The Impact of Psilocybin on Pain in Fibromyalgia Patients

Fibromyalgia Clinical Trial

— PsiloFM  

Official title:

The Impact of Psilocybin on Pain in Fibromyalgia Patients: a Multicentre Trial.

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06368492
• Other study ID #: P137
• Secondary ID: 2021-002909-10NL
• Status: Not yet recruiting
• Phase: N/A
• Start date: April 2024
• Est. completion date: December 2025

Study information

• Verified date: April 2024
• Source: Maastricht University
• Contact: Mauro Cavarra, MSc
• Phone: ?+31 433 88 23 55?
• Email: fpn-pim_p137[@]maastrichtuniversity.nl
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Rationale: Recent evidence shows that Lysergic Acid Diethylamide (LSD), even when administered in low, non-hallucinogenic doses, can produce analgesic effects and improve pain tolerance in a sample of healthy volunteers. Such results complement what was already observed with other serotonergic psychedelics such as psilocybin: survey studies and case series indicate that its use may lead to improvements in chronic pain conditions such as migraines, cluster headaches and phantom limb pain even at low, non-psychedelic doses. These effects have however not yet been investigated and confirmed in clinical populations under controlled experimental conditions. Fibromyalgia (FM) is a chronic condition characterised by widespread pain, hyperalgesia, anxiety, disturbed sleep patterns, impaired cognitive functioning and comorbid mood disorders. Most suggested therapies are only associated with small improvements in pain ratings and quality of life. Currently, there is no data concerning the effectiveness of serotonergic psychedelics in improving pain ratings in fibromyalgia patients. Objective: The present study will explore the effects that the administration of a placebo and 2 low psilocybin doses (5 mg or 10 mg) will have on pain perception in a group of fibromyalgia patients. Study design: The present study uses a double-blind, randomized, placebo-controlled design. All participants will receive a placebo and 2 doses of psilocybin (5 mg or 10 mg) and will undergo the Cold Pressor Test (CPT) and the Pain Pressure Threshold Task (PPT) o test its analgesic effects.

Description:

Rationale: Recent evidence shows that Lysergic Acid Diethylamide (LSD), even when administered in low, non-hallucinogenic doses, can produce analgesic effects and improve pain tolerance in a sample of healthy volunteers. Such results complement what was already observed with other serotonergic psychedelics such as psilocybin: survey studies and case series indicate that its use may lead to improvements in chronic pain conditions such as migraines, cluster headaches and phantom limb pain even at low, non-psychedelic doses. These effects have however not yet been investigated and confirmed in clinical populations under controlled experimental conditions. Fibromyalgia (FM) is a chronic condition characterised by widespread pain, hyperalgesia, anxiety, disturbed sleep patterns, impaired cognitive functioning and comorbid mood disorders. It has high direct and indirect costs and it is considered challenging to treat. Most suggested therapies, in fact, are only associated with small improvements in pain ratings and quality of life. Currently, there is no data concerning the effectiveness of serotonergic psychedelics in improving pain ratings in fibromyalgia patients. Objective: The present study will explore the effects that the administration of a placebo and 2 low psilocybin doses (5 mg or 10 mg) will have on pain perception in a group of fibromyalgia patients. Study design: The present study uses a double-blind, randomized, placebo-controlled design. All participants will receive a placebo and 2 doses of psilocybin (5 mg or 10 mg) and will undergo the Cold Pressor Test (CPT) and the Pain Pressure Threshold Task (PPT) o test its analgesic effects. Study population: 35 fibromyalgia patients aged 18 to 65 years. Intervention: Placebo, 5 mg or 10 mg of psilocybin in randomized order. Main study parameters/endpoints: Primary outcomes will be subjective and objective measures of pain perception. Secondary measures will assess the effects that placebo and psilocybin will have on mood, cognition and psychedelic experience. Finally, participants will take part to an additional CPT after receiving hypnotic suggestions of analgesia to test whether such intervention may moderate pain ratings of individuals who took small doses of psilocybin. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Participants will visit the research lab 5 times during 5 weeks. Before the first study day, subjects will come for a screening visit during which they will also be familiarized with tests and study procedures. This includes a medical screening by a licensed physician (medical history review, laboratory screening, electrocardiogram recording). The study visits will consist of taking the study treatment (5 mg or 10 mg of psilocybin or placebo), taking part to the experimental tasks, taking blood samples, completing computer tasks and filling out questionnaires. Finally, participants will take part to a final online visit to administer post-study questionnaires.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 35
• Est. completion date: December 2025
• Est. primary completion date: December 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Age between 18 and 65 years
• Normal weight, body mass index (weight/height2) between 18 and 28 kg/m2
• Fulfilment of the American College of Rheumatology criteria for FM diagnosis (43)
• A minimum Numeric Rating Scale (numeric rating scale) pain score of 5 out of 10
• Proficient knowledge of the Dutch or English language
• Written Informed Consent
• Understanding the procedures and the risks associated with the study
• No regular use of psychotropic medication such as opiates, antidepressants, muscle relaxants, anticonvulsants, sleep aids, benzodiazepines. Non pharmacological regimens will be allowed along 1 rescue therapy such as acetaminophen =4,000 mg/day, ibuprofen =1,200 mg/day, naproxen =660 mg/day, or ketoprofen =75 mg/day. Use of paracetamol (PCM) and non-steroidal anti-inflammatory drugs (NSAIDS) will be allowed and monitored.
• Willingness to refrain from taking psychoactive substances during the study.
• Willingness to drink only alcohol-free liquids and no coffee, black or green tea, or energy drinks after midnight of the evening before the study session, as well as during the study days
• Willingness not to drive a traffic vehicle or to operate machines within 24 h after substance administration

Exclusion Criteria:

• Presence of any other painful condition such as inflammatory rheumatic diseases, migraines or headaches and of other chronic or acute medical conditions
• Presence or history of any other psychiatric condition such as primary major depressive disorder, anxiety disorders or substance use disorder as determined by the medical questionnaire, drug questionnaire and medical examination
• Previous experience of serious side effects to psychedelic drugs (anxiety or panic attacks)
• Tobacco smoking (>20 per day)
• Excessive drinking (>20 alcoholic consumptions per week)
• Psychotic disorder in first-degree relatives
• Pregnancy or lactation
• Hypertension (diastolic > 90 mmHg; systolic > 140 mmHg)
• History of cardiac dysfunctions (arrhythmia, ischemic heart disease…)
• For women: no use of a reliable contraceptive

Related Conditions & MeSH terms

• Fibromyalgia
• Myofascial Pain Syndromes

Intervention

Drug:
• Psilocybin
Each participant will receive 2 different doses of psilocybin (5mg and 10mg) and a matching placebo on three separate occasions.

Behavioral:
• Hypnosis script
All participants will receive a brief hypnotic induction aimed at producing analgesia before the second administration of CPT

Locations

Country	Name	City	State
Netherlands	Leiden University Medical Center	Leiden	South Holland
Netherlands	Maastricht University	Maastricht	Limburg

Sponsors (2)

Lead Sponsor	Collaborator
Maastricht University	Leiden University Medical Center

Country where clinical trial is conducted

Netherlands, 

References & Publications (1)

Castellanos JP, Woolley C, Bruno KA, Zeidan F, Halberstadt A, Furnish T. Chronic pain and psychedelics: a review and proposed mechanism of action. Reg Anesth Pain Med. 2020 Jul;45(7):486-494. doi: 10.1136/rapm-2020-101273. Epub 2020 May 4. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Ischemic Pain perception	Pain tolerance (seconds) in the Cold Pressor Task	1.5, 2.5 and 4 hours after administration
Primary	Pressure-evoked Pain perception	Pain threshold (kPa) in the Pressure Pain Threshold	1.5 and 4 hours after administration
Primary	Self-reported pain	Painfulness Visual Analogue Scale (0: no pain; 10 worst pain)	1.5, 2.5 and 4 hours after administration
Secondary	Subjective effects: psychedelic phenomenology	5 Dimensions of altered states of consciousness (5D-ASC)	Baseline, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5 and 6 hours after administration
Secondary	Subjective effects: mood	Profile of mood states (POMS)	Baseline, 1, 2, 3, and 5 hours after administration
Secondary	Subjective effects: intensity of effects	Intensity of effects Visual Analogue Scale (VAS) (0: not under the influence; 10: very much under the influence)	Baseline, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5 and 6 hours after administration
Secondary	Subjective effects: Ego dissolution	Ego Dissolution Inventory(EDI)	6 hours after admnistration
Secondary	Subjective effects: Dissociation	Clinical Administered Dissociative States Scale (CADSS)	Baseline and 6 hours after administration
Secondary	Psychiatric symptoms	Brief Symptom Inventory (BSI)	Baseline and 6 hours after admnistration
Secondary	Cognitive performance	Digit Symbol Substitution Test (DSST) - time to complete in seconds and number of errors	1.5 and 4 hours after administration
Secondary	Vigilance	Psychomotor Vigilance Task (PVT) - number of attantion lapses	1.5 and 4 hours after administration
Secondary	Empathy	Multifaceted Empathy Test (MET) - emotion recognition accuracy (right answers/wrong answers)	1 hour after administration
Secondary	Creativity	Alternate Use Test (AUT) - Fluency and Originality, Flexibility, and Elaboration scores	2.5 hours after administration
Secondary	Creativity	Story Writing	2 hours after administration
Secondary	Autobiographical memory	Autobiographical Memory Test (AMT)	2.5 hours after administration
Secondary	Autobiographical memory	Autobiographical Recollection Test (ART)	Study baseline and 1 week after last experimental session
Secondary	Treatment expectancy	Credibility/Expectancy Questionnaire (CEQ)	Study baseline
Secondary	Treatment expectancy	Treatment Expectations in Chronic Pain (TEC)	Study baseline
Secondary	Fibromyalgia-related pain	o Fibromyalgia Impact Questionnaire (FIQ)	Baseline and 1 week after each experimental session
Secondary	Personality	Big Five Inventory (BFI)	Baseline and 1 week after last experimental session
Secondary	Absorption	Modified Tellegen Absorption Scale (MODTAS)	Baseline and 1 week after the experimental session
Secondary	Interpersonal Reactivity	Interpersonal Reactivity Index (IRI)	Baseline and 1 week after last experimental session
Secondary	Depression	o Beck Depression Inventory - II (BDI-II)	Baseline