent pain due to resistance in the brain to change, “psychedelics could create plasticity and, so to speak, allow for the slate to be wiped clean,” says Close.

Later this year, the results will be published from the world’s first early stage trial into the efficacy of psilocybin in rare headache attacks, conducted by the British firm Beckley Psytech (set up by Lady Amanda Feilding). Elsewhere, a Maastricht university study in 2020 announced that very low doses of LSD could be as effective as opioids for pain relief.

“LSD has such a prolonged effect that if you took a low dose in the morning you could be somewhat protected all day, whereas people have to redose opioids several times throughout the day – and there is also the potential for dependency and far greater scope for abuse,” Dr Jan Ramaekers – who led the research – told VICE. “Low doses of psychedelics do not induce psychoactive effects and therefore provide a practical way to use psychedelics as analgesics [pain relief].”

Psychedelics for pain have long shown potential. As far back as the 60s, clinical trials were discovered the profound pain relief that could be offered by LSD, but when President Richard Nixon’s war on drugs began in 1971, it soon halted all subsequent research and studies into the benefits of psychedelics. Only now is it being taken seriously again. And while hospital data from patients is still absent, the literature is growing. Companies are now making patent claims on psychedelics as medication for pain, such as a type of MDMA for care following surgery.

“Psychedelic substances have a generally favourable safety profile, especially when compared with opioid analgesics,” reads a review paper in a 2020 British Medical Journal publication. Another paper published in December noted that clinical observations over the past decade suggest that psychedelics may possess “heuristic value for understanding and treating chronic pain conditions”.

One of its co-authors, Amanda Pustilnik, a neuroscience law expert from the University of Maryland, told VICE: “There are numerous mechanisms in psychedelic drugs, particularly psilocybin, but possibly others, that could potentially affect chronic pain disorders. Their potential could be tremendous.”

Ketamine, arguably a psychedelic, is being prescribed privately in the US and UK for depression, and has been shown to dramatically reorganise pain pathways. “The domains of pain, anxiety and depression are all connected,” adds fellow co-author Dr David Borsook, a director of the pain and imaging neuroscience group at Massachusetts general hospital. “If you treat one, another often gets better.”

There is an urgent need for effective, non-addictive medications for chronic pain, adds Borsook, who also works as an advisor to a company commercialising psychedelic-based therapies. However, he says, “the opportunities need to be channeled into robust studies”.

Criticism over the pace of research and the bureaucracy around psychedelic experiments is growing, with psilocybin and LSD studies facing serious hurdles in many places across the world, including the US and UK. “But if you look at the number of articles being produced and the amount of academic centres committing to research in this domain, steps are being taken in the right direction,” says Borsook.

The demand for pain medication in the UK has been rising rapidly, mirroring trends in the US. There has been a steep increase in prescription for pregabalin and gabapentin pills, which are class C drugs due to their high strengths and addictiveness. “Chronic pain is the greatest clinical problem in the UK behind depression,” adds Close. “The response rate to the current treatments is very low.”

Some observers have described this rise in pain, and the absence of an effective treatment, as the collateral damage of the war on drugs, thanks to the politically-motivated prevention of research and enforced scientific dormancy. And the US opioid crisis is a stark example of these warped priorities. It has resulted in tens of thousands of deaths – partly due to institutional medical negligence driven by profit – when potentially better treatments may have otherwise been made available.

“There was a concerted strategy on the part of certain bad actors to promote these drugs to individuals who didn’t have the right medical indication for them as a business strategy to create addiction,” says Pustilnik.

Pressure is growing on health authorities to rapidly fund research and sanction the treatments through exemptions – such as in Canada – while the British prime minister has faced high-profile calls from within his Tory party to downgrade psilocybin from the strictest scheduling in order to reduce barriers to research.

“I tried dozens of medications including blood pressure pills, strong painkillers, oral steroids in huge doses and nerve blocks into the back of my head. But rather than properly treat me, I gained weight, was sleepless, agitated, got kidney stones, experienced cognitive fog and memory issues, plus my bones thinned and my joints became weak,” says Course, one of thousands of people to have used psilocybin to treat their pain.

“I find it very difficult to accept that psilocybin is classed as a schedule one drug, which we are told has no medical or therapeutic properties.”

@matthabusby





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