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Home > AnesthesiaExam Podcast > What is Kratom? Effects, Side Effects and Benefits in Pain Reduction
Podcast: AnesthesiaExam Podcast
Episode:

What is Kratom? Effects, Side Effects and Benefits in Pain Reduction
Category: Education
Duration: 00:11:14
Publish Date: 2025-12-11 11:47:00
Description: ️ PainExam Podcast Show Notes Kratom (Mitragyna speciosa): What Pain Physicians Must Know for the Boards

In this episode, Dr. David Rosenblum reviews the current science, pharmacology, risks, and clinical relevance of Kratom — an herbal substance widely discussed by pain patients and increasingly appearing on pain-medicine board exams. The discussion focuses on evidence-based mechanisms, safety considerations, and counseling points essential for ABA/ABPM/ABIPP/FIPP board preparation.

Key Board-Relevant Takeaways 1. Pharmacology & Mechanism

  • Kratom's primary alkaloids are mitragynine and 7-hydroxymitragynine.

  • They act as partial mu-opioid receptor agonists and demonstrate G-protein biased signaling, which may reduce β-arrestin–mediated respiratory depression seen with full opioids.

  • No FDA-approved medical use; pharmacokinetics and dose-response remain inconsistent.

2. Reported Effects

Potential Benefits (mostly anecdotal or preclinical):

  • Analgesia for chronic pain

  • Mood elevation and increased energy

  • Reduction of opioid withdrawal symptoms

Major Limitations:

  • No high-quality randomized controlled trials

  • Not a recommended analgesic for evidence-based pain practice

3. Adverse Effects & Safety Concerns

Commonly reported:

  • Nausea, vomiting, constipation

  • Tachycardia, palpitations

  • Hepatotoxicity in some users

  • Dependence and withdrawal syndrome similar to mild-moderate opioid withdrawal

Serious risks:

  • Product variability and contamination

  • Potential interactions with CNS depressants

  • Unpredictable potency of alkaloids

4. Regulatory Status

  • Kratom is unregulated, with significant variability in purity and composition.

  • FDA and multiple public-health agencies caution against its use due to safety concerns.

  • Not recommended as a first-line or adjunct pain therapy.

5. What Boards Like to Test

Expect questions on:

  • Mechanism: partial MOR agonist, G-protein bias

  • Differences from classical opioids

  • Adverse effects and withdrawal

  • Toxicology and contamination risks

  • Counseling patients who self-medicate

  • Lack of clinical trial data and regulatory approval

Board Prep Resources

Prepare for the ABA, ABPM, ABIPP, FIPP, and AOBPM exams with the PainExam Board Review and full curriculum at the NRAP Academy: https://www.NRAPpain.org
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