LSD and psilocybin could offer promising therapeutic potential for the treatment of chronic pain “on a mechanistic and experiential level,” according to a newly published literature review that highlights scientific findings happening as part of the “psychedelic renaissance”—a recent thawing of stigma and opposition into psychedelics research after decades of prohibition.
What’s more, authors note, the pain-relieving effects of LSD and psilocybin seem to increase with repeated treatment, unlike opioids, which display “decreased therapeutic effect” over time.
The narrative review, published last month in the South African Medical Journal, charts both the history of the two substances as well as scientists’ emerging understanding of their methods of action. It notes that the drugs seem not just to reduce pain but also better manage the experience of pain.
“Recent neuroimaging studies combined with small sample interventions with classic psychedelic agents,” authors wrote, “may point towards a possible means of improving the treatment of chronic pain on a mechanistic and experiential level.”
Classic psychedelics, the literature review explains, are those that bind to the central nervous system’s 5-HT2A receptors. They include both LSD and psilocybin.
The way psilocybin binds to receptors in the central nervous system “has similar effects to LSD on cognition, emotional processing, self-awareness and the perception of pain,” says the literature review, “which underpins its potential therapeutic benefit in treating people suffering with pain. Numerous small trials of LSD and psilocybin for chronic pain have already shown a good safety profile, with minimal physical dependence, withdrawal syndrome, or compulsive drug seeking compared with other analgesic agents.”
While the two drugs are part of the same family of alkaloids, their history is, of course, much different. The review describes explains that LSD was first synthesized in 1938, meaning humans have used it for less than a century. Psilocybin’s use stretches back thousands of years. In the modern U.S., psilocybin use was popularized in the late 1950s, while LSD grew to prominence in the ’60s and ’70s.
While there have been no reports of direct mortality from either substance and no withdrawal following chronic use, the study says, “the use of psilocybin in clinical research ended at the same time as LSD research as the Controlled Substances Act was enforced.”
Associations with counterculture and anti-government sentiment meant LSD and psilocybin research was abandoned, authors wrote. “From 1977 until the early 2000s, no more LSD research was published, despite overwhelming evidence pointing towards therapeutic benefit.”
Prior research had indicated LSD might be useful in treating depression, pain, and physical suffering in cancer patients and others. Among seven patients with phantom limb pain, participants treated with LSD reduced their analgesic requirements, and two patients’ pain was resolved.
During what the review refers to as the modern “psychedelic renaissance” or “the new wave of psychedelic research,” studies have found that psilocybin or LSD may help reduce cluster headaches, end-of-life depression in cancer patients and chronic pain.
In a pain study, a small sample of patients who self-medicate with the psychedelics “revealed a decrease in the experience of pain during the psychedelic session and for up to 5 days after treatment, before their pain returned to baseline.”
“The most exciting revelation from these interviews relates to the lasting psychological and emotional effect the psychedelics had on those interviewed,” the review says. “They describe increased resilience, body-self-awareness and psychological flexibility and psychological flexibility, which led to feelings of acceptance, agency and hope.”
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