Chronic pain and psychedelics: a review and proposed mechanism of action

2020 ◽  
Vol 45 (7) ◽  
pp. 486-494 ◽  
Author(s):  
Joel P Castellanos ◽  
Chris Woolley ◽  
Kelly Amanda Bruno ◽  
Fadel Zeidan ◽  
Adam Halberstadt ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Phantom Limb Pain ◽  
Opioid Analgesics ◽  
Phantom Limb ◽  
Neural Connections ◽  
Current State ◽  
Activation Pathways ◽  
Chronic Pain Conditions ◽  
Favorable Safety ◽  
The Mind

The development of chronic pain is a complex mechanism that is still not fully understood. Multiple somatic and visceral afferent pain signals, when experienced over time, cause a strengthening of certain neural circuitry through peripheral and central sensitization, resulting in the physical and emotional perceptual chronic pain experience. The mind-altering qualities of psychedelics have been attributed, through serotonin 2A (5-HT2A) receptor agonism, to ‘reset’ areas of functional connectivity (FC) in the brain that play prominent roles in many central neuropathic states. Psychedelic substances have a generally favorable safety profile, especially when compared with opioid analgesics. Clinical evidence to date for their use for chronic pain is limited; however, several studies and reports over the past 50 years have shown potential analgesic benefit in cancer pain, phantom limb pain and cluster headache. While the mechanisms by which the classic psychedelics may provide analgesia are not clear, several possibilities exist given the similarity between 5-HT2A activation pathways of psychedelics and the nociceptive modulation pathways in humans. Additionally, the alterations in FC seen with psychedelic use suggest a way that these agents could help reverse the changes in neural connections seen in chronic pain states. Given the current state of the opioid epidemic and limited efficacy of non-opioid analgesics, it is time to consider further research on psychedelics as analgesics in order to improve the lives of patients with chronic pain conditions.

Classification of Neuropathic Pain

2018 ◽  
pp. 11-16
Author(s):  
Abdullah Kandil ◽  
Danielle Perret
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Phantom Limb Pain ◽  
Pain Syndrome ◽  
Phantom Limb ◽  
Charcot Marie Tooth Disease ◽  
Amputation Stump ◽  
Stump Pain ◽  
Chronic Pain Conditions

Neuropathic pain encompasses a category of chronic pain conditions that are caused by disease or lesion of the somatosensory nervous system. Depending on the location of the lesion or disease, neuropathic pain can be categorized as peripheral, central, or mixed. Peripheral neuropathic pain includes such common pain conditions as painful diabetic neuropathy, postherpetic neuralgia, radiculopathies, post-amputation stump pain, various nerve entrapment syndromes, and neuropathies due to immune, hereditary, metabolic, and toxic factors. Central neuropathic pain is pain caused by stroke, spinal cord injury, spinal infarction, syringomyelia, multiple sclerosis, Parkinson disease, and phantom limb pain. In contrast, some conditions may cause pain through both central and peripheral mechanisms, such spinal stenosis, complex regional pain syndrome type II, Charcot-Marie-Tooth disease, fibromyalgia, and cancer pain. Classification of neuropathic may not only help guide the diagnosis and treatment of these chronic pain conditions but may also provide the framework for research of the mechanisms of generation of neuropathic pain.

Understanding transdermal buprenorphine and a practical guide to its use for chronic cancer and non-cancer pain management

2019 ◽  
Vol 15 (2) ◽  
pp. 147-158 ◽  
Author(s):  
Tony O’Brien, MB, FRCPI ◽  
Jin Seok Ahn, MD ◽  
Richard Chye, MBBS, FRACP, FFPMANZCA, FAChPM ◽  
Brian Le, MBBS (Hons), MPH, FRACP, FAChPM ◽  
Henry Lu, MD, DABPN, DPBPM ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Chronic Pain Management ◽  
Cancer Pain Management ◽  
Appropriate Use ◽  
Chronic Pain Conditions ◽  
Favorable Safety ◽  
Practical Recommendations

Transdermal buprenorphine (TDB) has demonstrated effectiveness in treating a range of chronic pain conditions, including cancer pain, nociceptive pain, and neuropathic pain and has a favorable safety profile. Worldwide, clinical experience of its use is relatively limited. There is considerable misunderstanding about the pharmacology, mechanism of action, and safety of buprenorphine. There is also limited guidance on the appropriate use of TDB for chronic pain management. This article presents an overview of TDB and also provides practical recommendations for its use as part of a multifaceted strategy in chronic cancer and non-cancer pain.

scholarly journals Psychological Factors Associated with Phantom Limb Pain: A Review of Recent Findings

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Xaver Fuchs ◽  
Herta Flor ◽  
Robin Bekrater-Bodmann
Keyword(s):  
Chronic Pain ◽  
Psychological Factors ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Body Perception ◽  
Limb Pain ◽  
Psychological Variables ◽  
Emotional Factors ◽  
Pain Symptoms

Phantom limb pain (PLP) is a common phenomenon occurring after the amputation of a limb and can be accompanied by serious suffering. Psychological factors have been shown to play an important role in other types of chronic pain, where they are pivotal in the acquisition and maintenance of pain symptoms. For PLP, however, the interaction between pain and psychological variables is less well documented. In this review, we summarize research on the role of emotional, motivational, cognitive, and perceptual factors in PLP. The reported findings indicate that emotional factors modulate PLP but might be less important compared to other types of chronic pain. Additional factors such as the amount of disability and adjustment to the amputation appear to also play a role. Bidirectional relationships between stress and PLP have been shown quite consistently, and the potential of stress and tension reduction in PLP treatment could be further exploited. Little is known about the role of cognitive variables such as attention or expectation. Catastrophizing seems to aggravate PLP and could be targeted in treatment. Body perception is altered in PLP and poses a potential target for novel mechanistic treatments. More research on psychological factors and their interactions in PLP is needed.

scholarly journals Can We Predict Addiction to Opioid Analgesics? A Possible Tool to Estimate the Risk of Opioid Addiction in Patients with Pain

2013 ◽  
Vol 6;16 (6;11) ◽  
pp. 593-601 ◽  
Author(s):  
Katrin Skala
Keyword(s):  
Chronic Pain ◽  
Family History ◽  
Opioid Analgesics ◽  
Opioid Addiction ◽  
Key Words Pain ◽  
Developmental Problems ◽  
Self Rating ◽  
Valid Instrument ◽  
History Of ◽  
Chronic Pain Conditions

Background: The use of opioid analgesics in the treatment of chronic pain conditions has long been controversial. They have been reported to be relatively safe when prescribed with caution, but a brief and valid instrument to estimate a person’s risk of addiction is still missing. Objective: The aim of this study was to investigate a self-rating questionnaire allowing an estimation of a person’s risk of addiction to opioid analgesics. Study Design: Retrospective review. Setting: Four Austrian hospitals. Methods: Seven hundred forty-one patients were interviewed. Of these, 634 patients were affected with chronic pain while 107 patients had a history of opioid addiction. Patients were interviewed about alcohol and nicotine consumption and family history of psychiatric disorders. Attitudes towards medication and the origin of pain were examined. We asked patients with an opioid addiction and patients suffering from chronic pain to complete a short questionnaire intended to help screen for addiction potential. Results: Compared to the patients suffering from chronic pain, patients with an opioid addiction significantly more often had alcohol- and nicotine-related pathologies and psychiatric comorbidity. A family history of mental illness and developmental problems were significantly more frequent in this group. Compared to those not addicted, those with an opioid addiction had significantly higher expectations concerning the potential of medication to change one’s mental state; they thought that psychological factors might contribute to the pain they feel. Limitations: The main limitation of this study is the use of a self-rating instrument which reduces objectivity and introduces the possibility of misreporting. Also, the 2 groups differ in number and are not homogenous. Conclusion: We found differences in questionnaire responses between patients with an opioid addiction and patients suffering from chronic pain to be dependent upon the prevalence of current or former addiction, psychiatric history, attitudes towards medication, and ideas about the origin of pain. We believe these factors have predictive value in estimating a patient with pain’s risk of addiction. Key words: Pain, opioids, analgesics, addiction, questionnaire, self-rating, screening

scholarly journals Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain

2021 ◽  
Vol 2 ◽  
Author(s):  
Breanna L. Sheldon ◽  
Jonathan Bao ◽  
Olga Khazen ◽  
Julie G. Pilitsis
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Health Care Systems ◽  
Phantom Limb Pain ◽  
Pain Syndrome ◽  
Cost Effective ◽  
Failed Back Surgery Syndrome ◽  
Phantom Limb ◽  
Failed Back Surgery

Neuropathic pain is a rampant disease exacting a significant toll on patients, providers, and health care systems around the globe. Neuromodulation has been successfully employed to treat many indications including failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), phantom limb pain (PLP), radiculopathies, and intractable pelvic pain, among many others. Recent studies have also demonstrated efficacy for cancer-related pain and chemotherapy induced neuropathy with these techniques. Spinal cord stimulation (SCS) is the most commonly employed technique and involves implantation of percutaneous or paddle leads targeting the dorsal columns of the spinal cord with the goal of disrupting the pain signals traveling to the brain. Tonic, high frequency, and burst waveforms have all been shown to reduce pain and disability in chronic pain patients. Closed-loop SCS systems that automatically adjust stimulation parameters based on feedback (such as evoked compound action potentials) are becoming increasingly used to help ease the burden placed on patients to adjust their programming to their pain and position. Additionally, dorsal root ganglion stimulation (DRGS) is a newer technique that allows for dermatomal coverage especially in patients with pain in up to two dermatomes. Regardless of the technique chosen, neuromodulation has been shown to be cost-effective and efficacious and should be given full consideration in patients with chronic pain conditions.

Trauma pain and procedural pain: prevention of chronic pain following acute trauma

2011 ◽  
Author(s):  
Johan Emmanuel
Keyword(s):  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Injured Patient ◽  
Femoral Shaft ◽  
Phantom Limb Pain ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Phantom Limb ◽  
Intravenous Morphine ◽  
Multimodal Management

Opioid analgesics should be used with extreme cautions in the self-ventilating head injured patient. Gastric emptying ceases after trauma. This will limit the efficacy of oral analgesics. Epidural analgesia has been shown to be an independent predictor of decreased morbidity and mortality in thoracic trauma. Femoral nerve block is as effective as intravenous morphine in femoral shaft fractures. Short-term non-steroidal anti-inflammatory drug use has no proven deleterious effects in humans, and should be part of multimodal management. Trauma is a risk factor for complex regional pain syndrome. Prevention should be aimed at early graded mobilizations with adequate pain relief. Post-amputation pain encompasses stump pain (nociceptive and neuropathic), and phantom limb pain.

Origin of phantom limb pain: A dynamic network perspective

e-Neuroforum ◽  
2017 ◽  
Vol 23 (3) ◽  
Author(s):  
Herta Flor ◽  
Jamila Andoh
Keyword(s):  
Chronic Pain ◽  
Dynamic Network ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Phantom Pain ◽  
Limb Pain ◽  
Functional Changes ◽  
Frequency Of Use ◽  
Pain Symptoms

AbstractFunctional and structural plasticity in neural circuits may actively contribute to chronic pain. Changes in the central nervous system following limb amputation are one of the most remarkable evidences of brain plasticity.Such plastic changes result from combined sensorimotor deprivation with intense behavioral changes, including both acquisition of compensatory motor skills and coping with a chronic pain condition (phantom limb pain), which is a common consequence after amputation. This review aims to discuss the latest insights on functional changes and reorganization in nociceptive pathways, integrating analyses in human patients across several scales. Importantly, we address how functional changes interrelate with pain symptoms, not only locally within the primary somatosensory cortex but at a network-level including both spinal and cerebral areas of the nociceptive and pain networks. In addition, changes in the function of neurons and neural networks related to altered peripheral input are dynamic and influenced by psychological factors such as learning, prosthesis usage or frequency of use of the intact limb as well as comorbidity with anxiety and depression. We propose that both central and peripheral factors interact in a dynamic manner and create the phantom pain experience.

scholarly journals Percutaneous Peripheral Nerve Stimulation for the Treatment of Chronic Pain Following Amputation

2019 ◽  
Vol 184 (7-8) ◽  
pp. e267-e274 ◽  
Author(s):  
Steven P Cohen ◽  
Christopher A Gilmore ◽  
Richard L Rauck ◽  
Denise D Lester ◽  
Robert J Trainer ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Military Service ◽  
Phantom Limb Pain ◽  
Peripheral Nerve Stimulation ◽  
Service Members ◽  
Phantom Limb ◽  
Limb Pain ◽  
Military Service Members

Abstract Introduction Chronic pain and reduced function are significant problems for Military Service members and Veterans following amputation. Peripheral nerve stimulation (PNS) is a promising therapy, but PNS systems have traditionally been limited by invasiveness and complications. Recently, a novel percutaneous PNS system was developed to reduce the risk of complications and enable delivery of stimulation without surgery. Materials and Methods Percutaneous PNS was evaluated to determine if stimulation provides relief from residual and phantom limb pain following lower-extremity amputation. PNS leads were implanted percutaneously to deliver stimulation to the femoral and/or sciatic nerves. Patients received stimulation for up to 60 days followed by withdrawal of the leads. Results A review of recent studies and clinical reports found that a majority of patients (18/24, 75%) reported substantial (≥50%) clinically relevant relief of chronic post-amputation pain following up to 60 days of percutaneous PNS. Reductions in pain were frequently associated with reductions in disability and pain interference. Conclusions Percutaneous PNS can durably reduce pain, thereby enabling improvements in quality of life, function, and rehabilitation in individuals with residual or phantom limb pain following amputation. Percutaneous PNS may have additional benefit for Military Service members and Veterans with post-surgical or post-traumatic pain.

scholarly journals Emotional and Motivational Pain Processing: Current State of Knowledge and Perspectives in Translational Research

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Susanne Becker ◽  
Edita Navratilova ◽  
Frauke Nees ◽  
Stefaan Van Damme
Keyword(s):  
Chronic Pain ◽  
Brain Activity ◽  
Pain Processing ◽  
Cellular Mechanisms ◽  
Related Information ◽  
Current State ◽  
Chronic Pain Patients ◽  
Fear And Anxiety ◽  
Chronic Pain Conditions ◽  
Pain Patients

Pain elicits fear and anxiety and promotes escape, avoidance, and adaptive behaviors that are essential for survival. When pain persists, motivational priority and attention shift to pain-related information. Such a shift often results in impaired functionality, leading to maladaptive pain-related fear and anxiety and escape and avoidance behaviors. Neuroimaging studies in chronic pain patients have established that brain activity, especially in cortical and mesolimbic regions, is different from activity observed during acute pain in control subjects. In this review, we discuss the psychophysiological and neuronal factors that may be associated with the transition to chronic pain. We review information from human studies on neural circuits involved in emotional and motivational pain processing and how these circuits are altered in chronic pain conditions. We then highlight findings from animal research that can increase our understanding of the molecular and cellular mechanisms underlying emotional-motivational pain processing in the brain. Finally, we discuss how translational approaches incorporating results from both human and animal investigations may aid in accelerating the discovery of therapies.

Chronic pain in lower limb amputees: Is there a correlation with the use of perioperative epidural or perineural analgesia?

2021 ◽  
pp. 1-10
Author(s):  
Benedetti Maria Grazia ◽  
De Santis Letizia ◽  
Mariani Giorgio ◽  
Donati Danilo ◽  
Bardelli Roberta ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Postal Survey ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Limb Pain ◽  
Simultaneous Use

BACKGROUND: Chronic pain is common in patients who undergo lower limb amputation. The use of epidural or perineural catheters seems to reduce acute pain after surgery but their effects in a longer follow up are unknown. OBJECTIVE: To evaluate the long-term prevalence of phantom limb sensation (PLS), phantom limb pain (PLP), and residual limb pain (RLP) and their correlation with perioperative use of epidural or perineural catheters. METHODS: Postal survey. Patients with trans-femoral, trans-tibial or hemi-pelvectomy amputation were asked to partake in the study. The Prosthetic Evaluation Questionnaire was used for the presence of chronic post-surgical pain. Presence of catheters was retrieved from medical notes. RESULTS: 57 patients at a mean of 4.4 years follow up were included. PLS was reported in 68.4%, PLP in 63.2 % and RLP in 54.4% of amputees. No correlation was identified between pain syndromes and the presence of individual catheters and the duration of their permanence. The simultaneous use of 2 catheters was related to a lesser presence of PLP. CONCLUSIONS: Data on prevalence of PLP, PLS and RLP are consistent with the literature. Favourable effects in PLP reduction in the long term follow up was related to the simultaneous use of two catheters.

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