872 - No More Opioids After an Encounter with Psychedelics in a Chronic Pain Patient

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

TW

Theodora K. Wong, MD

Resident Physician
University of California, Irvine
Orange, California, United States
Justin Tram, BA

MS4
Albany Medical College
Albany, New York, United States
Keshin Purohit, MD, MS

Resident
UC Irvine PM&R
Orange, California, United States

Co-Author(s)

AS

Adrian Darryll D. Sulindro, MD

Attending Physician
Biohealth Pain Management-
Lawndale, California, United States

Case Diagnosis: Chronic pain after brachial plexus injury

Case Description: A 29 year-old male presented to the clinic with severe neck and left arm pain secondary to brachial plexus injury after a motor vehicle collision. He underwent C7-T5 fusion and had since taken multiple opioids at over 250 OME. Severe neck pain persisted and radiated to the left arm, with accompanying weakness and paresthesia. Treatment with stellate ganglion blocks, and chronic opioids (MS Contin 15 mg every 8 hrs, and MSIR 15 mg every 4 hrs) had minimal effect. Additional surgeries to brachial plexus and spine also did not improve pain. Cervical stimulator trial was effective, but he wanted to attempt all non-invasive measures prior to implant. He subsequently completed a detox program with psychedelics in Mexico two years after the accident. He returned to the clinic with all his opioids stopped. Pain was well controlled with only lyrica a few months later.

Discussions: Limited research is available that examines the role of psychedelics in chronic pain. There is speculation that psychedelics may alter the areas of functional connectivity in the brain via serotonin 2A receptor agonists and reverse the changes seen in chronic pain states. This patient had a remarkable improvement in chronic neuropathic pain after a brief encounter with psychedelics, so much so that high dose opioids were discontinued. Details in dosing and amount of psychedelics used were limited. This is a recurring challenge described in literature due to the inconsistency in sourcing and variations in psychogenic concentrations among different mushroom batches. Further research is needed on psychedelics, including specific dosing, as an alternative analgesic for chronic pain patients who fail conventional measures.

Conclusions: Psychedelics may be an appropriate alternative analgesic for chronic pain. This may decrease overall use of opioids and their significant adverse effects.