Kratom Use Rises Among Chronic Pain Patients Despite Limited Research
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Despite growing popularity among individuals seeking relief from chronic conditions, data supporting the use of kratom remains scarce, raising concerns among medical professionals. The herbal remedy, derived from a tree native to Southeast Asia, is being increasingly used for pain management and opioid withdrawal, but its safety and efficacy are largely unproven.
“Its reported benefits include pain relief — it mitigates opiate withdrawal symptoms, it lifts mood and is energy boosting,” said J. Nicholas Manwaring, MSN, APRN, FNP-C, a nurse practitioner in the division of rheumatology at the Alaska Native Tribal Health Consortium, in Anchorage, and a commander in the U.S. Public Health Service Commissioned Corps at the Indian Health Service. “The caveat is that there is not a lot of research available.”
Understanding Kratom and Its Origins
Kratom is an herbal extract derived from the Mitragyna speciosa, an evergreen tree found primarily in Southeast Asia. Manwaring, speaking at the 2025 Rheumatology Nurses Society annual conference held November 6-8 in San Antonio, explained that users consume the substance in various ways, including chewing or eating the leaves, adding the extract to liquids, or brewing it like tea.
He drew parallels between kratom and other natural remedies that have become staples of modern medicine, such as willow bark (used to create aspirin) and poppy seeds (used to produce opioids). “When properly used, these things can be very helpful,” Manwaring said. “When not properly regulated, it can be a problem.”
A Complex Chemical Profile
The psychoactive component of kratom, mitragynine, is the subject of ongoing research. Manwaring urged attendees to review available studies on the substance, noting its complex pharmacological profile. “It’s basically a benzo and an opiate all in one,” he said, highlighting the potential risks associated with combining these types of substances.
Research into kratom’s safety and efficacy has yielded inconclusive results. “There are a lot of conflicting data,” Manwaring stated. “There is underreporting and confounding variables about fatalities and overdoses. There are very small sample sizes with observational design. And there is a lack of randomized, controlled trials, so it is difficult to standardize the dose.” Currently, the FDA has not taken regulatory action regarding kratom.
Clinical Implications and Patient Safety
Despite the lack of conclusive evidence, many patients are self-treating with kratom for a range of ailments. This trend necessitates caution from clinicians managing patients with chronic diseases and chronic pain.
“You have to ask patients if they are taking any herbal supplements,” Manwaring emphasized. “Really, you need to be careful. Natural does not always mean safe.” He underscored the importance of a thorough patient history, including inquiries about all supplements and alternative therapies being used.
For more information, J. Nicholas Manwaring, MSN, APRN, FNP-C, can be reached at [email protected].
Source: Manwaring N. Plant-Based and Problematic: Kratom’s Problematic Rise. Presented at: Rheumatology Nurses Society annual conference; Nov. 6-8, 2025, in San Antonio (hybrid meeting).
Disclosure: Manwaring reports no relevant financial disclosures.
