Psilocybin for Chronic Pelvic Pain (CPP) in Women: A Pilot Feasibility Study

Phase 1RecruitingNCT06988319

Oregon Health and Science University15 enrolled

Overview

The primary aim is to determine the feasibility of enrolling and 15 women with chronic pelvic pain (CPP) that have failed one conventional for CPP to obtain preliminary safety data on a single administration of a moderate dose of pharmaceutical grade psilocybin (25 mg) in combination with psychotherapy sessions (two pre-dose preparatory and three post-dose integration sessions).

Chronic pelvic pain (CPP) presents a significant challenge in healthcare, affecting approximately 15% of women in the United States and incurring annual healthcare costs upwards of $5.8 billion. This condition extends beyond persistent physical discomfort, profoundly impacting mental health and overall quality of life. Central to many chronic pain syndromes, CPP can lead to a heightened state of pain sensitivity known as central sensitization. This condition arises from neuroplastic changes within the central nervous system, leading to structural, functional, and chemical alterations in the brain that enhance neural reactivity, even in the absence of actual physical injuries. Central sensitization is characterized by widespread, multisite hyperalgesia and allodynia. These changes often co-occur with fatigue, mood and cognitive disturbances, sleep disruptions, and multisensory hypersensitivity, complicating the clinical picture and exacerbating the condition's impact on daily functioning. The use of psilocybin in chronic pain is a paradigm shift from conventional pain therapy where the goal is pain alleviation, to changing a person's relationship with pain, offering a re-alignment or 'reset' of one's view of their pain, this is an innovative approach. To date, there are no psilocybin studies evaluating CPP. This is a pilot feasibility and safety study to evaluate a single administration of psilocybin (25 mg) in women with CPP who have failed at least one conventional CPP therapy. The study will enroll 15 women, the primary aim is to assess feasibility that will be met when at least 80% of participants complete the study and attend 80% of 11 study visits (9/11 visits). Safety will be assessed by adverse event reports, safety labs, and vitals assessments.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Chronic Pelvic Pain

Interventions

Psilocybin (Usona Institute)DRUG

Single dose of pharmaceutical grade psilocybin (25 mg) combined with psychotherapy sessions

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Assigned female at birth, age 18-45 years (pre-menopause) * CPP for at least 6 months or longer with central sensitization, diagnosed by a provider who specializes in CPP (e.g. MD, DO, NP) * CPP with central sensitization includes endometriosis, adenomyosis, uterine fibroids, pelvic congestion, other pelvic inflammatory diseases, irritable bowel syndrome, inflammatory bladder disorders, myalgias, or any combination of the aforementioned1,3 * Failing at least 1 treatment for CPP. Failed conventional interventions include pharmacotherapy, non-pharmacotherapy (bladder installations, neuromodulation, trigger point injections, anesthetic blocks, surgery), physical therapy, and/or psychotherapy (e.g. Cognitive Behavioral Therapy) * Participants will be generally healthy with no exclusionary physical or mental health conditions. Exclusion Criteria: * Pelvic pain that is not defined as chronic (e.g. acute pelvic or vaginal infections such as sexually transmitted infections, urinary tract infections, pregnancy) * Have a history of or a current primary psychotic disorder or bipolar disorder type 1 * Current use of lithium. * Ketamine-assisted therapy within 12 weeks of the baseline visit (V3) or hallucinogen use within 6 months of study enrollment (e.g. psilocybin at a dose of 10 mg or 1 gram mushroom or greater, LSD, MDMA, DMT) * Cannabis use (THC, CBD). If willing to taper before the baseline visit (V3) the participant can be included. * A positive urine drug test for illicit substance use * a score of 5 or greater on the Alcohol Use Disorder Identification Test- Consumption (AUDIT-C) indicating heavy alcohol use * Suicidal ideation or serious suicide risk as determined by C-SSRS, if baseline score is 4 or greater. * Uncontrolled hypertension, cardiovascular disease, chronic neurologic disorders (e.g. Parkinson's disease, dementia, multiple sclerosis, epilepsy) * Have any current problem which, in the opinion of the investigator or study physician, might interfere with participation

Locations (1)

Oregon Health & Science University

Portland, Oregon, United States

RECRUITING

Outcomes

Primary Outcomes

Recruitment and Retention Feasibility

Proportion of eligible participants who complete the study from baseline to 1 month post psilocybin dose

Time frame: baseline to 1-month post psilocybin dose

Acceptability

Acceptability will use qualitative data collection to provide information on the benefits and challenges of the intervention using a semi-structured interview.

Time frame: End-of-Study Visit at 1-month post psilocybin dose

Number of participants with treatment related adverse events

Adverse events will be collected using a 12- item adverse events checklist covering all major organ systems will be included to probe for adverse events. The nature of each AE, its severity (mild, moderate, or severe), its likely relationship to study treatment (definite, probable, possible, not related, or unknown), its duration and any necessary treatment modifications or adjustments will be recorded. In addition to recording of AEs,, and labs to assess basic metabolic function (including liver function tests), a complete blood count

Time frame: From enrollment to 1-month post treatment

Secondary Outcomes

Patient-Reported Outcome Measurement Information System (PROMIS) Pain interference Inventory

Provides a rating on pain's impact on physical, emotional, and social functioning, enjoyment, and quality of life.

Time frame: From enrollment to 1-month post treatment

Central Sensitization Questionnaire

Provides a rating to assess symptoms associated with central sensitization (CS) and related conditions. The inventory is divided in two parts: Part A consists of 25 symptoms rated on a Likert scale from 0 (never) to 3 (often), with a total score ranging from 0 to 100, where scores 40 and higher are considered clinically relevant and indicative of a higher degree of CS. Part B screens for prior diagnoses of conditions related to CS, including seven chronic overlapping pain conditions (COPCs) such as irritable bowel syndrome, fibromyalgia, and migraine, as well as three CS-related disorders like anxiety, depression, and neck injury.

Central Contacts

Lynne H Shinto, ND, MPH

CONTACT

(503) 494-5035 shintol@ohsu.edu

Jacquelyn Knapp, MD

CONTACT

(510) 299-7662 knapja@ohsu.edu

Data from ClinicalTrials.gov

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