Ketamine, a non-competitive NMDA inhibitor with significant psychedelic properties, is widely used in the management of acute and chronic pain. Ketamine is used intraoperatively to spare opioids and prevent acute and chronic postoperative pain; it is also used in patients with complex pain syndromes and patients with opioid tolerance. Medical cannabis is already used widely in many countries to control pain and other conditions. Recently, psychedelic drugs like lysergic acid diethylamide (LSD), psilocybin, ecstasy (3, 4-methylenedioxy-N-methamphetamine or MDMA), ayahuasca, DMT (dimethyltryptamine) and others have regained a significant place among research and medical scientific talks for their therapeutic potential in pain management.
Historically, there has been interest in using psychedelics to treat chronic pain since 1960s where it was suggested that psychedelic drugs may be therapeutically useful in cancer and phantom limb pain, but due to lack of the methodological rigor of modern trials they haven’t gained much attention. Recent studies suggest that psychedelics may be therapeutically useful in treating intractable headaches such as migraine and cluster headaches, and few recent reviews hypothesize potential mechanisms and applications for psychedelics in chronic pain. Pharmacologically, this concept is plausible. The primary mechanism of action of classic psychedelics is via the 5-HT2A serotonin receptor, which is integral to descending inhibitory pain pathway. The acute effects of psychedelics may also contribute toward an analgesic response by reorienting attention away from unpleasant sensations toward altered perceptions, e.g., visual hallucinations.
Despite the great interest and possibilities, the current legal status of many psychedelic drugs imposes a hinder to obtaining robust research evidence regarding their effectiveness and safety profile.
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