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Psychedelics are reshaping the landscape for tough-to-treat conditions like PTSD, treatment-resistant depression, and addiction disorders to name a few. Now, early research suggests they might also hold promise for one of the hardest challenges in healthcare: persistent pain.
This isn’t about miracle cures. It’s about neuroplasticity, learning, and the potential to shift deeply ingrained pathways that may perpetuate pain.
It’s still early days, but for those of us supporting patients who’ve tried everything else, it’s a space worth watching—with curiosity and care.
Let’s dive in:
Here’s the basic idea: our brains get stuck. We tend to follow the same thoughts, beliefs, and emotional loops—over and over again. This is known as canalization: like a mental groove that’s been worn so deep, it becomes our default. Sometimes that’s adaptive—it makes us efficient. But when the groove is carved deep around beliefs like “I’m not good enough” or “I’m broken and fragile,” it can shape how we move, how we feel, and how we respond to pain.
Emerging research suggests that psychedelics like MDMA and psilocybin may help loosen those grooves. These compounds primarily act on 5-HT2A receptors and quiet the default mode network—the brain’s inner narrator. The result? A temporary window where that rigid groove softens, and new beliefs and behaviours can take root.
For people living with treatment-resistant pain, this shift might offer a new path forward—especially when entrenched thought patterns are part of the problem.
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👉 Study 1 – MDMA, PTSD, and Chronic Pain
In a re-analysis of MDMA trials for PTSD, over 60% of participants also had chronic pain. After treatment:
- Pain interference dropped by 22 points (vs. 4 in the placebo group)
- Pain severity dropped by 1.7 points (vs. 0.6)
- And this was without even targeting pain directly.
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👉 Study 2 – Psilocybin + Fibro
In a small pilot, folks with fibromyalgia took a single dose of psilocybin (~25 mg) with psychological support.
- Within 4 weeks, most saw meaningful improvements in pain, sleep, mood, and energy
- A follow-up protocol is using EEG to see if psilocybin helps “reset” brain networks
Couple quotes from participants:
- "The stars pointed to the origin of my original injury, a car accident when I was 13. That insight helped me understand how to repair my body—I started moving & doing yoga.”
- “I met my grandparents and great aunt again and gained such a sense of pride and love—I felt my grandmother’s touch, as clear as can be... Gratitude keeps surfacing—grateful for the journey, for this often challenging body, since it means I’m still alive.”
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It’s still early days—but the signal is interesting, especially for patient's with fibromyalgia. Psychedelics might help people get
unstuck from deeply embedded pain stories. We’ll need more and bigger trials before we draw firm conclusions—but it’s a space worth watching. If your curious, look at
cluster headaches,
phantom limb pain, and emerging
case reports on long covid.
I’ve been thinking about canalization—how the brain lays down
well-worn paths in response to stress, injury, or fear. Again, these patterns are often adaptive at first: efficient, protective, even life-saving. But over time, they can become so deep they crowd out other possibilities. What once helped us cope can start to limit how we move, feel, and relate to ourselves.
I’ve started to see persistent pain not as dysfunction, but as a kind of
overlearned stability—a pattern that makes it harder to stay flexible, curious, or open to new ways of moving and being. That reframe helps me—and sometimes my patients—approach change with more compassion.
Rehab, to me, is about
creating small rifts in those grooves—through words, movement, education, or touch. These moments of relief or insight open the door to prediction error and new
learning.
That’s also what psychedelics seem to do in a big way: they open a sea of possibility and may help people with
treatment-resistant pain get unstuck. Not through magic—but by creating the conditions for change in even the most difficult to treat conditions.
🔬 Nerd out more on canalization
here
If persistent pain is, in part, a story the nervous system keeps telling itself—a well-rehearsed prediction—then change might come from gently violating those predictions in safe, intentional ways.
That’s what fascinates me about canalization: grooves that were once helpful but now keep us stuck. Beliefs about movement, danger, or fragility don’t shift until we offer the system something new to learn.
🗣️ How do you think about canalization and disrupting stuck patterns?
If you’re curious about what safe, ethical psychedelic care actually looks like—start with
Entheo.org. They offer free, practical resources for harm reduction and experience optimization.
Whether someone is new, nervous, or just curious, Entheo walks them through the full arc: medical screening, intention setting, preparation, the experience itself, and integration. No hype. Just grounded, responsible guidance built for real people navigating real questions.
Psychedelics aren’t magic, they are not for everyone, and they’re certainly not a cure-all. At best, they open the door—or for some, they create a sea of potential. But it’s what happens after that shapes the outcome.
I don’t for a second think canalization is the new biomechanical boogeyman. I see it as just one of many ways to understand the nervous system’s survival strategies. Still, when those strategies start to hold people back, we’re offered a moment—not to fix, but to offer something different. Something unexpected. Something that might just shift the path and enable learning.
Because healing isn’t always about joint mobilizations, three sets of ten, or pain science lectures. Sometimes, it’s about catching the right moment to disrupt the pattern—and offering the nervous system a new place to go.
We can’t offer therapies like psychedelics in clinical practice just yet—but it’s a space worth staying curious about. Maybe one day, as the research evolves and if safety and efficacy are established, they’ll become an option for people whose pain hasn’t responded to first-line therapies.
Stay nerdy,
