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 ).