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Psychedelics for managing pain

Dr. Joanna Kempner

Dr. Joanna Kempner is a professor of sociology at Rutgers University, where she studies the overlap of science, medicine, technology, and inequality.

When institutionalized medicine has failed to provide adequate treatment options in the past, people tend to mobilise as a movement to develop their own options. In the past, this can be seen in the context of HIV, abortion, and environmental health. Cluster headache is just the same.

Cluster headaches are more than just a bad headache — they involve a severe, one-sided pain that occurs up to eight times a day, generally for periods of two weeks to three months. The pain is so severe that suicidal ideation is a common experience during the pain, with records of patient taking extreme actions to alleviate the pain, like shooting themselves in the eye, or trying to scoop their eyeball out. Other symptoms can accompany the headache, such as rhinorrhea, nasal congestion, and ptosis. Crucially, however, cluster headaches are typically chronic with no remission.

Due to the combination of such severe symptoms and a lack of formal treatment options, at-home therapies are regularly sought after. After only a brief search, you’ll run into the “Clusterbuster Method” — an informal treatment involving low doses of psilocybin, the active ingredient in magic mushrooms.

In the late 1990’s, a Scottish man named Craig Adams realised that his recreational LSD use was effective in preventing his cluster headaches. After some self-experimentation with doses and schedules, he developed a therapeutic LSD protocol. He then went to spread the word online to other people across the world who suffer from cluster headaches.

In 2006, data from the patient-led Clusterbuster movement was formally explored by researchers from Harvard University. in a paper entitled Response of cluster headache to psilocybin and LSD. From their interviews, they found that:

  1. psilocybin aborted attacks in 22 of 26 individuals

  2. psilocybin terminated attacks in 25 of 48 individuals

  3. LSD terminated attacks in 7 of 8 individuals

  4. psilocybin extended remission periods in 18 of 19 individuals

  5. LSD extended remission periods in 4 of 5 individuals.

They ultimately concluded that the research on the efficacy of psilocybin and LSD in treating cluster headaches may be warranted.

A recent trial at Yale University has now formally explored the treatment, with encouraging results, though the effects were not significant due to the small sample size. Interestingly, this trial used a protocol very closely resembling the patient-designed schedule. The primary researcher, Dr. Emmanuelle Schindler noted that this encapsulates the lesson that patients know more about their condition and how to treat it than they are often given credit for.

Julia Bornemann and James Close 

Julia Bornemann and James Close are leading PsiloPain, a study within the Centre for Psychedelic Research at Imperial College London exploring the use of psilocybin for individuals with fibromyalgia.

Fibromyalgia involves chronic and widespread pain across the body, and is typically associated with negative impacts on mental health. PsiloPain is using both neurophysiological (MRI, EEG) and psychological measures to explore the central mechanisms of fibromyalgia. The design of the study is based on a Patient and Public Involvement (PPI), using in-depth discussion, focus groups, and expert advisors to inform the entire research process.

The themes that were considered for this study were based on a 2021 qualitative investigation of individuals with lived experience of chronic pain who self medicated with psychedelics. This strategy underlies the emphasis on putting patients at the center of the research. The themes from the review are:

  1. Trust, openness

  2. Breathwork

  3. Mindfulness

  4. Movement (eg. Yoga, Qi Gong)

  5. Expressive outlets (eg. journaling, art)

To further inform the protocols and direction, the PsiloPain team involved input from patients, ex-trial participants, support groups, and professional specialists to create overarching rules to adhere to fundamental principles (trust, learning, inclusivity, purpose).

The overarching goal of PsiloPain is to improve the treatment options for individuals with fibromyalgia. This means providing a more effective, relevant and tailored intervention, reducing costs by improving retention, and providing novel avenues for future exploration.

Dr. Jan Ramaekers

Dr. Jan Ramaekers is a researcher and professor of Psychopharmacology and Behavioral Toxicology at Maastricht University in the Netherlands.

Research exploring the potential analgesic effect of psychedelics dates back to the 1960s. These early studies provided encouraging findings, with high doses of LSD providing pain relief in the short-term and long-term for individuals with terminal illnesses. Still, they found that these participants weren’t interested in repeating the experience due to the discomfort from the subjective hallucinatory experience. The natural evolution was for the research to explore whether lower LSD doses may still provide the same pain relief while minimising the discomfort of the experience. However, this exploration didn’t continue beyond the 1970s.

In a 2022 paper, researchers from Maastricht University and the Beckley Foundation compiled self-reported online survey data from 250 chronic pain sufferers. They found that a macrodose of psychedelics, though less common, provided more relief than microdoses of psychedelics or conventional medicine (including cannabis and opioids).

A 2020 study by the same researchers explored the effect of LSD microdoses on their pain perception in the context of cold water exposure. Twenty-four participants were given 0, 5, 10, and 20 micrograms of LSD 1.5 and 5 hours before a Cold Pressor Test which involved pressing their hands into an ice bath. The results found that the highest dose (20 micrograms) of LSD significantly increased their tolerance to the cold and reduced their subjective feelings of pain. Notably, they also found that LSD elevated blood pressure slightly, and increased levels of dissociation, anxiety, and somatization. These results indicate that there may be potential for psychedelics to relieve pain without significant disruptive or hallucinatory psychedelic effects.

While the mechanisms of psychedelic’s analgesic effects are known, there are suggested theories. One possibility is that the psychedelic experience brought on by LSD may cause a redirection of attention away from the pain sensation. Alternatively, the vasoconstrictive properties of LSD that lead to increased blood pressure may stimulate a hypoalgesic effect. A third proposed theory is that LSD may agonise the 5-HT2a and 5-HT1a receptors in the dorsal raphe — a brain structure involved in the descending pain inhibitory process.

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