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Kratom: a primer for pain physicians.

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Kratom, used for pain and opioid withdrawal, carries significant risks. Physicians must understand kratom

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Area of Science:

  • Pharmacology
  • Toxicology
  • Pain Management

Background:

  • Kratom is frequently used in the US for pain, opioid withdrawal, and fatigue.
  • Its use as an alternative to conventional treatments for opioid use disorder is common.
  • A comprehensive understanding for pain management physicians is crucial due to risks.

Purpose of the Study:

  • To provide a comprehensive discussion of kratom for pain management physicians.
  • To highlight the risks and potential interactions associated with kratom use.
  • To inform clinical decision-making regarding kratom as an adjunct therapy.

Main Methods:

  • Review of current literature on kratom's pharmacology and clinical use.
  • Analysis of kratom's receptor binding profile and metabolite activity.
  • Examination of reported adverse events and toxicological findings.

Main Results:

  • Kratom and its metabolites (mitragynine, 7-OH-mitragynine) interact with mu-opioid receptors but are not classic opioids.
  • Kratom use can lead to tolerance, dependence, and withdrawal, though typically less severe than traditional opioids.
  • Concerns exist regarding contamination with heavy metals and toxins, with potential for serious complications like seizures and death.

Conclusions:

  • Kratom's use as an opioid-sparing agent in pain management is associated with substantial risks.
  • Pain physicians must be aware of kratom's adverse effects and potential complications.
  • Informed clinical judgment is essential when considering kratom in multimodal pain treatment.