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Papers of the Week

2022 Sep 05


Microdosing psilocybin for chronic pain: a case series.


Lyes M, Yang KH, Castellanos J, Furnish T
Pain. 2022 Sep 05.
PMID: 36066961.


Psychedelic serotonergic agonists such as psilocybin have recently been shown to produce sustained benefit in refractory depression, end of life anxiety and addiction when administered in hallucinogenic doses and coupled with psychotherapy. While it has been suggested that similar high dose protocols may help chronic pain conditions, there are few published clinical trials of psychedelics for pain. The use of these agents in sub-psychedelic doses for chronic pain management has received even less attention. This case series details the experiences of three individuals who have used low dose psilocybin to manage chronic neuropathic pain. While the nature and etiology of each patient's pain varies, they share a common experience, including inefficacy of current therapeutics and decreased quality of life. Through self-administration of psilocybin, these patients have achieved robust pain relief with decreased reliance on traditional analgesic medications. Despite varying preparations and uncertain potencies, the analgesic effects for all three patients occurred at doses without a psychedelic experience and with minimal cognitive or somatic adverse effects. Furthermore, the efficacy of pain relief, and in some cases the duration of the effect, were magnified when coupled with functional exercise. Additionally, in one case, repeated dosing appeared to produce increased relief, suggesting a possible long-term plasticity mediated effect. These commonalities highlight psilocybin's therapeutic potential in the treatment of chronic pain that warrants further investigation.