Cherup Nicholas P, Finan Patrick H
Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States.
Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States; Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
J Pain. 2025 Jul 21:105507. doi: 10.1016/j.jpain.2025.105507.
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.
患有慢性疼痛和共病功能障碍的人常常面临身体和情感上的转变经历，这会影响他们的身份认同以及从生活中获取意义的能力。尽管使用了各种药物和非药物治疗来缓解症状，但镇痛程度和功能恢复情况仍远未达到最佳状态。包括抑郁和焦虑在内的心理障碍，以及诸如疼痛灾难化和运动恐惧等适应不良的认知情感状态，共同影响着参与者参与康复服务的程度，导致功能状态进一步恶化，同时使疼痛症状持续存在，陷入一个由回避和久坐行为构成的持续且痛苦的循环。已知裸盖菇素会通过改变负责自我参照和感觉运动处理的关键脑区之间的功能连接来产生意识改变状态。虽然初步证据表明其对患有精神障碍和应对技能不佳的人有显著且有益的治疗效果，但研究其镇痛潜力以及通过改变自我认知和意义构建过程来促进参与结构化康复项目的能力的研究却很有限。当前的焦点文章探讨了裸盖菇素作为一种心理物理适应原在慢性疼痛患者中的应用。我们提出，裸盖菇素可通过重新构建对运动参与的感知障碍，来同时改善疾病认知和神经运动结果。观点：这篇焦点文章探讨了裸盖菇素通过调节自我认知和意义构建过程来增强慢性疼痛康复中患者参与度的潜力，而这两个方面是成功进行疼痛管理的尚未充分探索但至关重要的障碍。我们还提出了一个新颖的综合框架，将有针对性的运动治疗课程纳入裸盖菇素研究方案中。
