A study suggests that LSD and Psilocybin may offer effective pain relief without the diminishing effects seen with opioids

A recent scholarly examination has brought into focus the potential therapeutic applications of LSD and psilocybin in the management of chronic pain, approaching this subject from both mechanical and experiential perspectives. This comprehensive analysis of scientific research findings symbolizes the era commonly referred to as the “psychedelic renaissance.” This contemporary period is characterized by a noteworthy shift in societal perspectives and a renewed enthusiasm for investigating the medicinal potential of psychedelic substances, marking a departure from decades of prohibition and inhibition in this field.

Moreover, the authors of this particular review have highlighted a significant divergence between the effects of LSD and psilocybin when contrasted with those of opioids. In stark contrast to opioids, which typically demonstrate a waning therapeutic efficacy over time, LSD and psilocybin have shown a propensity to enhance their pain-alleviating properties through repeated administrations.

The narrative review, recently disseminated in the South African Medical Journal, not only delves into the historical context surrounding these two substances but also elucidates the continually evolving comprehension within the scientific community concerning their mechanisms of action. It is paramount to note that this review accentuates not only the pain-mitigating qualities of these substances but also their potential to significantly enhance the overall management of the pain experience.

Psychedelic Substances and Chronic Pain Management: A Promising Path Forward

Recent advancements in the field of neuroimaging, when coupled with controlled interventions employing classic psychedelic substances, have unveiled a promising avenue for augmenting the treatment of chronic pain at both mechanical and experiential levels. This compelling proposition has been articulated by scholarly authors who hypothesize that classic psychedelics, including but not limited to LSD and psilocybin, possess the potential to facilitate the complex challenge of chronic pain management.

The elucidation of classic psychedelics, as expounded upon in the literature review, centers on substances that engage the 5-HT2A receptors within the central nervous system. Noteworthy within this category are the renowned substances LSD and psilocybin, celebrated for their capacity to induce profound alterations in consciousness and perception.

The literature review further delves into the intricate binding mechanisms of psilocybin to these receptors within the central nervous system. This exploration draws parallels between the effects engendered by psilocybin and those attributed to LSD, encompassing enhancements in cognitive faculties, emotional processing, self-awareness, and the modulation of pain perception. This convergence of pharmacological actions serves as a foundation for the potential therapeutic utility of psilocybin in the treatment of individuals grappling with the enduring burden of chronic pain. Additionally, the review underscores the promising outcomes of various modest-scale trials that have explored the application of LSD and psilocybin in the management of chronic pain. These trials have consistently demonstrated a favorable safety profile, characterized by minimal physical dependence, an absence of withdrawal syndrome, and a notable lack of compulsive drug-seeking behaviors—distinguishing these substances from specific conventional analgesic agents.

While both LSD and psilocybin share commonalities in their alkaloid family lineage, their historical trajectories have followed distinct courses. LSD, synthesized for the first time in 1938, has been in human use for a comparatively brief period of less than a century. In stark contrast, the historical utilization of psilocybin extends back millennia, tracing a rich and diverse history spanning thousands of years. Modern interest in psilocybin surged in the late 1950s, whereas LSD reached the zenith of its popularity during the 1960s and 1970s.

It is a notable aspect of these substances that no direct mortalities have been reported as a result of their use, and chronic usage has not been linked to the development of withdrawal symptoms. However, it is essential to recognize that the inclusion of psilocybin in clinical research was halted concurrently with LSD research as a result of the enforcement of the Controlled Substances Act. The literature review emphasizes that these decisions were primarily influenced by associations with countercultural movements and anti-government sentiments, which led to the abandonment of research efforts related to LSD and psilocybin. Intriguingly, despite the compelling evidence pointing to their therapeutic potential, no research involving LSD was published from 1977 until the early 2000s.

Prior research endeavors had already hinted at the potential utility of LSD in addressing conditions such as depression, pain management, and alleviating physical suffering in cancer patients and various other demographic groups. Notably, among a cohort of seven patients afflicted with phantom limb pain, those administered LSD experienced a notable reduction in their analgesic requirements, with two patients even reporting complete resolution of their pain—a striking testament to the intriguing therapeutic possibilities inherent to these substances.

Psychedelics and Pain Management: Promising Insights and Multidimensional Relief

In the modern era commonly characterized as the “psychedelic renaissance” or the “new wave of psychedelic research,” a sequence of remarkable findings has come to light, indicating the potential effectiveness of psilocybin and LSD in alleviating diverse manifestations of both physical and psychological anguish. These encompass conditions such as cluster headaches, end-of-life depression among cancer patients, and the management of chronic pain.

In the realm of pain management, a captivating study involving a relatively modest cohort of patients who engaged in self-administered treatment with these psychedelic substances has unveiled a compelling trend. Notably, these individuals exhibited a distinct reduction in their subjective experience of pain during the psychedelic sessions, with this ameliorative effect persisting for up to five days following the treatment before gradually reverting to baseline levels.

What emerges as particularly promising within this body of research is the profound and enduring psychological and emotional impact reported by those who underwent these psychedelic therapeutic interventions. Among the notable effects cited are heightened resilience, augmented body-self-awareness, enhanced psychological flexibility, and a newfound sense of acceptance, personal agency, and hope.

A recent development in this arena pertains to publishing a case series within the esteemed journal Pain. This case series presented the experiences of three individuals contending with chronic neuropathic pain who opted for the administration of low doses of psilocybin, a practice often referred to as ‘microdosing,’ as a means to address their symptoms. The findings stemming from this case series underscore the favorable outcomes of microdosing, which encompassed minimal side effects and reduced reliance on traditional analgesic agents.

It is imperative to underscore that what renders LSD and psilocybin particularly appealing in the context of pain management is their capacity to address pain as a multifaceted phenomenon. From the perspective of individuals experiencing it, pain transcends mere physical sensations, encompassing intricate interplays within psychological, social, and even spiritual dimensions. These substances appear capable of effectively engaging with this multidimensional nature of pain.

Furthermore, the review underscores that individuals grappling with chronic pain often harbor extensive psychological, social, and spiritual needs. They may seek to regain a sense of internal locus of control as they grapple with unresolved familial and relational issues. Contemporary paradigms of chronic pain management have evolved beyond the traditional reliance on oral analgesics and interventional pain procedures. Today’s approach integrates comprehensive psychological support, patient education, and physical therapy as essential components within the holistic care framework tailored to individuals living with chronic pain.

Additionally, the review delves into some of the underlying mechanisms of action that might contribute to the therapeutic effects of these psychedelics on pain. This line of inquiry navigates the intricate biochemical and neurological processes these substances operate, providing insights into their potential to offer profound relief to individuals enduring chronic pain.

Psychedelics, Chronic Pain, and Research Challenges: A Comprehensive Overview

The therapeutic efficacy of LSD and psilocybin, mediated through the descending noxious inhibitory control system and their impact on cortical processing, offers a compelling rationale for the utilization of these traditional psychedelic agents in the treatment of chronic pain. Notably, the analgesic effectiveness linked to 5-HT1A/2A agonism appears to enhance with repeated administration, distinguishing it from the typical pattern observed with opioid receptor stimulation, which often leads to receptor upregulation and subsequent diminishing therapeutic efficacy.

In the article’s concluding statements, the two authors from South Africa underscore the adverse global ramifications of U.S. prohibition. They highlight the significant disruption of clinical research caused by the enactment of the Controlled Substances Act of 1970, which markedly hindered the exploration of psychedelic agents and their potential contributions to addressing the mental health and chronic pain challenges of the 21st century. The ongoing resurgence of psychedelic research, steered by dedicated researchers and clinicians worldwide, has been characterized by meticulous and purposeful endeavors to reintroduce investigations involving these naturally occurring alkaloids. The contemporary complexities in managing patients grappling with chronic pain, compounded by their intricate interplay of physical and psychological comorbidities, may derive substantial benefit from the evolving research that delves into the role of serotonin receptor binding in the treatment of the neuroplastic mechanisms underpinning chronic neoplastic pain.

In a distinct study published last month, findings suggest that marijuana presents a multifaceted approach to addressing pain that transcends the limitations associated with opioid-based therapies. This research unveiled that cannabis exhibits an “equally efficacious” capacity in pain management when compared to opioids while additionally providing holistic effects, including enhancements in sleep quality, cognitive focus, and emotional well-being.

Furthermore, a study published in November presented empirical evidence demonstrating the effectiveness of CBD in treating dental pain, thus indicating its potential as a viable alternative to opioid-based analgesics.

Meanwhile, in October, the Drug Enforcement Administration (DEA) proposed a substantial increase in production quotas for marijuana compounds and psychedelics like psilocybin and ibogaine for the year 2023. This proposition was formulated to facilitate research and clinical trials related to these substances. These developments coincide with the anticipation of potential federal approvals for certain psychedelics, such as psilocybin and MDMA, as therapeutic interventions for the treatment of severe mental health conditions.

It is worth noting that the DEA has emphasized its Schedule I drug production quotas as a testament to its commitment to rigorous research on these substances. Nevertheless, the agency has encountered criticism from advocates and scientists who perceive specific actions as conflicting with promoting scientific inquiry.

In response to this criticism, the DEA recently rescinded a proposal to ban psychedelic compounds recognized by the scientific community as valuable for research purposes. This decision marked a significant triumph for the scientific community and occurred shortly after the DEA abandoned separate plans to categorize five tryptamine psychedelics as Schedule I substances.

Additionally, a federal appeals court ruled against the DEA in a lawsuit related to a petition by a Washington State doctor seeking the rescheduling of psilocybin. The court determined that the DEA had failed to provide a comprehensive justification for denying the petition, underscoring the need for a more thorough explanation of its reasoning.