3.6 Cognitive and psychosocial effects
Pain also involves cognitive and behavioral processes such as attention,
memory, and evaluation.52 Psychological factors, such
as coping strategies, significantly influence the overall experience of
pain.53 In patients with chronic low back pain, fear
of movement, or kinesiophobia , is associated with increased
activity in brain regions related to emotion and
fear.54 Higher levels of pain intensity can also lead
these patients to engage in more perseverative thinking, such as worry
and rumination, as they try to mentally problem-solve their
pain.55 In patients with chronic pain, these negative
metacognitive beliefs are associated with higher emotional distress and
lower mood.56 Psychedelics may have the potential to
facilitate changes in some of these harmful cognitive patterns by
loosening rigid mindsets like functional fixedness, and by allowing
greater problem-solving ability.57 Additionally,
psychedelics can induce a profound shift in consciousness, known as ego
dissolution, with increased emotional sensitivity58that could facilitate changes in maladaptive cognitions and emotions
related to pain. This may facilitate the revaluation of maladaptive
beliefs and attitudes towards pain, potentially promoting confidence in
one’s ability to perform tasks despite pain (i.e., self-efficacy).
Additionally, it has been suggested that psychedelics may impact
automatic cognitive phenomena such as attentional bias – a process in
which attention is preferentially captured by pain and its cues. It is
also worth noting that abnormal attentional bias for pain and opioid
cues have been respectively identified among those with chronic pain and
OUD59,60; and attentional bias for both cues are
potentially modifiable in individuals with chronic pain and OUD
receiving methadone or buprenorphine.61
In addition to altering pain-related cognitions, psychedelics have been
found to increase positive mood, feelings of social connectedness and
interpersonal closeness.62-64 A recent meta-analysis
revealed a significant inverse association between positive mood and
pain intensity in individuals with chronic pain.65Additionally, enhanced social functioning associated with psychedelics
could potentially improve interpersonal interactions despite
experiencing pain, and strengthen social support by improving openness
and communication. Together, these social and relational changes have
the potential to improve coping and readjust maladaptive pain-related
thoughts and behaviors.
In summary, psychedelics have the potential to improve pain management
through their multidimensional impact on sensory transmission,
inflammation, neuroplasticity, affect, anxiety, cognitive patterns, and
behaviors. Although these findings are promising, further research is
needed to comprehensively understand the various mechanisms by which
psychedelics may alleviate distinct forms of chronic pain. Elucidating
these mechanisms can further inform the development of interventions
that leverage these pharmacological and psychological effects to reduce
the suffering of patients with chronic pain (Figure 1 ).