Dosing with magic mushrooms for pain can be challenging. Psychedelic use in a recreational or spiritual sense is usually infrequent even among enthusiastic practitioners, but managing pain requires consistency. Due to the non-addictive nature of the classic psychedelics, I would estimate that the average aficionado only consumes them once or twice a year. Pain management requires significantly more dedication.
Even those who have rated their experience as deeply satisfying and pleasurable are hesitant about committing to another trip too soon. Take skydiving for instance. A person can have a great time and rate jumping out of a plane as one of the highlights of their life, and yet not be in a hurry to jump again anytime soon..
Tolerability and Repeatability
As a chronic pain patient, I am in a different situation. The frequency of dosing has made learning to control my trip experience a necessity.
There are several things that cause a bit of apprehension for me before committing to another trip. One is anxiety at the thought of losing control. The other is a sensation that is a bit hard to describe. I could compare it to that little bit of apprehension I always get right before jumping into a cold pool for an early morning swim. I know I will be fine once I am in the water but taking that initial step to just take the plunge gets to me even now.
Maybe My Experience Can Help Others
We are going through a second psychedelic renaissance, with active clinical trials in progress for a variety of conditions including migraine, cluster headache, phantom limb pain, depression, and PTSD at various prestigious institutions. It is natural that anyone dealing with a disabling pain condition would be curious to know if using them had the potential to improve their quality of life. They worked for me, and I am happy to share my insights from personal experience.
Dosing For Comfort
In the chart below, the doses are arranged into four distinct categories. Microdosing is more like a cultural phenomenon that does not seem to apply to pain management. Minidosing has an application and is the amount often used in headache studies. Macrodosing is the most common range for recreational users and covers the amounts used in most clinical studies regarding depression. The aptly named “heroic dose” so far to my knowledge is not used currently in any specific clinical setting.
Keep in mind that measuring doses with dried mushroom material can be very “hit and miss”. The concentration of psilocybin in mushrooms can vary significantly from batch to batch. I do my best to mitigate this by grinding them into a powder to make a homogeneous mixture. I may not know for sure how much psilocybin is present in each gram, but at least I know that each dose will be consistent with the last.
I wrote an entire article dedicated to microdosing that can be found here.
Microdosing has no effect on my pain levels. Some reports indicate that it may have some benefits for mental health though. Elevated mood seems to be good, even for pain, but I have never experienced a direct impact on pain from microdosing. In fact, I have experienced exacerbated pain when I take a microdose that is a bit on the heavy side and approaches the lower minidose level.
As a popular cultural phenomenon, you will undoubtedly find individuals claiming that microdosing is effective for pain. Promoting the idea of microdosing easy, because you do not have to worry about the actual effects of the medication. It seems convenient at first, like a way to enjoy the benefits of psilocybin without having to go through the more challenging aspects. But by skipping the difficult part, you also miss a chance at the benefit. Many successful pain treatments rely mostly on the placebo effect, like homeopathy and acupuncture. I do not doubt that some people have found transient relief even from microdosing.
A minidose is usually very mild. To me, it feels like having had one glass of wine. Sometimes it is accompanied by a rush of nervous energy and racing thoughts, which can make trying to sleep soon after taking it a bit difficult for me. It does a good job as a weekly maintenance dose for my headache condition, and I find it easy to work it into my schedule. I often take this dose on a weekday evening after getting home from work, spend a few hours watching TV, then go to bed to avoid the mild rebound headache that usually follows.
I try to avoid going to bed too soon after taking it. Trying to sleep with racing thoughts is very unpleasant. While it does a good job for me as a maintenance dose, it does not do a great job when I am actively in pain. I avoid this dose if I am in pain because it feels like there is a mild stimulating effect. This exacerbates whatever pain I currently have. Taking this type of dose while in pain may help in the long run, but the experience itself is miserable. The racing thoughts and inability to sleep paired with persistent pain is not a good mix. For some headache conditions, the rebound headache that occurs afterwards can be quite severe.
A macrodose is the amount usually used in the studies regarding depression and PTSD. As a dose that is also quite common for recreational users, I imagine that most people who have tripped have probably consumed a dose that falls in this range. I avoid this dose range because I find it unpleasant and unpredictable.
If this is the dose range that is usually used in the treatment of PTSD and depression, what makes it so unpleasant? Well, a pleasant and smooth trip is not exactly necessary for psilocybin therapy to be successful in managing depression. Many people, including those who have had very favorable results, describe their therapy sessions as possibly the most difficult and challenging experience of their life. Many say that they are glad they did it but would not do it again. It works well in this model because they only meet for a couple of sessions. If taking mushrooms for my pain condition were as unpredictable and challenging as the average recreational dose, I would never be able to keep up with the frequency required to keep my pain under control.
Not Exactly Comfortable
Most nonclinical facilities that offer psilocybin for spiritual or mental health purposes are not really concerned with the comfort level during the trip. A macrodose can cause significant amounts of nausea along with the psychologically challenging aspects, and these facilities can have a decidedly unscientific approach regarding these symptoms. I have heard of people being encouraged to purge “bad feelings and energy” through the act of vomiting, which sounds like a miserable experience to me. The interaction between psilocin and our serotonin receptors causes the majority of nausea occurrences. You can mitigate this with the right preparation and antiemetics, so all this added physical misery is not truly necessary. Having a potentially nausea filled traumatic experience can be acceptable for the individual looking to occasionally expand their mind, but it is a major barrier for a pain patient who can benefit from incorporating magic mushrooms into their pain management plan.
Directing The Experience
The main tool that I have at my disposal for controlling a trip is redirection. If I encounter an unpleasant sensation, I redirect my attention through physical cues. A quick distraction is usually sufficient to send your thoughts drifting to a completely different direction. Unfortunately, the standard recreational dose leaves me too clear headed for easy redirection, and my attention is difficult to break if it lands somewhere unpleasant. At the retreat we focus on techniques involving diversion of attention and other coping mechanisms.
Avoiding the “Bad Trip”
People take recreational doses of magic mushrooms all the time and have a perfectly pleasant trip. Some of the same people also report the dreaded random seemingly unexplainable “bad trip”. At a recreational dose, everything goes well until it does not. Without practicing redirecting your attention and learning to navigate the trip, you are sort of stuck with what you get. And if what you get is uncomfortable, you are stuck riding that train until the very last station. It is this unpredictability that can make this dose range tough for anyone who is looking for pleasant predictability. I do not think I would be able to maintain a regular schedule to manage my pain if every dose involved rolling the dice on a potentially unpleasant experience.
The heroic dose is my personal sweet spot. In my opinion, this is the best mushroom dose for pain. The name can sound intimidating, and for that I blame the late Terrence Mckenna, who originally coined the term. The trip level is intense and can be very disorienting but is the easiest to navigate for me. Most importantly, this dosage never fails to dissipate any pain. I am pain free for the duration of the experience. This is important, because it is difficult to have a pleasant trip if there is any physical discomfort. I also have never experienced a rebound headache at this dose. At this dose I find that I am both hyper focused and easily distractible. I have cultivated a variety of physical cues to redirect myself if there are any unpleasant fixations. This keeps me comfortable throughout the experience.
Approach With Caution
I do not think that anyone should approach this dosage without guidance or preparation. It is very intense. Everything about it is intense, both the good and the unpleasant moments. Without the skills to redirect yourself it is easy to get “stuck” with an extremely uncomfortable sensation. Every trip is a series of strange and intense moments that can seem to manifest randomly. I like to compare it to those novelty eight ball toys used to answer questions or tell the future. You never know what kind of sensation is next, but the heroic dose keeps things flowing so you can continue to shake the ball every time a feeling that is not welcome manifests.
Still Waters Run Deep
The one of the best explanations I have been able to come up with regarding dosing uses a surfing analogy. You can compare minidosing to walking along the shore ankle deep. You are still very much in control, and it really does not matter what the ocean conditions are because you are firmly on your feet. Macrodosing is like going in chest deep. It can be a great experience, but you are very much at the mercy of the conditions of the ocean. If the waves get rough, they will toss you around and you will have a tumultuous time. The heroic dose can be compared to paddling out past the breakers. The water is deep, which can be off-putting, but the ride is much gentler and the breaking waves are not battering you.
Not Like Other Medications
Dosing with mushrooms for pain is not like using other medications. While a strong trip may usually be pain free, the more valuable pain relief comes after the actual psychedelic effects have passed. You can’t approach like you would a “pain medicine”. Ketamine infusions have a similar function with most of the benefits enjoyed after the psychoactive effects have passed. Most ketamine infusion clinics do a loading dose period followed by a maintenance schedule, and psilocybin works for me with a similar approach.