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Review
Psilocybin and chronic neuropathic pain: a systematic review
  1. David S Jevotovsky1,
  2. Harman Chopra2,
  3. Daniel J Pak3,
  4. Shravani Durbhakula4,
  5. Alexander Shustorovich5,
  6. Tanya Juneja2,
  7. Mustafa Y Broachwala2,
  8. Tariq AlFarra6,
  9. Caroline Silver1,
  10. Greg Kreitzer7,
  11. Philip Oreoluwu8,
  12. Braden B Weissman1,
  13. Abraham AlFarra9,
  14. Brian G Mayrsohn10,
  15. Vwaire Orhurhu11,
  16. Trent Emerick11,
  17. Timothy Furnish12 and
  18. Joel P Castellanos12
  1. 1Physical Medicine & Rehabilitation, New York University Grossman School of Medicine, New York, New York, USA
  2. 2Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Anesthesiology, Weill Cornell Medical College, New York, New York, USA
  4. 4Anesthesiology, Pain Medicine Division, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  5. 5Physical Medicine & Rehabilitation, Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
  6. 6Interventional Spine & Pain, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  7. 7The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  8. 8Psychiatry, Cooper University Health Care, Camden, New Jersey, USA
  9. 9Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
  10. 10Pain Medicine, Maywell Health, New York, New York, USA
  11. 11Anesthesiology, Pain Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  12. 12Division of Pain Medicine, University of California San Diego, San Diego, California, USA
  1. Correspondence to Dr Joel P Castellanos; jcastellanos{at}health.ucsd.edu

Abstract

Background/Importance Chronic pain affects many people globally, requiring alternative management strategies. Psilocybin is gaining attention for its potential in chronic pain management despite being classified as Schedule I.

Objective This systematic review critically evaluates the evidence for psilocybin, a Schedule I substance, in the treatment of chronic pain. The exact purpose of the review is to assess the impact of psilocybin on chronic pain relief, focusing on dosing protocols, treated conditions, and patient outcomes.

Evidence Review A comprehensive review of PubMed, CINAHL, Web of Science, Cochrane Library, and EMBASE was conducted up to January 2024. Eligibility criteria included studies evaluating psilocybin for chronic pain management. The risk of bias was assessed using the MASTER (MethodologicAl STandards for Epidemiological Research) scale, and the strength of evidence was graded using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation).

Findings The review identified 28 relevant studies focusing on dosing, treated conditions, and outcomes. The majority of the included studies (76.2%) were of low or very low quality. Several studies with moderate-to-low-quality evidence utilized a 0.14 mg/kg dosing protocol. The findings suggest promise for the use of psilocybin in chronic pain relief, though the quality of evidence is generally low.

Conclusions The current research shows potential for psilocybin as a treatment option for chronic pain relief. However, methodological issues and a lack of high-quality evidence underscore the need for further investigations with standardized protocols. Despite these limitations, the potential for psilocybin in chronic pain management is encouraging.

PROSPERO registration number CRD42023493823.

  • Neuralgia
  • CHRONIC PAIN
  • Pain Management
  • Complementary Therapies
  • ETHICS

https://doi.org/10.1136/rapm-2024-105532

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    Footnotes

    • X @danieljpak, @ShravaniD_MD, @TanyaJunejaMD, @TrentDEmerick, @joelcaste11anos

    • Contributors All authors contributed equally to the production of this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.