The Potential of Kava Kava for the Brain and Pain
What is Kava Kava?
The Piper methysticum shrub, native to Polynesian and Pacific Islands, contains an extract that is used both as an herbal remedy and an important component of the local village rituals and ceremonies. Kava kava, though colloquially referred to as just “kava”, is the extract that helps to facilitate family and village bonding rituals, as well as political meetings between tribes by reducing social inhibition. Through modern consumerism and increased attention to the island drug, a development in its popularity has been exhibited and can be seen across an array of discussions—most notably, those of clinical research and biomechanics. At the intersection of these discussions exists the strong belief that kava may one day be prescribed as an herbal treatment for anxiety and pain management.
How is Kava consumed traditionally?
Kava is isolated from the Piper shrub by one of three means: the traditional preparation, the streamlined micronized preparation, and the even further simplified concentrate preparation. The first of the three refers to the soaking, beating, and drinking of the ground root; the second refers to the mixing of a dissolvable powder from the root into a liquid drink; the third refers to a consumable pill. The first two methods have encouraged tourism and economic benefits to the countries from which it originates by bearing close resemblance to the symbolic, earth-flavored experience; the concentrate speaks to the drug’s future as an easily administered agent with natural anxiolytic (anti-anxiety) and analgesic (anti-pain) properties.
What are the active chemical compounds in Kava?
The kavalactone and flavokavain compounds found in kava extract are notorious for producing these effects in the human body and do so by resembling the structure of GABA, an inhibitory neurotransmitter. The associated depressant effects produced by the body upon the drug’s administration (pill and liquid consumption, alike) resemble those of pain and anxiety medications by providing an immediate body high. A suppression of the overactive nerves induces a sense of relaxation and calmness throughout one’s core and extremities—with an added numbing sensation of the tongue when drank.
What makes Kava unique?
Certain properties specific to kava set it apart from the currently administered drugs whose aims are to reduce anxiety or discomfort. Despite its classification as a psychoactive drug—typical for compounds that act on the central nervous system—moderate levels of consumption have proven ineffective at altering one’s state of mind or level of consciousness. This is in contrast to the most common painkillers (i.e. opioids) that induce the necessary effects related to a body high, while also initiating an addictive head high. Similar can be said for anti-anxiety medications that target the issue at hand but in turn, often promote unwelcomed sleepiness. This has been a fundamental piece of evidence in the now wide consideration of kava as a non-addictive drug. Even more specific to kava in comparison to other popular drugs, like alcohol or caffeine, is its reverse-tolerance nature. The body develops an increased sensitivity and response to the kavalactones and flavokavains from the extract with prolonged usage, as opposed to requiring more and more to achieve the same effect. Needing to increase the dosages of one’s kava-based treatment with time would therefore be an unlikely and unnecessary course of action by the physician. This may further refine the impacts on the body to only those that are intended.
Why is Kava not currently used to treat chronic pain?
The different ways by which the drug acts are mostly positive, and well-understood; however, the actual extent to which kava acts as an analgesic and anxiolytic agent on the human body must show equal promise. In fact, kava’s performance should fare against the reigning anti-pain/anxiety medication champions. A comparison of this sort is typically approached via a meta-analysis of all the available longitudinal and experimental studies. Ideally, each would shed a little light on how the drug performs alongside positive and negative controls (rivals and placebos, respectively). Unfortunately, kava’s increasing visibility has yet to reach a point where enough studies have been performed and can conclusively speak to its clinical effectiveness. Only a few smaller-scale studies have pointed to potential short-term (<6 months) applications of the drug for anxiety or pain relief.
A potential health consequence may stand in the way of kava’s rise to medical stardom—more specifically, the user’s potential for hepatotoxicity with its long-term use. This proposed impact on the liver by the drug has been cause for concern after one experimental study was cut short because incidence of liver injury seemed too high to continue. Many details remain unknown about the biomechanical pathway; however, a negative interaction of kava with alcohol is becoming increasingly understood. This study may have involved misuse of the drug, as directions of usage are often accompanied by the warning to not cross-consume in the same sitting. Even if all precautions were taken, a more mutually exclusive approach for the two than is currently recommended may be necessary. Just as the positive effects cannot be stated with complete consequence but show promise, the potential negatives must also not be immediate cause for pulling the plug and should instead be further evaluated.
Overall, the reverse-tolerance, non-altering, and non-addictive natures of kava make in an exciting prospective pharmaceutical treatment in the field of pain management. The United States’ health care system and pharmaceutical industries have been under fire for their role in the current opioid epidemic, with annual opioid-related overdoses nearly quintupling in the twenty-year period from 1999 to 2019. The positive trend may soon—or even may have already—brought annual deaths to over 50,000. Though physicians have finally begun reducing the extent to which opioids are prescribed, the death-toll continues to climb at an increasingly higher rate. There is promise in kava’s ability to fill the role as the effective but non-addictive replacement for current pain medications like opioids. Perhaps if they were only prescribed as a last resort or in the most severe of cases would we see a flattening of the curve and an eventual decline in deaths related to opioid overdoses. For this hope to actually garner potential, an allocation of proper resources and funding into kava research would be the first of many necessary steps.
Author: Camden Rowe
Editor: Ospina Medical Team