{"doi":"10.1093/pm/pnae124","title":"Chronic pain education: past, present, and future of psychedelics for the management of chronic pain","abstract":"Known for their capacity to alter perception and consciousness, psychedelics are increasingly being explored for therapeutic applications in treating conditions such chronic pain, major depressive disorder, and post-traumatic stress disorder.1,2 Despite historical stigmas and legal restrictions, recent changes in legislation and the United States Food and Drug Administration (FDA) recognition are driving renewed interest in these substances. To keep pace with this expanding field, medical education needs to integrate formal training on psychedelics. This report addresses the history, pharmacology, current state of psychedelic education, and outlines a proposed curriculum to prepare future clinicians for the evolving landscape. Classic psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, and N, N-dimethyltryptamine, primarily act as 5HT2A receptor partial agonists, influencing areas of the brain involved in mood, perception, and decision-making.1 Historically, these substances were used in spiritual and cultural rituals for thousands of years. The discovery of LSD in 1938 by Albert Hofmann marked the beginning of modern psychedelic research, with psychedelics gaining widespread popularity in the 1950s and 60s. Activation of these receptors increases glutamate release, an excitatory neurotransmitter, disrupting neural circuits, and contributing to the effects of these drugs. Research has demonstrated that psychedelics can promote synaptic growth, release oxytocin, and exhibit anti-inflammatory effects.3 Magnetic resonance imaging (MRI) studies suggest that psilocybin can disrupt connections between the anterior hippocampus and the default mode network, potentially explaining some therapeutic effects.4 Psychedelics have a dose-dependent effect profile (Table 1). Low doses, known as microdosing, may cause mild side effects such as nausea and mood changes, while moderate doses can induce pronounced hallucinations, anxiety, and physiological changes.5 “Heroic dosing,” or very high/macro doses, can lead to intense hallucinations and significant cardiovascular effects.5 Research supports microdosing for conditions such as attention deficit hyperactivity disorder (ADHD) and depression, while macrodoses show promise in treating depression, substance use disorders, and end-of-life anxiety.6 Challenges include side effects, legal restrictions, and the need for careful clinical oversight. Summary of psychedelic dosing strategies and known side effects. Actual dosages are not given. However, societal concerns led to the passage of the Controlled Substance Act in 1970, classifying most psychedelics as Schedule I drugs, indicating a theoretically “high” potential for abuse with no accepted medical use.7 This designation significantly restricted research.7 In recent years, attitudes have shifted, with the FDA granting “breakthrough therapy designation” to some psychedelics such as psilocybin. This status has facilitated research into their therapeutic potential. From 2015 to 2020, psychedelic use among people over age 12 increased by over 40% in the United States with over 7.1 million reporting use between 2019 and 2020.8 Despite the increase in use, the integration of psychedelic education in medical training is limited. Psychedelic-related curricula has had a growing interest and there are positive attitudes among medical students toward psychedelics’ therapeutic potential, despite limited formal knowledge.9 Informal educational models such as interest groups, journal clubs, and lecture series, such as the Stanford Psychedelic Science Group, offer insights into the field but are not standardized across medical schools. There is a call for support from influential organizations that shape medical curricula, starting with individual medical school curriculum committees and continuing into residency and fellowship programs. Pain medicine, in particular, could benefit from incorporating psychedelic education into the International","journal":"Pain Medicine","year":2024,"id":507242,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9559,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1358522,"name":"Pawan Solanki","orcid":"0000-0001-9708-2556","position":1,"is_corresponding":false},{"id":1349740,"name":"S Snyder","orcid":"0009-0002-9372-4907","position":2,"is_corresponding":false},{"id":887194,"name":"Adam Amir","orcid":"0000-0002-7773-9706","position":3,"is_corresponding":false},{"id":1358523,"name":"Antje M. Barreveld","orcid":"0000-0003-1126-2797","position":4,"is_corresponding":false},{"id":1062517,"name":"Rory Vu Mather","orcid":"0000-0002-5667-9732","position":5,"is_corresponding":false},{"id":280713,"name":"Ivo H. Cerda","orcid":"0000-0003-4992-9841","position":6,"is_corresponding":false},{"id":1358855,"name":"Michael Motoc","orcid":null,"position":7,"is_corresponding":false},{"id":756167,"name":"Harman Chopra","orcid":"0000-0003-1574-278X","position":8,"is_corresponding":false},{"id":1358524,"name":"R. Jason Yong","orcid":"0000-0001-6960-9621","position":9,"is_corresponding":false},{"id":19286,"name":"Joel Castellanos","orcid":"0000-0002-7365-7260","position":10,"is_corresponding":false},{"id":537925,"name":"Timothy Furnish","orcid":"0000-0002-4615-3366","position":11,"is_corresponding":false},{"id":161379,"name":"Alan D. Kaye","orcid":"0000-0003-2464-0187","position":12,"is_corresponding":false},{"id":381109,"name":"Vwaire Orhurhu","orcid":"0000-0002-2794-738X","position":13,"is_corresponding":false},{"id":738855,"name":"Trent Emerick","orcid":"0000-0002-3802-5946","position":14,"is_corresponding":false},{"id":1358521,"name":"Christopher L. Robinson","orcid":"0000-0002-6276-9056","position":0,"is_corresponding":true}],"reference_count":8,"raw_metadata":null,"created_at":"2026-07-19T02:10:58.484528Z","pmid":"39658247","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}