Kratom is a herbal medicine made from the leaves of a tree native to Southeast Asia. It’s also known as Mitragyna speciosa. It has been traditionally used as a medicine in Asia for 150 years to treat aches and pains, increase energy, and improve mood.

In recent years kratom has become popular in the US and Europe. It’s thought that in the US alone there are 4 to 5 million people using Kratom.

The leaves are dried and sold as a supplement in capsule or powder form. It’s sometimes sold as tea, liquid, or patches that go on the skin. The dried leaves can also be smoked. Kratom is usually sold in local smoke and herb shops or online.

Kratom works on the brain’s opioid receptors. The two main chemicals in kratom are called mitragynine and 7-hydroxymitragynine. They are known to work on the primary opioid receptor known as the “mu” receptor.

Since kratom works on the brain’s opioid receptors, some scientists say it should be classified as an opioid. Others feel it isn’t an opioid, so more research and clarification is needed.

Kratom comes in different strains, which can have different effects and side effects in a similar way to different strains of cannabis. Common strains you might hear talked about include red vein, white vein, and green vein.

There is little research on the benefits and safety of kratom for chronic pain, but many people find it helpful.

Reduced Pain

Some research suggests that kratom has an analgesic effect, meaning it can reduce pain. It works similarly to opioids, by attaching to the opioid receptors and blocking specific pain signals.

A 2023 narrative inquiry on the subject studied adults who regularly use kratom products and found that: “kratom’s subjective effects were consistently described comparably to a mild opioid mixed with caffeine, or even a low-dose opioid.”

A 2020 study found that participants taking kratom: “demonstrated a substantial and statistically significant increase in pain tolerance.” In theory, this means that even if pain isn’t reduced, patients taking kratom may find the back pain they experience less distressing. 

It’s also thought that kratom may change pain perception. A 2020 comprehensive review on kratom stated that: “mitragynine (one of the chemical components in kratom) appears to block pain signaling through other mechanisms as well, suggesting a multimodal role in regulating pain perception.” The same review also mentions that kratom can have anti-inflammatory effects, so may help with chronic back pain where inflammation is present. 

However, studies on kratom for chronic pain relief are limited. More research is needed to establish whether it could be a viable pain treatment.

Opioid Alternative

Since opioids can be harmful to take long term and have serious side effects, many patients choose to gradually stop opioid treatment. Withdrawing from opioids can be very difficult since your body and mind become dependent on them. Some pain patients have found that using kratom has helped them stop taking opioids and reduce the withdrawal effects. However, experts don’t recommend this and there isn’t enough information to determine if kratom is helpful in this way.

Kratom may be a safer alternative to opioids, but research is mixed on the topic. Some professionals believe that kratom doesn’t cause respiratory depression (breathing issues) in the same way as opioids.

Researchers at Johns Hopkins Medicine state that kratom: “has a lower rate of harm than prescription opioids for treating pain, anxiety, depression and addiction.”

Positive Effects on Mood

Some people have found that kratom helps with mood disorders, anxiety, and depression. Since chronic pain is difficult to live with and often leads to mental illness, this could be helpful for pain patients.

Many users have reported positive effects such as a sense of wellbeing, relaxation, increased sociability, and even a feeling of euphoria.

Some evidence suggests that kratom may be more effective at treating mental health conditions than chronic pain. A review of patients with pre-existing health conditions who used kratom found that: “Self-reported improvements in pre-existing mental health symptoms attributed to Kratom use were greater than those related to somatic symptoms (back pain, rheumatoid arthritis, acute pain, chronic pain, fibromyalgia).”

Sedative or Stimulant Effects

Some strains and strengths of kratom are thought to work as a sedative. Others are thought to have stimulant effects which some evidence suggests may help with the fatigue that often comes with chronic pain. Users report that lower doses tend to work as a stimulant while higher doses work as a sedative, but this isn’t proven yet.

Several studies have found that mitragynine (one of the chemical compounds in kratom): “may bind to adrenergic receptors, serotonin receptors and dopamine receptors, which may be responsible for some of the arousing effects some people who use kratom report experiencing.”

There are many risks to taking kratom, so it’s crucial to do plenty of research and talk to your doctor before making any decisions.

Potential Side Effects

There are several side effects of taking kratom, but as with most medicines, not everyone will experience them. Lower doses tend to result in fewer side effects. One 2022 article states that: “Doses of up to 5 g of Kratom presented with lower odds ratios for detrimental effects than doses of 8 g or more.”

Possible side effects of kratom include:

• Nausea
• Constipation 
• Sweating
• Itching
• Dizziness
• Dry mouth
• Hallucinations and delusions
• Seizures
• Liver damage
• Tachycardia (increased heart rate)
• Drowsiness
• High blood pressure 
• Confusion
• Respiratory issues
• Cardiac arrest 

After using kratom for a long period, there may be other side effects including:

• Darkened facial skin
• Dry mouth
• Frequent urination
• Anorexia and weight loss
• Ongoing constipation
• Insomnia
• Liver issues
• Problems with memory
• Issues with cognitive functioning
• Ongoing psychiatric symptoms
• Coma

A number of case reports have found that: “regular, long-term, kratom use in large amounts may be associated with serious liver problems.” However, this could be influenced by many other factors and more research is needed. 

Research shows that cardiovascular effects such as cardiac arrest, cardiac palpitations, elevated blood pressure, prolonged QT interval, or tachycardia are common. Between 2014 to 2019 cardiovascular effects were reported in: “36.8% of adults 60 to 69 years of age and by 51.9% of adults 70+ years old among cases in which kratom alone was used.”

Case reports have also found that neurological effects of long-term use are common, especially when a patient stops taking kratom. This includes: “neurological symptoms, such as seizure, aphasia, coma, disorientation, or headaches.”

It’s also important to note that evidence shows kratom isn’t safe to use in pregnancy, as it can pass to the baby and cause withdrawals when they’re born. A 2022 narrative review on kratom stated that: “Clinical reports have detailed development of neonatal abstinence syndrome among children born to mothers who used kratom—among other substances—during pregnancy.”

Other Risks

It’s important to keep in mind that kratom is not approved by the U.S. Food and Drug Administration (FDA) as safe, which also means it isn’t regulated. This means how it’s made and dispensed isn’t guaranteed to be safe and companies don’t have to follow the strict safety protocols as with regulated medicines.

The U.S. Drug Enforcement Administration (DEA) has listed kratom as a “drug of concern”, which means it’s legal in many places now but may not be in the future. In fact, in some states and cities in America, the drug is already banned and is illegal to sell. It’s also banned in the UK.

Several studies found that kratom products were contaminated with other harmful ingredients including: “heavy metals and harmful bacteria”

Some sources claim that there have been multiple deaths from kratom, but this is widely discredited as there could have been other causes for the deaths of these patients. Research suggests that death caused directly by kratom is very rare.

Withdrawal Symptoms

With regular kratom use the body becomes dependent on the drug. When patients stop using kratom, they typically experience a range of withdrawal symptoms including:

• Changes in mood including negative mood, aggression, and hostility
• Muscle and bone pain
• Jerky movements of the limbs
• Nausea and vomiting
• Chills
• Diarrhoea
• Hypothermia
• Sweating
• Drooling
• Restlessness and irritability
• Feeling tense and on edge 
• Tremors
• Nervousness and anxiety
• Depression
• Loss of concentration
• Shakiness/jitters
• Runny nose
• Insomnia
• Fever and chills
• Loss of appetite
• Itching

Risk of Addiction

Kratom is known to cause dependence and has the potential to be highly addictive. The FDA released a statement that kratom: “appears to have properties that expose users to the risks of addiction, abuse, and dependence”

The longer you take it, the more likely it is to cause serious withdrawal effects. A 2023 study found that kratom can be addictive when used over a long period and concluded that: “Severe kratom dependents were more likely to suffer from intense withdrawal symptoms.”

Interactions With Other Medications

Kratom is known to interact with a range of other medications, which can increase the risk of serious side effects. A number of case reports show that: “polysubstance use (the use of multiple drugs) involving kratom has been associated with severe adverse effects, such as death and liver problems”.

Before starting any new medication or supplement, it’s crucial to check with your doctor that it’s safe to be taken alongside any other medications you currently take.

If you are living with chronic back pain and need help, but don’t feel kratom is for you – don’t worry! There are plenty of other treatment options including:

• Prescription medications: This can include painkillers and anti-inflammatories; antidepressants which can sometimes reduce chronic pain; anticonvulsants which can reduce pain signals, and steroids. 
• Over-the-counter pain relief: There are over-the-counter painkillers; heat and cold therapy; and a variety of topical pain relief. 
• Talking therapies: Therapies like Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help you cope with your pain and have a better quality of life. 
• Physiotherapy: A professional can help you increase your range of movement, improve your strength, and practice exercises that can reduce pain over time.
• Hydrotherapy: Movement in water can aid in reducing pain and increasing your mobility. 
• Other manual therapies: Massage therapy, acupuncture, chiropractic, and osteopathy may help pain patients relieve tension, reduce pain, and improve strength. 
• Occupational therapy: An occupational therapist can help you to make your day-to-day life more manageable and help you adapt tasks that are difficult for you. 
• Mindfulness: Learning to be mindful can help you cope with living with chronic pain, as well as reduce stress and muscle tension. 
• Creative therapies: Some pain patients find music, art, or dance therapy helpful to deal with their emotions and encourage gentle movement. 
• Exercise-based therapies: Finding ways to exercise that work for you can help strengthen your muscles, reduce pain and stiffness, and improve confidence. 
• Pain clinics or pain management programmes: These clinics help you to learn about your pain and find ways to tackle it that work for you and your lifestyle. These programmes could be in person or online, like Pathways Pain Relief.

Don’t be afraid to ask your doctor or pain specialist about pain treatments that you think might work for you. There are also many ways we can help ourselves reduce our chronic pain at home, like trying to sleep well, eating a healthy diet, and exercising when we can manage it.

Kratom is currently unregulated and therefore, has many risks as a chronic pain treatment. Results of studies are mixed and there is not enough research to be sure one way or the other. Many pain patients have found kratom helpful and some results suggest it could be an effective pain treatment that is less damaging than opioids.

In the future, more research is needed. Ideally, kratom should be regulated rather than criminalised so that patients have clear guidance on dosage and how to take kratom as safely as possible.

If you want to take kratom, it’s best to do detailed research beforehand and talk to your doctor to ensure it’s safe for you.