Psychedelic Medicine: Exploring Their Pain Management Potential with Maya Armstrong, MD

Welcome back to the Pain Science Education Podcast with Maya Armstrong, MD

In this week’s episode of the Pain Science Education Podcast, we delve into the intriguing and emerging field of psychedelic-assisted therapy for pain management. Our guest, Dr. Maya Armstrong, a board-certified physician in addiction and family medicine, shares her insights and research on this topic. Dr. Armstrong discusses her background and how her personal experience with chronic pain and her professional journey in addiction medicine led her to explore the potential of psychedelics in treating chronic pain. We explore the concept of pain as an emergent property of a complex system, emphasizing the importance of understanding pain beyond the traditional biopsychosocial model.

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Psychedelic Medicine: Exploring Their Pain Management Potential with Maya Armstrong, MD

Welcome to the Pain Science Education Podcast, where we discuss ways to treat and reverse persistent pain. I’m your host, Dr. Joe Tatta a licensed physical therapist and founder of the Integrative Pain Science Institute, where we train practitioners on whole person pain care. This podcast also serves as a public health campaign to support those living with chronic pain. This podcast is for informational purposes only, and it’s not intended to be a substitute for professional medical advice. Hey there, friends. Welcome to this week’s episode of the Pain Science Education Podcast. On today’s episode, we’re discussing the potential role of psychedelic assisted therapy in pain management. My guest this week is Dr. Maya Armstrong. Dr. Armstrong is board certified in addiction medicine and family medicine, and currently works at the University of New Mexico in Albuquerque, where she splits her time between pain management, addiction medicine, and currently working in psychedelic assisted therapy research. On today’s episode, we discuss the growing interest in psychedelic assisted therapy for the treatment of chronic pain and mental health conditions. We’ll discuss the different types of psychedelic assisted substances. We explore the neuroscience and the theory supporting psychedelic-assisted therapy, the indications, precautions, and contraindications for psychedelics, and finally, the role of cognitive, mindful, behavioral, and embodied movement therapies that should run alongside psychedelic-assisted therapy. During this conversation, we discuss the potential role of psychedelics, which are currently being investigated in a number of clinical trials, but most of which are not currently legal in the United States of America. If and when some of these therapies do become legal and available in a healthcare setting, it is likely that clinicians will require specialized training to be able to work with these compounds. We are not promoting the use of unregulated psychedelics outside the context of a clinical trial at this time. And as always, the content of the Pain Science Education Podcast is for informational purposes only, does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice, and does not indicate a doctor-patient relationship. Okay, without further ado, let’s begin and let’s learn about the role of psychedelics in pain management. Hi there, Maya. Thanks for joining me this week on the Pain Science Education Podcast.

Hi, Joe. It’s a pleasure to be here. Thanks for inviting me.

I’m excited to speak with you. We’re going to talk about the implications of the upcoming field of psychedelic assisted therapy for people with chronic pain of course that overlaps with mental health conditions and other physical health conditions. really new and broad topics. I’m excited that you’re bringing this to all of us here on the podcast. I’d like to just kind of first like just know a little bit about your background before we dive deep into the psychedelics about how you got involved in chronic pain, how you got involved in addiction medicine and all the specialties that you have today.

Oh, great, thanks. Well, I should say, because it may be of some interest to your listeners, that I have experienced chronic pain in my body. Feeling pretty good today, I have to say, but I understand the challenges, at least as I’ve experienced them. And that’s part of what got me interested. And then when I got into medicine and I was initially trained as a family doc, primary care, pain just kept coming up over and over and over and over. I was, I really saw how it interfered, not only with quality of life, but overall health in general. And, you know, in primary care, we’re trying to address so many different things and dealing with so many chronic conditions. And people that are really struggling with pain on a daily basis or a frequent basis, they have a hard time taking care of much anything else, whether it’s their diabetes or their high blood pressure or certainly mental health. So it was so relevant. And then also as an addiction medicine physician, which I did after that, went to fellowship, I saw so much overlap and not just the obvious ways, not just the I hurt my back, They gave me Percocet and now here I am with this terrible dependence, but some more interesting and deeper and complex relationships. So, um, I guess that those two things, the chronic pain and for, in many cases, the substance abuse, um, I feel like they both need to be addressed in order for either to get better. and really have fueled much of my research interest as well.

And obviously, as a physician, you have a toolbox of psychopharmacology to use, right? And I’m sure you have used a lot of that. How did psychedelics start to become an interest of yours? I guess, where do you really see psychedelics starting to fill a gap that might not be in a physician’s prescribing book, if you will?

Yeah, oh my goodness. Well, I think the hype and the excitement around psychedelic medicine right now is partly because we haven’t done very well in certain areas of medicine, Western medicine. We’re really great at taking out your gallbladder. We’re really great at a lot of things, but these chronic relapsing, remitting, conditions that include chronic pain and include all the things that lead up to substance use disorders and include other things, diabetes, hypertension, we’re less good at those chronic conditions. And some really debilitating ones like chronic pain, PTSD, anxiety, depression, really haven’t moved the needle very much in recent years. And so as some of the research is coming out, and of course, a lot of people have been interested in psychedelics for a long time, but it’s been some really some of the important research that came out of Johns Hopkins and NYU and other places kind of put it more on on the table for like a legitimate discussion. And then, of course, got picked up by the media. And so a lot of people are very interested. And I was one of them. I became interested about 10 years ago. And have pursued additional training and now I’m involved in research. And there’s a lot, lot, lot we don’t know, and it is not going to be a panacea, but it’s really exciting.

Yeah, I think, you know, I always mentioned to everyone on this on this podcast, we try to take an evidence of forms approach. And with some things are very large bodies of evidence that we can talk about and discuss. And with other things, there’s some really new and exciting happenings that are going on in the realm of evidence based medicine. But yeah, we don’t have kind of a solid base, we might have on something like exercise for pain, or cognitive behavioral therapy for pain. although people like you are starting to kind of build that evidence-based forest. I think it’s probably a good time now to point our viewers to a paper that you wrote, which is called Chronic Pain as an Emergent Property of a Complex System and the Potential Roles of Psychedelic Therapies, which was in Frontiers in Pain Research in April of 2024. I think it’s important because obviously this is not a randomized controlled trial. but it’s a really nice perspective paper that’s probably about 25 pages long that looks at a little bit of the history and theory, some mechanisms, and then how we could potentially go forward with regard to psychedelic-assisted therapies for chronic pain. So I thank you for the paper. Tell us a bit, I think, like, first, the emergent idea of pain, right? So, so far we’ve heard the message that pain is biopsychosocial. Um, everyone who follows this podcast has heard that numerous, numerous times. Um, I personally like, and I’ve started to use emergent property as well, because I think it gives people a different idea of actually what’s happening both within their body and their nervous system, but also with regards to their experience. So explain to us how you see pain as an emergent experience or complex.

Sure. And first, I will warn people about the paper. It is long and super nerdy and not for everyone. But there’s nuggets in there, I think. And you can skip around if you’re so inclined. It is freely available. So complexity science is a whole field that I am not an expert in. And there’s lots of books out there and articles and other podcasts and things that people are interested. Gosh, I can’t even tell you when I kind of first made the connection, but I’m not the first. Other people have talked about pain and certainly depression and a variety of other things as being emergent properties. OK, so what is what does that mean? We have to first step back and say, well, what is a complex system? Right. And we are complex systems for sure. And lots of other things. But a complex system is based on a few key principles, then a very simple way to put it is it’s more than the sum of its parts, right? We are not just a head attached to a neck attached to shoulders and or a skeletal system and a, you know, vascular system. It’s the way that things interact with each other and also with the environment. And, um, there are certain properties or behaviors of complex systems that include these things such as emergent properties. And something that maybe is a little bit simpler to understand for folks is traffic. And traffic, a traffic jam, can be an emergent property of a complex system when you have a whole bunch of cars and road conditions and weather conditions and time of day and erratic behavior by other drivers. And I live in Los Angeles currently, so traffic is a really huge thing. And sometimes there’s a tremendous traffic jam. And then suddenly it clears, and there’s no evidence of an accident. And it’s like a mystery, right? So traffic jams can be emergent properties. And I’m arguing in this paper that pain can be an emergent property. And we can talk about some of the many complex things that interact together and feed into that complex system. But, um, and with the caveat that I’m not an expert, you know, I got I took a deep dive, or not even a deep, maybe a somewhat shallow dive into this field that is much bigger than than what I’m doing. So forgive me if I don’t do the best job of explaining it. But I’ll stop there and ask, let you ask your next piece.

Well, I appreciate the complexity part, because when we start to talk about things like, well, I think pharmaceuticals in general, we look at it as like, OK, this one drug or this one pill is going to solve your diagnosis. And it sounds very clear and logical in some way.

And wouldn’t it be nice if it were true?

It would all of us want that right now all of us who went into healthcare went into these professions, with, you know, helping lean in mind obviously we’re helping professions, and we want that it’s, but the complexity of human conditions that we see today that run the gamut from non communicable diseases to mental health conditions to the chronic pain syndromes and all the overlap that happens in between those. or not simple they are complex in some way. And I think it’s important that we encourage people and practitioners as well as the average person to start to think on a complex level because I think it helps all of us solve the problem of chronic pain for that particular person so I think it’s important that we bring this one into literature and then, you know, to into the diaspora that we’re kind of talking in today. How do you start to like have this conversation like with patients though, right? Because when we look at, you know, so biopsychosocial in and of itself, it can be confusing to people because people say, okay, well, is it biological then? Meaning is it like something with my physiology or metabolism? Is it my psychology? Meaning like, is it depression or anxiety that’s causing the pain? Or, you know, is it something social, meaning whatever, as you mentioned, something in the environment, so to speak. How do we start to have these more nuanced conversations with patients?

Yeah, well, first the answer is yes, and, right? But the conversations are so important. And the really frustrating thing, at least in medicine, especially in primary care, is finding the time for those conversations, right? If you have a 15 minute visit, how on earth? And I know there are some good tools. There’s some great tools in the physical therapy world that try to break it up And so it kind of depends on the patient and where they’re at and what they’re interested in. But I do try to open up the conversation that especially chronic pain, it’s not the same as stubbing your toe, right? And that there’s a lot of things that go into it and kind of warming up, introducing this biopsychosocial idea and see how responsive people are, where it’s confusing, where there might be barriers to their curiosity or understanding or things like that. The worst thing is that some people have been told or have internalized this thing. Oh, well, that means it’s just all in your head. It’s, quote, all in your head. And that is usually said in a very derogatory way. Right. my take on it is, well, a lot of it is in the head, but that is bigger, and more complex and more nuanced, and actually more empowering than most people think about it when they when they say that. But so I have little snippets of pain neuroscience education, you know, I, I talk about things like depression and sleep and diet, and it kind of depends where is it going to grab for that person? What’s going to stick? If the sleep piece really stands out to them as being something that’s crucial, maybe we start there, or the anxiety or something else, or maybe they are interested happen to be interested in weight loss as well, and we can add nutrition and physical activity and things like that. So just like this topic is complex and pain is complex, the approach is not necessarily complex, but it has to be individualized.

Yeah, I mean, I love the emergence emergency of the I love the emergent property idea in the paper, because as you’re working your way through the paper, you’re getting this idea that, okay, in some way, psychedelic assisted therapy is going to help with this emergent property or this emergent experience that I’m having that we call chronic pain. Part of that experience, which you spent a lot of time talking about in your paper, is our interoceptive experience. So essentially what we’re feeling in our body physically and emotionally in our body. I love the world of interception because it overlaps so well with embodiment approaches, which really speak well to I think physical therapy practice it also speaks well to psychology practice in many ways. And I think there’s a real embodiment piece in psychedelic therapy that we’re going to see kind of evolve over the next probably decade or so. But just give us a little bit of kind of your view on interoception. What is it? How is it related to chronic pain? And maybe talking a little bit about something kind of a little nerdy, as you mentioned, which is interoceptive accuracy.

Yeah, yeah. So it’s wild. I mean, who among us consciously thinks about like our own heartbeat. Some of us more and more are noticing our breath, right, through different mindfulness and breathing and yoga practices. Do you think about your internal organs very much? No, like there’s so much data that our brains are collecting constantly, constantly, constantly data from our organs that is beneath our conscious awareness, right? Sometimes bits and pieces of it bubble up into our conscious awareness. But even though we’re not conscious of all of that data, it’s it’s getting processed in our brain in different ways, and our brain has to make some sort of sense of it. And, of course, it contributes to all this this emergent, you know, properties that we’re talking about. So In the scientific literature, the one piece of interoception that is commonly tested has to do with interoceptive accuracy, but it’s tested in one specific way, which is something called a heartbeat tracking task. And I don’t know about you, but I rarely notice my heartbeat unless I’m exercising or I’ve just been in an anxiety-provoking situation and suddenly it’s very like in my throat, but different people are able to sense their heartbeat to different degrees, different levels of sensitivity, right? And different levels of accuracy. So the task is basically, and I’ve never done it, this is just based on my reading, in different settings, you know, you would ask me, okay, what do you think your heart rate is? Ish, you know, 50, 70, 90, whatever. And then at the same time, we’re actually testing it, right? So we can see how accurate am I? And that’s pretty simplistic. To me, it sounds pretty simplistic. It has some data, there’s some information in that. Oh, isn’t that interesting? That some people are more or less accurate, maybe in different settings, we’re more or less accurate. But it certainly does not capture interoception, right? So I think there’s a lot that we are not understanding about how an individual senses what’s going on internally and how that data gets interpreted by our brains. So, but, or and, so it’s a big question that is not well answered. but it’s clearly affecting so much of what we do. I mean, our emotions, like you said, many people talk about how sub-perceptual data coming from our bodies sort of helps us to say, oh, I’m anxious. How do you know you’re anxious? Well, I get this funny feeling in my stomach. My heart feels like it’s racing and my body gets tense and I start to go tingly and all these things, right? So that’s all various versions of interoception, but it’s almost like once your body is screaming at you, as opposed to the subtle, subtle communication that maybe you may or may not be getting from your body. So I think it’s really important, not only in things like anxiety, but to me, it’s obvious how important it’s gotta be in chronic pain.

Yeah, I know when I have this conversation. Oftentimes the occupational therapist and the pediatric physical therapists are very excited to have these conversations because from a developmental perspective as humans we develop this interoceptive sense this ability to sense what’s happening in our body. And it’s not, as you mentioned, heart, breathing, digestive organs, but it goes so much further than that. Skin, sweat, and then, of course, all that informs us about the actual emotional experience or the valence that we’re having within a particular, let’s bring it back to what you said before, how that all emerges in our body, essentially. And, you know, I wrote a pain model called PRISM, and in that model, embodiment is an essential process as part of the pain recovery process. And I did that very intentionally because right now we’re so focused on the brain and that’s important. We want to make sure we move just from a cognitive perspective to also an embodied perspective within chronic pain recovery. I know a lot of that is going to be really important as we start to talk about psychedelics here in our conversation. I think a lot of what you’re talking about as far as kind of interoception and kind of like this idea of sensation coming up through our body, right through our nervous system, into our brain, and then our brain has to decide what to do with it. Correct?


Predicted processing, Bayesian theory, all that’s kind of wrapped up in there. Would you say that’s correct?

Yes. And that’s a whole other level of nerd in the paper. I was joking with my friends. I was like, somebody throw me a pocket protector. I’m drowning in the waters around nerdlandia. Yeah. So again, I’m not a Bayesian theorist. There’s a whole realm of computer learning that is fascinating and totally not my area. some really interesting work that’s being done through that to kind of tie some of this together. Let’s see, what do I want to, I’m sorry, I lost, was there a specific question or did I jump in too soon?

Maybe not, we were just talking about, you know, predictive processing and how interoception is really a key part of predictive processing.

Yeah, and interception is part of it. Also, our past experiences are part of it. Learning is part of it. But yeah, so predictive processing, basically, so yes, first of all, I completely agree with you. This is not just about the brain. Many folks are being very brain centric on this. And my paper is very brain centric. I had a whole other section planned, the more embodied piece of it, but the paper was already so ridiculously long it had to be cut. But the brain piece of it with this predictive processing, it can be helpful to think about the brain as a supercomputer, managing all of this data. And much of this data is kind of squishy. It’s kind of gray. It’s not black and white. There’s I don’t know how many billions of input. And some of that is vague. And some of it is, I guess, can be interpreted in multiple ways. But we, as complex organisms, we cannot process each piece of data independently and then kind of slowly come up with an answer. Nothing would ever happen, right? And so our brains, the supercomputers that we have, do take shortcuts. and they make a lot of very good inferences, but they’re inferences. And sometimes, either because the information is incomplete and vague and squishy, the decision that the brain makes about either what is causing the pain or what is happening in my body or what that means in my life may be flawed in some way. And that’s kind of a big concept to think about. Or also how you fill it, how our brain fills in the pieces. Like if you see stripes on a page and you say, oh, that’s a zebra, but then you look at it more closely and know it actually isn’t a zebra. It’s just some wiggly lines. But our brains know what zebras look like. and that kind of matches well enough. So there are these leaps, these jumps that our brain makes, and it’s very important and it helps us immensely. But in that, there are some errors and it can be very relevant to chronic pain. And I feel like I’m doing a great injustice right now in my poor explanation, but maybe it’ll make more sense as we talk a little bit more.

You know, I think it makes sense. Obviously we’re a human that’s embedded within a certain environment and our body is taking all this information that’s being fed into our brain. And our brain has to make a decision or predict what’s going to happen based really based on survival. That’s really what it’s, what it’s based on. I think as we start to kind of move into the survival topic, I think it’s probably a good idea to bring. a trauma-informed lens into this conversation, because as we’re starting to talk about pain and psychedelic-assisted therapy, we want to make sure we approach this from a trauma-informed perspective and start to make some of those connections between what those two emergent experiences are, because trauma can be an emergent experience, and chronic pain is one as well, and some of those have some overlaps to them.

Oh my goodness, so much. Yeah, and hats off to you, for your focus on this. I listen to your podcast a lot, and I’ve heard you talk about it a lot and bring in lots of different experts. It’s so important. And I think there’s a greater awareness around trauma, generally, these days. It’s also, unfortunately, becoming a little bit diluted in some ways, I think. Our understanding is now, it’s like, well, everyone has trauma. So what does it even mean, right? I think that’s true that everyone or most everyone does have some form of trauma. And we need to think about it in some really concrete ways. And as you have emphasized, be aware of that. have a trauma-informed perspective when we’re dealing with trauma pain, or excuse me, chronic pain, and also with my patients who have substance use disorders. I mean, I can’t think of one that doesn’t have significant trauma in their life. So, yeah, specifically with chronic pain, I mean, we know it’s not just the acute trauma, like, oh, I was in a car accident or I broke my leg, and that’s the trauma that led to my pain is often these more insidious and complex traumas, more chronic and things that occur during childhood. I’ve heard you talk about, and probably many of your listeners are familiar with ACEs, right? Adverse childhood events. And some people, there’s other terms, other terminology around that, but that trauma can translate to chronic pain or an increased risk for pain through a lot of different mechanisms, but a really exciting piece that we’re learning more and more about is epigenetics. And I think I’ve heard you talk about that as well. And maybe we should talk just a little about what that is, what is epigenetics so that it’s kind of the link. It’s an important link between the trauma piece and the pain piece. Would you agree?

It is because right now there are people looking for the one gene for fibromyalgia. And, you know, both you and I know that’s probably never going to show up and it really hasn’t shown up. They’ve mapped the genome. But we’re looking at how multiple genes can turn on based on someone’s experience, their life experience.

Yeah. And it’s wild because, um, I think I’m a little bit older than you, but you know, when, when. I learned with genetics, epigenetics wasn’t even a thing that that was much, much later. And, um, and there was this whole discussion, you know, nature versus nurture and, and Darwinian, um, approach to genetics and evolution, whatever. And it is so much more complex and interesting than, than I learned, you know, way back then and what epigenetics is. So most people have heard about DNA, right? Our genes, but they’re not so fixed, right? They turn on and off, they get controlled in different ways. And some of the ways that they get controlled is through epigenetics. So this is not the genetic code, right? The ADGT code, right? some of us have learned in schools, there’s ways that the DNA can become. It was usually through methylation, so it’s sort of like a little a little add on to the DNA. It can be modified basically. After you’re born or you know some of this can happen in utero and a lot of it can happen after we’re born and the way that the DNA is modified, it may affect how It folds. It may affect how genes are transcribed and translated. It can affect which proteins are created, how things are activated. And it’s then through those proteins and all these different changes that ultimately, like, that’s what we’re made of. We’re made of proteins and other things. The enzymes in our body, the nerves in our body, so many different things are affected through not only the genes that are encoded, but through these epigenetic processes. And the cool thing about it is that they can be reversed too, right? So one of the really, one of the important things that I want people to take home from the paper, should they ever choose to read it or just through this conversation, is that even though this is all incredibly complex and interesting, It’s also really awesome because there’s more than one way to address chronic pain and we’re not stuck. Once we’ve arrived there, there’s, there’s lots of things that can be undone and can be reversed and can be improved. And epigenetics is one of those things. So it’s not a life sentence. There are things that we can do to change our epigenetics so that, um, our biologic systems function more optimally.

Yeah, and as we’re talking and moving into the psychedelic conversation, what’s important about that is we’re talking about protein synthesis. We’re really talking about how two nerves communicate and how they can make new connections and grow, which we know is neuroplasticity. And psychedelics may have a positive impact on our epigenetic functions that happen within or between nerve cells and other cells within our body. So I think it’s probably a good time to give people a little bit of background to shift a little bit and just talk about some of your research in the area and kind of where you’re starting to go in the direction of psychedelics and chronic pain.

Sure. So most I’m just getting started, actually, in the research. And the current research that I’m involved in, unfortunately, is not with chronic pain. Currently, the work that we’re doing is with psilocybin for more depression-related things. So one has to do with major depressive disorder. And then there’s another one actually with MDMA that is for postpartum depression. And there’s something else going on. Oh, and PTSD. So, but there is a growing interest in how these therapies may be relevant for chronic pain. And actually there was a recent sort of announcement. I don’t, I think it was through NIH, basically a request to researchers like We want to think about this, how psychedelics may be important in the space and as a therapeutic modality for chronic pain. So I think we’re going to see a lot more of that in the upcoming few years. But back to you commented on the neuroplasticity, that is one piece. It’s not the whole story, but it’s one piece how we believe these psychedelic therapies are important and why they seem to be helpful for a lot of different things. So the focus here is chronic pain, but there’s a lot of overlap, as you mentioned, with trauma, with depression, with anxiety. So how is it that psychedelic therapies can affect all these different things? And one piece of that we do think is through the neuroplasticity. So what is that? Well, neuroplasticity is basically, our brains ability to change and learn and form new connections. And we have that throughout our life, we have it as adults. Of course, there are times in our life, where our brain is much more plastic, right as infants and young children. And then there’s another time during kind of adolescence, where there’s a lot of plasticity, a lot of change. And then our The ability, it seems like the normal tendency of the brain over time is to be a bit less plastic, but it doesn’t have to be. There’s a lot of things that encourage neuroplasticity. Physical therapy and exercise and other movement therapies is one great way to encourage neuroplasticity. and psychedelics are another. And there’s some really fascinating research around that and much more to be understood. The connection between psychedelics and epigenetics, I think we have even less information about. And I think is, will at one point be a super hot topic, but we’re just not there yet. But I’m positive that we’re going to see that. But so far, the focus, I think, has been more on what’s happening to the connections of the neurons, the branching of how those neurons, the branching at the ends of the neurons and how those communicate.

And when we’re talking about psychedelics, we’re talking about a group of compounds, if you will. And maybe you want to just kind of run through what those are for people and if there are differences between them.

Oh, sure. So a lot of what people think about when they think about psychedelics, they may folks may have heard the term classic psychedelic or a serotonergic class serotonergic psychedelic. And those are generally psilocybin, which is like magic mushrooms, but also some other things. LSD. Ayahuasca, which actually, so the active ingredient is the DMT, and mescaline. I think those are the big four. It does not include things like I mentioned earlier, MDMA, ketamine. A lot of your listeners may have heard of ketamine. Ibogaine is something that I’m very interested because it’s relevant for substance use disorders. The classic psychedelics are called that or called serotonergic psychedelics because a very important part of their activity seems to go through the serotonin, one of the serotonin receptors. There’s all these different subtypes of receptors and it’s the 2A receptor, okay? And that is not the only way that they work, but it’s a very important part of how they work. And it seems to be important for the neuroplasticity.

And the other, the other, um, that you mentioned, um, what we said there, I guess, basically we’ll work on, they’re working on, let me slow down for a minute. They’re working on receptors that are different, but have similar functions, so to speak.

Yeah. There’s so much that we’re still learning here. Um, but for example, um, Let’s take MDMA, because folks may be familiar with that one, because it’s in the press a lot around PTSD. That does affect some of the serotonin receptors. It also affects like the, oh gosh, I’m losing it, dopamine. It affects oxytocin. It affects like adrenaline, noradrenaline. So there’s a lot of different receptors in the brain that some of those other substances, chemicals can activate and like interact with different receptors. And then those receptors cause have various downstream effects in the brain. And yeah, gosh, as far as the effects, we’re still teasing a lot of it out. But some of those effects do seem to be similar. And then there’s a lot of differences. And gosh, I’m trying to answer your question in a cogent way, and I’m failing badly. And I think part of the reason I’m failing is that there’s a lot we need to understand. And part of the trick, part of the difficulty in understanding is you can’t just open up a human’s brain while they’re having a psychedelic experience, right? So we’re limited in the ways that we can assess this. And we have some really fancy imaging techniques for doing that. And then we have animal studies and we have in vitro studies. And I think that they’re going to start to use these little brain organoids more and more for some really fascinating stuff. But when you try to translate what’s happening, say, like in mouse neurons to what’s happening in a human brain, you’re gonna lose a lot. And so there is a great deal to be understood, but I also wanna say there’s hundreds and perhaps thousands of years of traditional wisdom without the benefit of functional MRIs and in vitro studies, but through amazing observational skills and lots of trial and error, who I think have brought a lot of wisdom to the table that can help point us in the right direction. But as scientists, we have a certain way of trying to understand the world. And when we’re talking about medical therapies and the FDA, we have to understand things at a certain level to know that they’re safe and effective. And so that’s kind of where we’re at. And there’s just so much yet to be learned.

Yeah, it’s interesting. There’s a really blend happening of traditional medicine practices that we are seeing with psychedelics versus, you know, our scientific process, which we don’t have a whole bunch around the psychedelics just yet. And, you know, we start talking about all the different types of psychedelics. It actually leaves some people at a loss. Well, do I try LSD? Do I, you know, do I try ayahuasca? Which one do I try? And it sounds like the answer is we really don’t quite know yet. Is that correct?

Yeah, and of course, it’s most of that’s illegal in this country, too, right? So we’ve got that to deal with.

Is there anywhere in the US where it’s currently legal? That was a question that came from our our community around, you know, how can people access this right now? And, you know, all of us know that this is being done kind of in the shadows by certain practitioners. People are going to other countries access type. But I think there is some movement in certain parts of the country with what ketamine is one, right?

Sure. So ketamine is legal. It is, but most of ketamine is now being used in an off label sense. That means it’s not like FDA approved for this particular purpose. But a really wonderful thing about ketamine is it has a very large window of safety. It’s been used for a long time, so we know many of the risks associated with it. Ketamine is not a classic psychedelic, as I mentioned, but it does have some really interesting effects, including stimulating neuroplasticity. So yes, ketamine is legal, but many practitioners don’t use it in their practice. So for people who are interested in exploring ketamine-assisted therapy for chronic pain, they’re probably going to have to do a bit of research in their area, in their community, to find out who might be doing that. And I would caution folks, it’s my personal opinion, that ketamine treatment alone For example, you can find infusion centers that you go to and they basically hook you up with a ketamine drip for a period of time. And then usually you have to sign something and say, yeah, I’m in therapy right now, but there’s really no integration of that. There’s no coordination and there’s really not even, you know, you could lie, right? you could not be in therapy, get your infusion and then walk away. And I don’t think that’s a very good model. I think at best, that’s leaving a lot on the table. It’s not optimizing the therapy. And at worst, I think that there’s some risks in that. So that’s my personal preference is to find somebody who’s doing not just ketamine infusions, but ketamine assisted therapy. And what that usually means currently is some form of psychotherapy where you’re working with a therapist. And what’s really fascinating, I know what you’re interested in, Joe, is, well, how do the physical therapists get involved? How do we use that piece? How do we incorporate movement therapy? How do we incorporate these embodied practices so that we can take advantage of the neuroplasticity? We can take advantage of some of these other benefits of the psychedelics and really optimize it for pain. But to get back to your question, so currently, ketamine is the only federally legal of all of those substances. Now, in some parts of the country, there’s local changes. So the state of Oregon, the state of Colorado have initiated some legal changes. And Oregon was first. Colorado followed. There’s still things that are evolving in that space.

And that’s around mushrooms and psilocybin basically.

Yes. I believe both of them are like sort of natural products, right? It would not include something like MDMA, which is synthetic, but, uh, and it would not include even synthetic psilocybin, but whole mushrooms, uh, and whole cannabis. And, um, in some, in some cases, yeah. maybe ayahuasca is included in that. I’m not actually sure of the details. I’m sure people can find it.

Yeah, it’s kind of like with a medical marijuana trend that happened a couple years ago, every state has their own legislative process for deciding what do we do with this particular chemical, if you will. And it’s, you know, like many things in the US, things need to be vetted, but it can be incredibly complex. And sometimes it can be long for people who are trying to access these types of alternatives.

Oh, for sure. Because when it comes to access, what part of it is, well, will my insurance cover it? And right now, no, it will not. I mean, the only thing that to my knowledge that insurance will cover is S-ketamine, which is the nasal spray for treatment resistant depression. That’s it. So anything else, it’s out of pocket, it’s off label. And so one, my group, that I’m joining at the University of New Mexico, one of the things that’s very important to us is to work toward getting these therapies covered by Medicaid and other insurers. Because even though the substance itself, like ketamine or psilocybin, may not be very expensive, often it comes with a lot of therapy and therapy hours, and that adds up. and a lot of insurance doesn’t cover therapy well, but it’s a huge conversation in the field. And everybody is aware, like this, this has to be a goal to increase accessibility for folks.

So I think it’s important that we spend some time on that, actually, because, you know, the word psychedelic assisted therapy, I really think it should be psychedelic supported therapy. Because really, what we’re saying is, we’re using this particular chemical or substance to promote neuroplasticity. The reason why that’s important is because we want parts of the brain that may not be functioning optimally, or may not be making connections, we want those parts to kind of grow, and we want to be able to optimize them, so to speak. But the therapies, all the therapies in essence, right, will help support that process as well. So, you know, this is probably a bad analogy, but it’s like just taking an opioid and expecting that your pain is going to go away long term. We know that that’s probably not the case in the majority of people. And I’m not against any kind of substance or opioid or I obviously would not be having this this conversation. I see all substances as tools to support the natural therapy, psychotherapy, physical therapy, whatever therapy it is that we’re using to help someone become more resilient to pain, and of course, overcome pain.

Yes. And another piece of it, in addition to the neuroplasticity, which is huge, but is also the disruptive effects of psychedelics, right? So that’s sort of the supportive effect of psychedelic, but there also can be, especially with the right set and setting, a safe container, appropriate use, all that good stuff, they can disrupt certain maladaptive, not certain, they can sort of generally, they generally disrupt what’s known as the default mode network, which many of your listeners may have heard about and other networks in our brain. And this is something that happens during the actual trip, right? During the psychedelic experience. So the neuroplasticity, we’re not sure exactly when it starts, but it continues after the, after the psilocybin is out of your system, the MDMA, the Ibogaine, whatever it is, is out of your system, that neuroplasticity continues. And it seems to continue to different lengths depending on the substance, right? So there’s a window that is open for either a short amount of time, a medium amount of time, or a longer amount of time where that neuroplasticity is happening. And when you, yes, absolutely need to have these other supportive therapies involved, to optimize that neuroplasticity.

Do we know how long those windows are?

Not in people. So there’s a great paper that is cited in my paper. I cannot remember the first author, which is terrible, but she comes out of Goldolum’s lab, D-O-L-E-M. So she is the last author. That was at Johns Hopkins. And the study was done, it was either mice or rats. I’m not remembering. But really interestingly, so they looked at ketamine, MDMA, LSD, psilocybin, and another one, maybe it was DMT, I’m not sure. So the duration of the subjective psychedelic experience, how do you determine that in rodents is a whole other story, but they actually have some cues. So the duration of that psychedelic experience, whether it’s two hours, four hours, eight hours, 12 hours, seems to correlate directly with the duration of that plasticity window. So the shorter acting agents, like maybe DMT, which is very fast, or ketamine, which is pretty brief, in rodents, then that window of neuroplasticity is also shorter. And the longer acting agents like LSD, psilocybin, ibogaine have a longer window of neuroplasticity. Interesting. Yeah. But just circling back real quick to finish the, the sort of that disruption of the, of the default mode network or the DMN, there’s a lot that we are, have already discovered both of things like pain and anxiety and depression. where that default mode network kind of gets into patterns that end up supporting these things that we don’t want, supporting pain, supporting depression, supporting anxiety, kind of enhancing the likelihood that those are emergent properties, that we end up with depression, anxiety, and pain. And so it’s like, If you like the westward movement and the wagon wheels, right, that were wagon after wagon after wagon that went along that trail, that trail gets deeper and deeper and deeper and more rutted out. And it’s this process that we now talk about as canalization. And so you get kind of directed into these patterns. And we’ve seen this in ourselves behaviorally, like when we’re on autopilot, right? But it can happen in a lot of other ways. And one of the exciting things that seems to happen with psychedelics is a disruption of the default mode network. It’s like shaking up the snow globe a little bit. And then as the snow settles in the snow globe, it’s less likely to settle into those deep ruts. But again, that’s where the supportive therapies come in, right? To help promote new pathways. and new ways of our bodies moving and new ways of our brains thinking and our emotions reacting and all of that.

Yeah. What’s interesting about the default mode network, and you mentioned this in your paper, is that psychedelics impact that. But so does mindfulness. And I think this is where, you know, we start to bring in other therapies in alignment with psychedelics, mindfulness, mindful movement. This is why I train physical therapists and mindfulness based approaches. So I think they’re so important when it comes to chronic pain. And we’re seeing that all these things have overlap so you know we talked about a window right so obviously someone is going to go receive hopefully a psychedelic experience from a licensed healthcare provider, who will be there to support that experience. That’s probably a, you know, someone who has a prescribing privilege. and then I’m typically a mental health provider, right? But that window afterwards is probably somewhere between four and eight weeks when I start to read the literature. That’s when we start to bring in the other supportive therapies to take advantage of the neuroplasticity, or as you mentioned, this disruption that happens in the brain that we can now say, okay, we’ve kind of shaked up the snow globe. Let’s help the snow kind of settle in a way that’s adaptive for that person. Instead of, oh, I went, I don’t know, to a different country. I took psychedelics for a night, but I had no other therapeutic intervention to help me process what was happening. I think there’s also a danger in that as well.

Oh, for sure. Oh my goodness gracious. Yeah. So I’m sure that many people have done that and had beautiful, wonderful experiences, but we know for a fact that that’s not the case for everyone. And, um, Gosh, there’s lots of pieces what you just said that I’d love to comment on. Let me just take a moment now to talk about sort of the safety issues, because that’s critical. The whole set and setting people have probably heard that that was a term that came out in the 60s with, you know, Tim Leary and a lot of those folks. And what does it mean, right? So the set has to do with your mindset, right? So What are your intentions? What are your goals? What is the preparation? Um, are you doing this? Well, and then the setting is the space, the container, right? And who’s with you and who’s supporting you. And so there could be, there’s a huge difference between, um, you know, taking a substance like at a concert. Um, and, and maybe there’s a lot of chaos. Maybe there’s other things on board. meaning, you know, you’re, it’s not, it’s not just a substance, something scary happens, you know, there’s, there’s a lot of difficult things that can come up during the psychedelic experience, you have to be prepared for that. And you have to have a plan for it. And you have to have a support person. And so I don’t think it’s the only approach, but especially for now, in in the stages where we’re at. I highly encourage people to, um, gosh, how do I want to say this? You know, whether we’re talking ketamine or whether they are going to another country where some of these therapies are legal, um, to do so very intentionally to do their homework and to pay attention to what’s being done and what’s not done, what’s being encouraged and discouraged so that they’re more likely to have benefit. Because as I said, a lot of challenging things can come up, right? Psychedelic experience. And sometimes those are critical. You know, there’s actually whole scales that are like the challenging experience questionnaire. And oftentimes people will say the most difficult stuff, the most difficult trip they’ve had, the most difficult psychedelic experience they had ended up being incredibly transformative and healing. But it’s not a guarantee. You know, people also have almost like a PTSD from from bad trips, right. So one of the things I’ll just loop it back in, because you mentioned mindfulness, one of the things that I think is really awesome, in preparation, and even like You know, hey, you may never desire or never have the opportunity to have a psychedelic experience using chemicals. People have very psychedelic experiences through meditating and through drumming, through dancing, right? But a lead up to any of those things, oh, through breathwork, of course, holotropic breathwork and other forms of breathwork. whether you embark on any of those a really wonderful preparation is some form of mindfulness or meditation because you begin to explore parts of the mind Some of the darker places some of the scarier places and also to develop a certain amount of equanimity or neutrality and that is a really I personally think critical starting place before ever embarking on a psychedelic therapy and then continuing those practices afterwards.

Yeah. I appreciate the mindset piece really. And the preparation piece, um, in that prison model that, um, our group authored, um, there’s a central domain in that pain model, which is called my pain mindset essentially. And your pain mindset can be very fixed. where you’re fixed on these maladaptive pain and or core beliefs about yourself, or you can have a very flexible mindset where you’re starting to work with these different ideas and I think it’s really important that if people are going to use one of these interventions, any type of psychedelic, that there should be some kind of mindset or psychological flexibility, mindfulness preparation before they go in. So we kind of start the neuroplasticity process, right? Yes. Then we can use this really amazing tool that we have, psychedelics. then we can continue that process in the weeks that come with good therapies led by a licensed health professional. I think that’s really important and that also starts to tie into embodiment approaches as well because we know that psychedelics do affect your experience of your body in some way.

Oh yeah and I mean how common is it that people with chronic pain like dissociate from their body. It happens all the time, right? Because it sucks to be there. It’s really unpleasant to be in pain all the time. And so that can be a strategy, right? And what you just said to talk about like a fixed mindset, that’s linked into the concept of rigidity and canalization, right? Which we touch on in the paper. And I’ll just point folks out, if they’re not interested in reading the whole paper, the second figure in the paper It’s pretty cool. It’s adapted from some other folks, a paper that was looking at mindfulness and other meditation practices versus psychedelics. That paper focused on depression, and I modified that figure and kind of added in some pieces relative to chronic pain. And so I think that figure is a great piece if you don’t want to read the paper. What was I going to say? I lost it. But oh, and, you know, there are reasons why some people should never do a psychedelic, right? It’s not for everyone. No treatment is for everyone. And so I hate with all of the hype that’s out there, people to have it be as their last chance, their last hope, like, oh, I have to get a chance to do this MDMA therapy or this psilocybin therapy. It’s my only hope. And then when that opportunity is taken away from them because of some reason, the disappointment, the letdown, the depression, it is not going to help everyone. It could harm some folks, so you really want to be careful and be working with providers. And for those folks who are really, really interested and want to have an experience sooner rather than later, I would refer folks to So And then you can search for different clinical trials that are going on. And there’s more and more that are looking at different psychedelic therapies in relation to different chronic pain syndromes. And I think I just went way off topic, but I wanted to take a moment to emphasize safety and to emphasize it’s not the only way. Like you’re saying, through mindfulness, through embodied practices, through nutrition, through sleep hygiene, there’s so much we can do. And that’s kind of the point of the paper and this complex system. There’s so many different points of entry. And that’s why one thing never works. It’s no one medicine, no one therapy, no one surgery. And there’s not one magic formula. It does require some patience, some curiosity, some trial and error. But what you were just saying, the mindset, the rigidity versus flexibility, that’s huge. And that’s something that is really well explored in a lot of mindfulness practices and going in with a specific intention. Absolutely.

Yeah, which is that that attention, that intention should not be developed. The day you decide to take the psychedelic, it should be prepared and explored beforehand. And that may actually take months for some people to figure out what that intention actually is for them. Because a lot, as you mentioned, a lot of things that are wrapped up here and in the pain experience. The one thing we didn’t two things I want to ask you that just came up as we’re talking. I know we’re a little bit long, but I think people are going to hang on for this one. One, are there contraindications that we should all be aware of if we can kind of just talk about those? And then two, the one thing that we’re probably unsure of, and I’m just interested to hear your perspective on this, is dosing. Because we’re talking about, you know, upwards of eight substances so far, and then dosing each of them might be different based on the individual. Is that correct?

Yeah. And I think earlier you asked a question that I didn’t answer. about maybe is one substance better than another to address a particular thing. And let me be clear, we don’t have answers for most of this. We’re beginning to, and we’re all very interested in learning more. But let me start with the contraindications. So I would say a very important contraindication is pregnancy, right, and also lactation. In general, Things like psilocybin, let me focus on that first, really quite safe compared to a lot of pharmacotherapies that are already out there. Even in my opinion, in some ways, compared to some over-the-counter medicines. There’s an article that I cannot cite to you off the top of my head, but that basically compares a lot of different medicines that are used commonly and sort of looking at their risk safety profiles and comparing it to some of the psychedelics, including psilocybin. And in general, psilocybin is very safe and it’s not completely benign and it’s not safe for everyone. So some of the contraindications that we currently think about when we’re doing these clinical trials, one of the big ones is a history of psychosis. Now, if you’ve had an episode of psychosis, does that always exclude you from these trials? No. But if you have a diagnosis of schizophrenia, I’m afraid you’re not going to get into any of these trials. May one day we have enough safety information. I hope so. But that’s a big one. That a history of psychosis, especially something that’s recurrent, something that was not necessarily induced by a substance or like, I don’t know, an acute event that, you know, 20 years ago that never occurred or things like that. The other sort of Alzheimer’s dementia. Oh, what a good question. So that is definitely not psychosis, as we generally think about, there’s a huge interest in how psychedelics may be helpful for neurodegenerative conditions such as Alzheimer’s, but we can definitely not answer that question yet, but I think there’s a ton of interest in that. But yeah, probably currently if somebody has like Alzheimer’s, and largely that would be because can they really consent can they really consent to the process if they have certainly an advanced Alzheimer’s, there’s no way, right? But other things that can exclude you would be uncontrolled hypertension. So a lot of these substances will temporarily raise your blood pressure or may temporarily raise your heart rate. So if you already have bad high blood pressure, they probably won’t let you in. For example, the studies that I’m working on, you can have hypertension, but it has to be controlled. So as long as your hypertension, your high blood pressure is controlled on your medication regimen or through some other way, nutrition, stress management, management, whatever, then that’s fine. But if you arrive on a day of dosing with a sky high blood pressure, we have to let you rest for a little while, retake it, um, maybe try some short acting hypertensive antihypertensive medication. Cause we don’t want you starting out at a high blood pressure because you can get a bump similarly because you can get a bump in your heart rate. Um, if you have a weak heart, we’re not going to feel safe doing that. Right. Um, other things like if you have really brittle diabetes, because you’re going to be sort of out more or less, for about eight hours. And you’re not going to have the same feedback from your body. Someday, if you have a CGM and an insulin pump or something, maybe down the road. But currently, when we’re doing these trials, we want it to be as safe as possible. And so we’re trying to be more inclusive, but we can’t be so inclusive. And so if poorly controlled chronic condition that would cause a potential safety concern. Those are the things that are going to exclude a person from the trials.

What about acute PTSD?

Well, I mean, that is you mean you mean if somebody comes to a dosing session and they’re in the middle of an acute exacerbation, is that what you mean?

Yeah, I mean, they’re imagine there are people that are have recently experienced a trauma.

Oh, I see.

They probably clinically fit the category for acute PTSD. Would this be for them? Or would that be a contraindication, so to speak?

That’s a great question. I don’t know the answer to that. The studies that have been done with PTSD have been with chronic PTSD.

Chronic PTSD, yeah.

But wow, I mean, what if a well-supported ketamine or MDMA experience within that acute window could prevent the evolution of chronic PTSD? I think it very well could, possibly. That’s just a guess. But I don’t know if anybody’s doing that research yet? It’s a great question.

And obviously, treatment resistant depression is not a contraindication, because a lot of the studies are being looking into that. But what about someone who’s in the middle of a major depressive episode?

No, so there’s actually another thing that I want to come back to are certain medicines that are currently contraindicated. I’ll touch on that in a second. But in the middle of a depressive episode. So it’s probably going to depend on the trial. So our trial that I’m involved with is for major depressive, not even treatment resistant. just MDD, major depressive disorder. So actually, they need to be depressed to be in this study. They need to hit a certain score on some of the depression scales in order to qualify, because we want to see, well, what is the effect? What happens to your depression in the day after, the weeks after, the months after? So no. However, in our study, active suicidality is a contraindication. So, but on the other hand, ketamine, one of its best uses is in aborting active suicidality, and is used in a lot of psych emergency departments, right? So, so it’s really interesting. And life saving for some folks. But in in our in this particular study, because we’re looking at major depressive disorder, but again, it’s a safety issue in that case. So if somebody is actively suicidal, we are not willing, the answer is go to emergency room, go to emergency psych situation, get supported in the ways that you need to be supported. We don’t feel safe giving you this treatment in that situation.

And what about teenagers, children under the age of 18, so to speak?

Yeah, there’s so much interest. I think I think. Gosh, and also old folks to older adults who are often excluded from trials, there’s more and more trials that are not excluding people based on age, they may get excluded based on health conditions. But if you’re a healthy 90 year old, you know, what is that? Can you safely take psilocybin? So we’re looking at that. There’s a lot of interest in younger folks. I think my guess is that there probably would be, you know, a lot more caution, lower doses, fewer sessions, probably a cutoff age, you know. And my guess, I mean, again, this is so jumping the gun because none of these things are legal currently. But let’s say if MDMA or psilocybin is rescheduled from a schedule one to a less restrictive schedule. That’s something the FDA is going to have to decide is what are the age parameters. And then probably what will happen, let’s say best case scenario, these do get rescheduled. We have more access. We gather more and more data. As we get more data around safety and optimizing therapy, then it’ll probably get loosened. It’ll probably go from maybe 21 years old to 18 to 16. Will we ever be able to use them in young kids? Well, we already use ketamine in the emergency department with little ones.

A lot of other psychotherapeutics.

Well, yeah, yeah, yeah. Good point. I mean, like just kind of mean, for example, if a kiddo breaks their arm or a leg and they need to get it set in the emergency department, they usually give them ketamine. So we already have some safety data on that. And yes, to your point, there are younger folks using different SSRIs and using a lot of other psychotropic medications off label. So yes, but while I’m thinking about it with respect to medicines, there are some medicines that seem to either increase risk for problems with psychedelics or interfere with the efficacy of the psychedelics. And there’s kind of on the fence with that. The big question is usually around SSRIs. And some studies have concluded that you can be on a stable dose of an SSRI and still have a psychedelic experience and have it still be effective. But there’s also data both from some controlled studies and from more like just community anecdotal information that depending on what medications people may be on, it can blunt or interfere with the psychedelic experience. So we’re still learning more about that and again, you know, this is why I as a physician have to be cautious and even though I’m really excited. I’m absolutely not telling your listeners to just go out and find a source and have an experience because there’s a lot of safety involved. But there’s also the good news that more and more clinical trials that people can get involved with and more and more data that will allow us to bring these medications, hopefully, to a clinic near you.

Yeah, the topic of medication is important, too, because we’re talking about chronic pain. We know there’s a lot of overlap with substance use. So I think there are people probably listening and wondering, well, what if I have a substance use problem? Can I enroll in one of these studies, so to speak?

So it’s going to depend on the study. Right. So I’m involved in studies where we’re looking at these substances specifically for folks with opioid use disorder or with a mixed use disorder. But in our depression study, that would exclude you, right? So in our depression study, if you are also using opioids, benzodiazepines, methamphetamine, things like that, that would exclude you. But yes, it’s an important, it’s a really important place to take this eventually and to have more realistic trials. So historically trials are really, really conservative with the kinds of folks they let in because they want to have very healthy people who don’t have a lot of other conditions that might muddy the waters, right? Or be on other medications that might make it confusing or interfere with the medication that we’re interested in, right? But we also, coming back to access, we need to know, well, is it safe for people who are taking an SSRI? Or is it safe for people who have a history of opioid use disorder or things like that? So, to be continued, all of these are fantastic questions that are actively being investigated And it takes so much longer than we would like. I had a friend just the other day who was like, why is this taking so long? I was like, because we have to do it right.

It’s a good point. Safety first is the way we approach things, especially in the pain world. We have a history of opioid use in this country that has injured a lot of people. And I think we want to make sure that we maintain hope in new therapeutic approaches. But we’d also give people a good evidence-based balanced perspective, which I think we’ve done here well today. And I thank you for joining me and providing that perspective. Of course, people can read your paper. Chronic pain as an emergent property of a complex system and the potential roles of psychedelic therapies. Everything that we spoke about today is in that paper, just kind of built out a little bit more for the clinician and scientist who wants to go a little bit deeper. Dr. Armstrong, let us know how we can learn more about your work and how we can follow you.

Yeah, I’m super lame like that. I’m not on most of the social medias. I am on LinkedIn. Feel free to post that. I am hoping one day to get a website together, and if and when that happens, I’ll be happy to update my profile for you. For now, check out the paper, and there’ll be more papers coming, I think. and there’s such a world, it’s such an exciting time and so much information out there. I really encourage, though, people to use well-vetted information for now, at least, because like anything else, you know, on the internet, you can find a lot of misinformation out there. So my heart goes out to everyone out there struggling with chronic pain. I know it. I’ve experienced it. And I also am excited about a lot of different options and a lot of different ways that we can heal ourselves. And so I hope if nothing else that people who have maybe lost a bit of hope can rekindle it, and not just through psychedelics, but through all these other modalities that we have. So thank you to you, Joe, for all the work that you do in bringing so much of this out into the world.

Thank you. So we’re going to make sure to include a link to the paper. And we’ll, of course, include a link to Dr. Armstrong’s information if you’d like to reach out to her and learn more about the work that she’s doing in the space of psychedelic-assisted therapy for chronic health conditions, mental health, chronic pain, and other chronic diseases. If you know someone who’s interested in psychedelics and psychedelic-assisted therapy for chronic pain or mental health, Please make sure to share this episode on your favorite social media channel. You can find me everywhere at Link in with me on LinkedIn or Instagram. That’s where I play the most. I’m Dr. Jotata. Thank you for joining me this week. We’ll have more on this coming up. So stay tuned to the pain science education podcast. Take care and have a good week. Thank you for listening to the Pain Science Education Podcast. To subscribe to the podcast and learn more, visit That’s Sign up to receive weekly updates and learn about our continuing education courses. If you enjoyed this episode, leave us a review on your favorite podcast platform and share this episode with your friends. Please join us next week as we share more science-backed solutions for treating and reversing chronic and persistent pain.

Important Links and Resources

Armstrong M, Castellanos J, Christie D. Chronic pain as an emergent property of a complex system and the potential roles of psychedelic therapies. Front Pain Res (Lausanne). 2024;5:1346053. Published 2024 Apr 19. doi:10.3389/fpain.2024.1346053

Robinson CL, Fonseca ACG, Diejomaoh EM, et al. Scoping Review: The Role of Psychedelics in the Management of Chronic Pain. J Pain Res. 2024;17:965-973. Published 2024 Mar 11. doi:10.2147/JPR.S439348

Kooijman NI, Willegers T, Reuser A, et al. Are psychedelics the answer to chronic pain: A review of current literature. Pain Pract. 2023;23(4):447-458. doi:10.1111/papr.13203

Van Der Walt J, Parker R. LSD and psilocybin for chronic nociplastic pain: A narrative review of the literature supporting the use of classic psychedelic agents in chronic pain. S Afr Med J. 2023;113(11):22-26. Published 2023 Nov 6. doi:10.7196/SAMJ.2023.v113i11.814

Zia FZ, Baumann MH, Belouin SJ, et al. Are psychedelic medicines the reset for chronic pain? Preliminary findings and research needs. Neuropharmacology. 2023;233:109528. doi:10.1016/j.neuropharm.2023.109528

Dr. Maya Armstrong is board-certified in addiction medicine and family medicine. Maya has always been a super-curious person whose favorite questions begin with “why” and “how.”Her diverse interests took her in multiple directions before landing in medicine, with forays into lab- and field-based research, holistic studies, contemplative practice, and a fair amount of travel and exploration. Currently, she works as a physician and researcher at the University of New Mexico in Albuquerque, NM, where she splits her time among a multidisciplinary pain clinic, an addiction medicine consult service, and research involving psychedelic-assisted therapies. Her aim is to help people struggling with unhealthy substance use, pain, mental health, and to conduct evidence-based clinical research in psychedelic medicine.

Email: [email protected]


Instagram: @drmayaarmstrong

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