Case Series Examines Psilocybin Microdosing for Chronic Neuropathic Pain

A case series published in Pain found evidence supporting microdosing of psilocybin as a potential therapeutic for chronic neuropathic pain.

Investigators at the University of California, San Diego (UCSD) conducted video-based interviews with 3 patients who contacted faculty at UCSD Pain Medicine and self-disclosed using psilocybin for chronic pain. The interviews included discussions about their pain history, previous analgesic strategies, patterns of psilocybin use, perceived psilocybin effects, and adverse effects.

Patient 1 was a 37-year-old man who had quadriplegia secondary to a vehicular accident approximately 8 years earlier in which he sustained a cervical spinal cord injury. The patient has no motor function distal to T4 but experiences lower extremity neuropathic pain that originates in the mid thoracic region and radiates through the abdomen and down both legs. The patient described feelings of burning with electric shocks that have been increasing in intensity and frequency since the accident. The patient described the pain as being unresponsive to tramadol and diazepam.

Patient 1 reported experiencing near total relief from lower extremity neuropathy with dried ground psilocybin 250 mg lasting 6 to 8 hours. The psilocybin also induced muscle spasms in his paralyzed muscles, which the patient felt to be therapeutic and akin to exercise. The patient had been using psilocybin 50 mg/d for 6 months, reporting 90% to 95% pain relief lasting 6 to 8 hours.  He reported that he was able to discontinue tramadol, valium, and cannabis. He did not experience rebound pain or withdrawal symptoms on nonuse days.

Patient 2 was a 69-year-old woman with complex regional pain syndrome secondary to lower extremity trauma approximately 5 years earlier. The patient experienced unpredictable flares of burning pain, cramps, spasms, and leg weakness with no clear triggers.  She also described hyperalgesia and allodynia. She reported minimal pain relief with both nonpharmacologic and pharmacologic approaches, including nonsteroidal anti-inflammatory drugs (NSAIDs), oxycodone, fentanyl patches, buprenorphine patches, gabapentinoids, duloxetine, and amitriptyline.

For more than a year, the patient had been using 500-mg psilocybin-containing mushrooms daily for 7 to 10 days followed by 2 or 3 days of abstinence. This dose provided the patient with 80% pain relief for 3 to 4 hours without psychedelic effects. She did not experience rebound pain or withdrawal symptoms on nonuse days.

Patient 3 was a 40-year-old woman with radiculopathy secondary to degenerative disc disease manifesting as stiff musculoskeletal pain in the low back. For the past 5 years, the patient’s pain had worsened progressively, evolving to bilateral radicular pain. The patient underwent laminectomy, which mildly improved symptoms.  She relied on NSAIDs, muscle relaxants, and opioids for pain relief.

The patient consumed a chocolate bar containing 1000 mg of dried ground mushroom every 6 to 8 weeks. She reports that this dosing strategy reduced her pain from a score of 8 to 0 and that the pain relief lasts for 2 to 4 weeks. No adverse effects were reported.

In this case series, 3 patients with differing types of chronic pain endorsed the use of low doses of psilocybin to manage their symptoms without adverse effects.  The investigators advise that “[s]tudies looking at both microdosed and full psychedelic doses of psilocybin are needed to more clearly elucidate therapeutic dose ranges as well as mechanisms of action in the management of chronic pain.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.