Psilocybin as a psychophysical adaptogen in chronic pain rehabilitation.

Those living with chronic pain and comorbid functional disabilities are often confronted by a physically and emotionally transformative experience, impacting their identity and ability to derive meaning in life. Despite the use of various pharmacological and non-pharmacological treatments to moderate symptoms, the degree of analgesia and functional recovery are far from optimal. Psychological disorders including depression and anxiety, and maladaptive cognitive-affective states such as pain catastrophizing and fear of movement collectively impact participant engagement with rehabilitation services, leading to further deteriorations in functional status while perpetuating pain symptoms into a continuous and distressing cycle of avoidance and sedentary behavior. Psilocybin is known to produce altered states of consciousness through altered functional connectivity among key brain regions responsible for self-referential and sensorimotor processing. While preliminary evidence suggests drastic and favorable therapeutic effects among those with psychiatric disorders and unhelpful coping skills, there is limited research examining its analgesic potential and ability to foster participation in structured rehabilitation programs through changes in self-perception and meaning-making processes. The current focus article examines the application of psilocybin as a psychophysical adaptogen among those suffering from chronic pain. We propose psilocybin may be used to simultaneously improve illness identity and neuromotor outcomes through a reframing of perceived barriers to exercise engagement. PERSPECTIVE: This focus article examines the potential of psilocybin to enhance patient engagement in chronic pain rehabilitation by modulating self-perception and meaning-making processes-two underexplored yet critical barriers to successful pain management. We also propose a novel integrative framework embedding targeted movement therapy sessions into psilocybin study protocols.