🎙️ 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

🫁 Hands-On Ultrasound Training for Pain Physicians

Boost your procedural skills with live ultrasound-guided interventional pain and regional anesthesia workshops: 👉 https://www.nrappain.org/pages/ultrasound-training

📚 References (Condensed)

• Kruegel AC, Grundmann O. Neuropharmacology of kratom alkaloids. Neuropharmacology.

• Eastlack SC et al. Kratom: Pharmacology & clinical implications. Phytother Res.

• Striley CW et al. Health effects of kratom. Front Pharmacol.

• FDA Public Health Advisory on Kratom.

Educational Offerings & Learning Opportunities

PainExam / NRAP Academy Training & Programs:

• Neuromodulation & Regional Anesthesia Workshops

• Ultrasound-Guided Pain Procedures

• Regenerative Pain Medicine Training

• Virtual Pain Fellowship

• Pain Management Board Review & Question Banks

Learn More / Register: 🔹 https://PainExam.com 🔹 https://NRAPpain.org

Board Prep & Certification Support

Prepare for:

• ABA Pain Boards

• ABPM

• ABIPP

• Pain Management Board Certification Exams

• (No reference to FIPP included, per request)

Access Board Prep Courses & Q-Banks: ➡️ https://PainExam.com ➡️ https://NRAPpain.org

Clinical Practice

AABP Integrative Pain Care (Brooklyn & Great Neck, NY) To schedule a consultation or referral: 🌐 https://AABPpain.com 📞 Brooklyn: 718-436-7246

About the Host – David Rosenblum, MD

Dr. Rosenblum serves as Director of Pain Management at Maimonides Medical Center and Managing Partner at AABP Integrative Pain Care in Brooklyn, NY. He is recognized as an early adopter and leading educator in ultrasound-guided pain procedures, neuromodulation, and regenerative medicine.

He has:

• Developed regional anesthesia training programs

• Published widely in pain medicine literature

• Lectured nationally and internationally through ASIPP, ASPN, NANS, IASP, and more

• Helped over 3000 physicians pass pain board exams

• Hosted the PainExam, AnesthesiaExam, and PMRExam podcasts

Awards (Selected):

• New York Magazine Top Doctors: 2016–2025

• Top Doctors NY Metro Area: 2016–2025

• Schneps Media Honors: Multiple Years

Connect with Dr. Rosenblum

• LinkedIn: https://www.linkedin.com/in/davidrosenblummd/

• Instagram: https://www.instagram.com/painexam/

• Facebook: https://www.facebook.com/david.rosenblum.16

• X (Twitter): https://x.com/AlgoSonic

Episode Call-to-Action

✅ Join the NRAP Community ✅ Register for an Upcoming Workshop ✅ Access Pain Board Review Training

Start here → https://NRAPpain.org | https://PainExam.com