From the Guidelines
Kratom should be avoided for pain management due to its potential for serious side effects, including dependence, addiction, and respiratory depression, and the availability of safer, more effective alternatives. The use of kratom for pain management poses significant risks, including nausea, constipation, liver damage, and dependence or addiction, as it contains compounds that act on opioid receptors 1. The FDA has not approved kratom for medical use, and its product quality and potency vary widely without regulation.
Instead, better alternatives for pain management include FDA-approved medications like acetaminophen, NSAIDs (ibuprofen, naproxen), or prescription options such as gabapentin for nerve pain, duloxetine for chronic pain, or tramadol for moderate pain when other options fail 1. Non-medication approaches are also effective, including:
- Physical therapy
- Cognitive behavioral therapy
- Acupuncture
- Massage
- Heat/cold therapy
- Mindfulness meditation
For those with severe pain, a pain specialist can develop a comprehensive treatment plan that may include carefully monitored opioid medications when appropriate, as outlined in the CDC clinical practice guideline for prescribing opioids for pain 1. These alternatives offer more predictable results with better understood safety profiles than kratom, which lacks standardization and clinical research supporting its use.
The CDC guideline recommends that nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain, and clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient 1. The guideline also emphasizes the importance of patient education and discussion before starting opioid therapy, including reviewing available low-cost options for pain management, being explicit and realistic about expected benefits of opioids, and advising patients about serious adverse effects of opioids 1.
In contrast, kratom's potential for harm and lack of standardization make it a less desirable option for pain management. As such, healthcare providers should recommend evidence-based alternatives to kratom for pain management, prioritizing the safety and well-being of their patients.
From the Research
Risks of Kratom Use
- Kratom has been associated with serious adverse effects, including liver toxicity, seizures, and death 2, 3
- Kratom use has been linked to physical and psychological dependence, with some individuals experiencing classic opioid withdrawal symptoms upon abrupt cessation 2
- Kratom may potentiate the toxicity of coadministered medications through modulation of cytochrome P450, P-glycoprotein, and uridine diphosphate glucuronosyltransferase enzymes 2
- High doses of kratom can cause negative effects, including nausea, constipation, and respiratory depression 4
Alternatives to Kratom for Pain Management
- Traditional opioid medications, such as methadone and buprenorphine, may be effective for pain management, but they carry a higher risk of respiratory depression and addiction 2, 3
- Non-opioid pain management options, such as acupuncture, physical therapy, and cognitive-behavioral therapy, may be effective for some individuals 5
- Other herbal supplements, such as cannabidiol (CBD) and turmeric, may have anti-inflammatory and analgesic effects, but their efficacy and safety for pain management are not well established 5
Kratom as a Substitute for Opioids
- Some individuals use kratom as a substitute for opioids to relieve pain and withdrawal symptoms 6
- Kratom may be helpful for reducing opioid use and relieving withdrawal symptoms, but its efficacy and safety for this purpose are not well established 6
- Further study of kratom, including systematic characterization of its safety and efficacy for various conditions, is warranted 6
Patterns of Kratom Use
- Kratom is primarily used by middle-aged, middle-income individuals for self-treating pain and emotional or mental conditions 4
- Kratom preparations present with a dose-dependent effect, with negative effects mainly presenting at high doses and frequent use 4
- Kratom is often used in conjunction with other substances, which can increase the risk of adverse effects and interactions 3, 5