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In this episode of the Psychedelic Medicine Podcast, Jon Dean, PhD joins to discuss the potential of psilocybin therapies for phantom limb pain. Dr. Dean is an assistant professor at UC San Diego, where he co-founded the Center for Psychedelic Research and his laboratory conducts fMRI-based studies on psychedelics such as psilocybin and DMT for relief of chronic pain and neurological conditions.
In this conversation, Dr. Dean discusses emerging research on psilocybin as a potential treatment for phantom limb pain, a condition that affects many people following an amputation. Preliminary findings from his small pilot study suggest that a single dose of psilocybin may produce clinically meaningful reductions in both phantom limb pain and residual limb pain lasting at least four weeks. Dr. Dean also explores potential neurological mechanisms underlying these effects, including changes in communication between the brain's default mode network and thalamus, and discusses the importance of further research to establish the treatment's safety and efficacy. Looking ahead, he considers how combining psychedelics with targeted interventions such as mirror therapy could improve outcomes for people living with chronic pain.
In this episode, you'll hear:
- What phantom limb pain is, how common it is among amputees, and how it differs from residual limb pain
- How Dr. Dean's colleague Albert Lin's experience with psilocybin and mirror therapy inspired research into psychedelic treatments for phantom limb pain
- The preliminary findings from Dr. Dean's pilot clinical trial investigating the safety and efficacy of psilocybin for chronic pain
- The role of the brain's representation of a missing limb in the experience of phantom limb pain
- Why the subjective effects of psychedelics may be important to their potential therapeutic benefits
- How future research may combine psilocybin with mirror therapy and other targeted interventions
Quotes:
"In the smaller sample size, we did see clinically meaningful - 30% or more - reductions in phantom limb pain and also residual limb pain at the site of the amputation upwards of four weeks after just one dose of psilocybin, which we did not see that in the niacin [control] group—pain either stayed relatively the same or maybe as a mean kind of increased a little bit." [13:41 - 14:04]
"One of the things that we keep seeing—and this has been known with psychedelic research on things like depression, etc. There's this really well studied network in the brain called the default mode network. It kind of incorporates areas across the cortex and into the subcortex too, select medial prefrontal cortex, precuneus… Anyhow, this network is pretty well established to be involved in processing self-referential types of thought—so things like pain catastrophizing and rumination and depression. This network is pretty hyperactive, and you see in the psychedelic work on things like depression, there is some correlation with acute psychedelic administration dampening this network and that correlating with the clinical outcomes such as less depression. And so one of the things that we are very interested in appreciating—because we would be seeing this in our psychedelic work, including this trial and the preliminary data, and in the mindfulness data—that when someone is having the relationship with their pain change (and they're literally telling us this from the studies, especially in the mindfulness stuff) … people will say with their back pain, 'I still feel my back pain, but my relationship to it's quite different.' And we do see this self network being modulated by mindfulness. And we see it in our psychedelic study too. So specifically in phantom pain, in the preliminary data, what we found was a decoupling of the default mode network from the thalamus, which is like the main sensory gate in your brain." [16:56 - 18:45]
Links:
The Center for Psychedelic Research at UC San Diego website
The Center for Psychedelic Research on Instagram
The Center for Psychedelic Research on X
Dr. Dean's randomized trial: "Feasibility and Tolerability of Psilocybin for Phantom Limb Pain"
Previous episode: Can Psychedelics Help Stroke Recovery? With Dr. Steven Zeiler MD, PhD
