Chronic pain is somewhat of a mystery—it’s a common and complex condition with frequently unidentifiable causes, the development of which is not fully understood. Over time, the experience of repetitive pain signals appears to strengthen certain neural connections through peripheral and central nervous system sensitization, resulting in the physical and emotional perception of pain that is long-lasting and disrupts the quality of people’s lives.

Chronic pain is a significant source of suffering and disability and is often associated with mental and emotional health complications, including anxiety and depression. The most common form of treatment is prescription opioids, which are highly addictive and usually provide limited short-term relief or, in a relevant portion of those who suffer from chronic pain, no relief at all.

Psychedelics, such as psilocybin, MDMA, ketamine, LSD, and ayahuasca, have demonstrated promising therapeutic potential for a variety of disorders that include treatment-resistant depression, PTSD, and even addiction, and growing research indicates they may also benefit individuals afflicted with chronic pain. A 2023 study surveyed chronic pain patients about psychedelic use and the relative relief levels they experienced with both conventional treatments and psychedelic dosing. Across the five pain conditions this research examined—fibromyalgia, arthritis, migraine, tension-type headache, and sciatica—participants reported that psychedelics led to better pain relief compared to conventional medications in four of the five, sciatica being the exception.[1]

Chronic pain often co-occurs with substance use disorders, further complicating treatment options. While previous studies have suggested that psychedelics can potentially help alleviate pain symptoms, until now little has been known about their impact on substance use patterns in people with chronic pain.

According to recently published findings in the British Journal of Pain, based on a large survey of patients with chronic pain, naturalistic psychedelic use (that is, self-directed use without any professional structure or guidance) led to significant reductions in substance use, as well as perceived improvements in physical and mental health symptoms.[2]

Researchers conducted a cross-sectional survey using data from the Global Psychedelic Survey, distributed online between May and June of 2023. They analyzed responses from 466 adults ages 21 and older who reported using psychedelics to self-manage chronic pain conditions. Participants provided information on their psychedelic use, changes in non-psychedelic substance use, and perceived health outcomes. Of the 466 participants included in the survey, 46.1% were women and the mean age of all participants was 42.6 years.

Among 453 participants who had previously used non-psychedelic substances, 86.3% reported reducing or stopping at least one substance following psychedelic use. The most commonly reported substances that were discontinued or reduced were alcohol (71.1%) and prescription opioids (64.1%), followed by antidepressants (63.1%) and illicit opioids (60.7%). However, 39.1% of participants reported an increase or initiation of substance use after psychedelic experiences, with the highest increases observed for illicit opioids (27.8%) and cannabis (21.5%).

The specific psychedelic most frequently identified contributing to reduced substance use was psilocybin (29.9%), followed by ketamine (12.5%), and ayahuasca (11.8%). Notably, 21.2% of participants who decreased their substance use reported sustained reductions lasting more than 26 weeks.

Perceived effectiveness of psychedelics for physical and mental health was positive and durable, based on retrospective reports. 78.8% of participants reported that psychedelics were effective in managing physical health conditions, with chronic pain, migraines, and sleep disorders being the most frequently mentioned. Additionally, 99.3% of participants found psychedelics beneficial for mental health conditions, particularly depression, anxiety, and post-traumatic stress disorder.

Participants attributed reduced substance use and health improvements to increased feelings of connection: to self (62.7%), to others (52.2%), and to nature (50.4%). Dissatisfaction with conventional treatments was cited as the primary reason for turning to psychedelics as an option (41.2%).

The limitations of this study include its reliance on self-reported data and potential recall bias. Moreover, the survey sample was recruited from psychedelic interest groups, with the potential for inherent bias toward positive outcomes.

Potential Mechanism of Action of Psychedelics on Chronic Pain

Research suggests the mind-altering qualities of psychedelics occur through the activation of a specific serotonin receptor (5-HT2A) that effectively resets areas of functional connectivity in the brain that appear to play prominent roles in many neuropathic states. Psychedelics may help to reduce chronic pain through the activation of this serotonin receptor, which can alter functional connections within the regions of the brain associated with chronic pain. These alterations may help reverse the changes in neural connections that develop in chronic pain conditions. Healthy neural reconnections made through the neuroplastic effects of psychedelics can potentially result in sustained pain relief.[3]

While certainly not without risks, psychedelics have a generally favorable safety profile, especially when compared to opioids. In addition, psychedelics do not have the addictive potential of opioids. Even with recent declines in opioid-related deaths, the current state of the opioid epidemic and limited efficacy of non-opioid analgesics and other treatments indicate that further research on psychedelics as a pathway that can improve the lives of patients with chronic pain is an idea whose time has come.

Copyright 2025 Dan Mager, MSW