Abstract：
The rise of psychedelics in contemporary medicine has sparked interest in their potential therapeutic applications. While traditionally associated with countercultural movements and recreational use, recent research has shed light on the potential benefits of psychedelics in various mental health conditions. In this review, we explore the possible role of psychedelics in the management of chronic pain and opioid use disorder (OUD), 2 critical areas in need of innovative treatment options. Pain control remains a significant clinical challenge, particularly for individuals with OUD and those who receive long-term opioid therapy who develop marked tolerance to opioid-induced analgesia. Despite the magnitude of this problem, there is a scarcity of controlled studies investigating pain management alternatives for these populations. Drawing from preclinical and human evidence, we highlight the potential of psychedelics to act on shared neurobiological substrates of chronic pain and OUD, potentially reversing pain- and opioid-induced neuroadaptations, such as central sensitization. We elaborate on the multifaceted dimensions of the pain experience (sensory, affective and cognitive) and their intersections that overlap with opioid-related phenomena (opioid craving and withdrawal), hypothesizing how these processes can be modulated by psychedelics. After summarizing the available clinical research, we propose mechanistic insights and methodological considerations for the design of future translational studies and clinical trials, building on a shared clinical and neurobiological understanding of chronic pain and OUD. Our intention is to provide timely perspectives that accelerate the development and exploration of novel therapeutics for chronic pain and OUD amidst the escalating opioid crisis.
摘要：
当代医学中迷幻药的兴起引发了人们对其潜在治疗应用的兴趣。虽然传统上与反文化运动和娱乐用途有关，最近的研究揭示了迷幻药在各种心理健康状况中的潜在益处。在这次审查中,我们探讨了迷幻药在治疗慢性疼痛和阿片类药物使用障碍（OUD）中的可能作用，2个关键领域需要创新的治疗方案。疼痛控制仍然是一个重大的临床挑战。特别是对于OUD患者和接受长期阿片类药物治疗并对阿片类药物诱导的镇痛产生明显耐受性的患者。尽管这个问题很严重,缺乏针对这些人群的疼痛管理替代方案的对照研究.从临床前和人类证据中，我们强调了迷幻药对慢性疼痛和OUD的共同神经生物学底物起作用的潜力，潜在逆转疼痛和阿片类药物诱导的神经适应，比如中央敏化。我们详细阐述了疼痛体验的多层面(感官，情感和认知)及其与阿片类药物相关现象(阿片类药物渴望和戒断)重叠的交叉点，假设这些过程如何被迷幻药调节。在总结了现有的临床研究后，我们为未来的转化研究和临床试验的设计提出了机械见解和方法学考虑，建立在对慢性疼痛和OUD的共同临床和神经生物学理解的基础上。我们的目的是提供及时的观点，在阿片类药物危机升级的情况下，加速慢性疼痛和OUD新疗法的开发和探索。
