Psilocybin and neuroplasticity

“Introduction phantom limb pain (plp) is a difficult-to-treat, neuropathic pain syndrome generally presenting within days of an amputation. the incidence is 50- 80% , with duration that is variable and may last years. analgesic agents and mirror box therapy have shown some efficacy, but therapeutic options remain limited. we present a case of refractory plp successfully treated with psilocybin combined mirror box therapy. there is no literature on the use of psilocybin for the treatment of pain. results/case report a 35 year old male suffered a complicated tibial fracture, with subsequent below the knee amputation. aggressive treatment of his perioperative pain included opioids, pregabalin, nortriptyline, ketamine, and peripheral nerve block catheters. he denied plp while block catheters were in place, but developed moderate plp after their removal. four weeks post-operatively, his neuropathic stump pain and plp increased and he developed severe paroxysms of phantom ankle pain. he stopped using opioids as they provided little relief but continued taking pregabalin 200mg tid with only modest pain reduction. mirror box therapy produced modest but brief pain relief. he was seen in follow-up and reported recent use of psilocybin containing mushrooms, which completely eliminated both the phantom pain and stump pain for 2-3 hours but with sensory disturbances and hallucinations. he subsequently tried low dose psilocybin which did not induce hallucinations and significantly reduced the pain. he then began a regimen of combining daily low dose psilocybin with mirror box therapy sessions. over the course of 2-3 weeks he noted 30-60% improvement in his plp and near complete resolution of the paroxysmal phantom ankle pain. the effect of mirror box therapy was reportedly much more vivid in combination with psilocybin. at 9 weeks post-operatively, he had reduced use of the psilocybin to several times per week and was tolerating use of a prosthetic limb. patient consent for submission of the case report for publication and presentation has been obtained. discussion plp is thought to involve peripheral and central neuroplastic changes. centrally, cortical reorganization has been shown to be positively correlated with the presence of plp. psilocybin has been shown to be efficacious in treatment of depression, anxiety, and ocd , but there is no literature on its use for pain. studies have shown its role in enhancing neuroplasticity and modulating prefrontal cortex activi…”

“After a pause of nearly 40 years in research into the effects of psychedelic drugs, recent advances in our understanding of the neurobiology of psychedelics, such as lysergic acid diethylamide (lsd), psilocybin and ketamine have led to renewed interest in the clinical potential of psychedelics in the treatment of various psychiatric disorders. recent behavioural and neuroimaging data show that psychedelics modulate neural circuits that have been implicated in mood and affective disorders, and can reduce the clinical symptoms of these disorders. these findings raise the possibility that research into psychedelics might identify novel therapeutic mechanisms and approaches that are based on glutamate-driven neuroplasticity.”