Feasibility and Tolerability of Psilocybin for Phantom Limb Pain.
Jon G Dean, Ethan Hurwitz, T. Furnish, Joel Castellanos, Arwynn A. McKinty, Brian K. Farrell, Daniel Barrows, S. K. Peck, Julie Trim, Elowyn Samadhi, Gordon Renwick, Robert Mudge, Cassandra Vieten, Bruna Cuccurazzu, P. Coleman, A G Lin, Mark A. Geyer, Fadel Zeidan, Adam L. Halberstadt
Journal of Pain August 1, 2026 DOI: 10.1016/j.jpain.2026.106404 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized clinical pilot trial Placebo-controlled Double-blind Pilot study Peer reviewed |
|---|---|
| Sample size | 9 |
| Population | Individuals with one amputation and phantom limb pain |
| Intervention | Psilocybin |
| Dose | 25 mg oral |
| Topics | Psilocybin |
| Registration | NCT05224336 |
| Key findings | Psilocybin at 25 mg was tolerable in five participants with phantom limb pain, with no serious adverse events or emergent suicidality. Exploratory pain intensity ratings suggested trends toward reduction (>30%) at two and four weeks, though possibly due to small sample and unblinding. |
Abstract
Phantom limb pain (PLP) is a refractory condition defined by pain experienced in a missing limb. Psilocybin, a classical serotonergic psychedelic drug, can alleviate various treatment-resistant disorders but has scantly been investigated for chronic pain. This placebo-controlled, double-blind, randomized clinical pilot trial (NCT05224336) tested the feasibility, tolerability, and preliminary safety of psilocybin in individuals living with PLP. Nine participants (mean±SD 37±13 years) with one amputation and PLP were randomized to receive a single 25-mg oral dose of psilocybin (n=5; 2 female) or 100-mg niacin (n=4; 2 female). The dosing sessions were supervised by two monitors who met with participants during three pre-dosing preparatory sessions and a 1-day post-dosing integration session. Suicidality was assessed across all visits. Blood pressure (BP), heart rate (HR), and adverse drug effects were assessed during the dosing session. Headache was evaluated during the dosing and integration sessions. No emergent suicidality or serious adverse events were observed. In both groups, adverse drug effects (anxiety, psychological/physical discomfort) and transient elevations in BP and HR after drug administration resolved spontaneously prior to discharge. After psilocybin administration, two participants reported nausea and three reported headache. Exploratory self-reported ratings for weekly PLP intensity showed trends toward reduction (>30%) two- and four-weeks post-psilocybin administration but these effects may be attributed to the small sample size and functional unblinding. This is the first trial providing evidence of the tolerability of a 25-mg oral dose of psilocybin for PLP, a debilitating, enigmatic and treatment-resistant chronic pain condition. PERSPECTIVE: This article demonstrates that psilocybin was tolerable when administered to five individuals suffering from phantom limb pain, a unique, treatment-resistant and centralized pain syndrome. These phase 1 feasibility findings support future placebo-controlled trials investigating the efficacy and mechanisms of serotonergic psychedelics for refractory pain syndromes.
Comparable studies
Other randomized controlled trials on psilocybin, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial Cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety | 2016 | Randomized controlled trial | n = 51 |
| Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial Patients with cancer-related anxiety and depression | 2016 | Double-blind, placebo-controlled, crossover trial | n = 29 |
| Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance Hallucinogen-naïve adults reporting regular participation in religious or spiritual... | 2006 | Double-blind study | n = 36 |
| Trial of Psilocybin versus Escitalopram for Depression Selected group of patients with depression | 2021 | Randomized controlled trial | |
| Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder Adults aged 21 to 75 years with major depressive disorder, not currently using... | 2020 | Randomized controlled trial | n = 24 |
Citations in the library
Cites 26
- Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial Journal of Psychopharmacology November 30, 2016
- Pilot Study of Psilocybin Treatment for Anxiety in Patients With Advanced-Stage Cancer Archives of General Psychiatry September 7, 2010
- Psychedelics Promote Structural and Functional Neural Plasticity Cell Reports June 1, 2018
- Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression. New England Journal of Medicine November 3, 2022
- Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later Journal of Psychopharmacology May 30, 2008
and 21 more in the library