Knowledge, Perceptions, and Use of Psychedelics among Individuals with Fibromyalgia

Fibromyalgia (FM) is a chronic pain condition affecting an estimated 2–4% of the population and is commonly managed with combinations of pharmacological and non-pharmacological approaches. Glynos and colleagues note that existing FDA-approved medications for FM are not always preferred by patients and that many non-pharmacological options lack insurance coverage, which contributes to the uptake of alternative therapies. In parallel, there has been renewed clinical interest in psychedelic-assisted therapies (for example psilocybin, ketamine, MDMA) following small trials showing benefits for depression and anxiety, and mechanistic hypotheses suggesting psychedelics might modulate brain network dynamics, attention to sensation, and promote psychologically meaningful experiences that could plausibly affect chronic pain. This study aimed to characterise past use, knowledge, and perceptions of both serotonergic (classic) and non-serotonergic psychedelic substances among individuals with FM, and to assess interest in psychedelic-based treatments. The authors hypothesised that most participants would express interest in psychedelic therapies and that past psychedelic use would be associated with self-reported improvements in health and well-being.

Glynos and colleagues conducted a cross-sectional, anonymous online survey via Qualtrics between 1 December 2020 and 22 February 2021. Recruitment used the National Fibromyalgia Association (NFA) e-mail listserv and social media (including Reddit and BlueLight). The survey prevented duplicate responses via a Qualtrics setting that blocks repeat access from the same IP address. Analyses were confined to participants residing in the United States or Canada who self-reported a physician or medical provider diagnosis of FM. Eligibility criteria were: age ≥18 years, fluent English reading/speaking, persistent chronic pain ≥6 months with average pain ≥4 on a 0–10 Numeric Rating Scale, and voluntary consent. The survey gathered demographics, FM and pain characteristics, and histories of trauma. Validated instruments included the 2011 FM Survey Criteria (continuous 0–31 score), the Brief Pain Inventory short form (pain severity and interference, 0–10 scales), the Life Events Checklist for DSM-5 (LEC-5) for traumatic exposures, and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) for probable PTSD screening (scores ≥3 indicating probable PTSD). Participants were asked about self-rated knowledge and perceptions of psychedelics, perceived risk, and willingness to participate in psychedelic clinical trials. Past psychedelic use was assessed via a checklist of serotonergic and non-serotonergic agents (LSD, psilocybin, DMT, 5-MeO-DMT, ayahuasca, mescaline, MDMA, ketamine, ibogaine, and other novel compounds). Those reporting past use were subgrouped as "Have used" versus "Never used," and the "Have used" group was further classified by intention (use intended for treating chronic pain versus other reasons). Users who had taken psychedelics while experiencing chronic pain were asked to recall a single experience that provided the most relief or no relief and to report additional contextual details (dose, setting, motivation, outcomes). Complete case analysis was performed. Categorical associations were tested with chi-square (X2) tests and effect sizes reported using Cramer's V. Continuous between-group differences used independent-samples t-tests with Cohen's d for effect size. Significance was set at p < .05 (two-sided). Analyses were performed in SPSS version 27. The extracted text references an exclusion flowchart (Supplementary Figure) but that figure is not available in the provided extraction.

Of 610 participants who started the survey, 481 completed it (78.9% completion rate). After applying exclusion criteria and restricting to North American residents reporting a physician-diagnosed FM, the analytic sample comprised 354 respondents. The sample was predominantly female (93.2%) and white (91.8%), with a mean age of 54 ± 12 years; 92.9% resided in the United States and 7.1% in Canada. The most represented US states were California, Michigan, Florida, and Pennsylvania. Overall, 106 participants (29.9%) reported past use of at least one psychedelic, while 248 (70.1%) reported no past psychedelic use. Those with past use were more likely to have accessed the survey via social media (37.7% vs 23.8%) and less likely via the NFA (60.4% vs 73.0%), a difference that reached statistical significance (p = .03, Cramer's V = 0.14). Clinical comorbidities commonly reported alongside FM included chronic low back pain (49.7%), irritable bowel syndrome (48.0%), migraine (45.2%), osteoarthritis (41.5%), and chronic fatigue syndrome (39.5%). Longstanding symptoms were common: 77.4% reported pain for ≥10 years, and 22.9% stated symptoms were not improving with current treatments. Past psychedelic users expressed greater interest in exploring alternative pain treatments than non-users (mean difference = 0.26, 95% CI 0.04–0.47, Cohen's d = 0.27, p = .02). No significant differences by past psychedelic use were observed for FM survey score, pain severity, or pain interference. However, past users reported greater trauma exposure (mean difference = 0.71, 95% CI 0.08–1.32, d = 0.26, p = .03) and had a higher prevalence of probable PTSD (62.3% vs 45.2%, p = .003, Cramer's V = 0.16). Self-rated knowledge of psychedelics was generally low across the sample, though most participants were aware that psychedelic therapies are being researched. The extraction truncates one reported mean difference for knowledge, so the exact value is not clearly reported here. Among the 106 participants who had used psychedelics, 58.6% had used them more than three times. LSD was the most commonly reported substance (79.2% of users), followed by psilocybin mushrooms (68.9%). Reported motivations for use were predominantly recreational (67.4%) and spiritual exploration (31.5%), with smaller proportions reporting therapeutic motives: treating chronic pain (13.2%), managing past trauma (12.0%), and improving mental health (9.8%). Regarding perceived effects, 59.4% of past users indicated psychedelic use had no effect on overall health and well-being, 36.8% reported improvements, and 2.8% reported negative effects. Improvements were more frequent among those who used psychedelics with the explicit intention to treat chronic pain (71.4%) compared with those who used for other reasons (31.5%). Of 36 participants who had chronic pain at the time they used a psychedelic and who answered related questions, 47.2% reported improvements in chronic pain symptoms and 2.8% reported negative effects. Improvement rates were markedly higher when use was intentional for pain: 11 of 12 participants who used psychedelics with the intention to treat chronic pain (91.7%) reported symptom improvement, versus 6 of 24 (25.0%) who used for other reasons. Only a minority of psychedelic experiences occurred in clinical settings (13.9%) or in the presence of a therapist or healthcare professional (11.1%). Qualitative-style responses were provided by approximately two dozen participants (the extraction reports a small inconsistency in counts). Those narratives were roughly split between reports of improvement and no improvement in pain. The authors selected exemplars from each subgroup to inform hypothesis generation; most detailed reports involved LSD and chronic pain duration >10 years, and only one of the detailed reports described use in a clinical setting.

Glynos and colleagues interpret their findings as the first descriptive effort to characterise psychedelic knowledge, perceptions, and use among people with FM. They highlight that nearly 30% of respondents reported prior psychedelic use, most commonly LSD and psilocybin mushrooms, and that perceived impacts on overall health, well-being, and pain were generally neutral or positive with few reports of harms. Interest in psychedelic therapies was high across the sample, with many participants believing psychedelics may have potential as pain treatments and expressing willingness to join psychedelic clinical trials. The authors note no observed association between past psychedelic use and validated FM or Brief Pain Inventory scores, but they did find that prior users reported greater trauma exposure and higher rates of probable PTSD. They propose two non-mutually exclusive explanations: individuals with trauma histories may be more likely to seek or use psychedelics, or psychedelics may be used as a coping strategy for trauma-related symptoms. The paper also discusses stigma and legal concerns as factors that could inhibit participation in clinical research among psychedelic-naïve individuals; non-users reported greater worry about legal status and health risks. Subjective reports and subgroup analyses led the authors to suggest that intention and context may be important correlates of perceived benefit; improvements in pain were most frequently reported when psychedelics were used with a specific intention to treat pain. The discussion links reported themes from positive accounts—acute pain reduction during experiences, post-experience symptom reduction, and altered pain perspectives—to mechanistic proposals in the literature, including 5-HT2A receptor activation, changes in brain functional connectivity, and psychologically meaningful experiences that can increase flexibility. Conversely, the authors acknowledge that negative or null reports indicate psychedelics will not be effective for all individuals and that dose, setting, and preparation likely influence outcomes. Key limitations are acknowledged: the cross-sectional design and reliance on retrospective recall prevent causal inference and are subject to recall bias; only a minority of users (34% of past users) took psychedelics while experiencing chronic pain, limiting direct inferences about FM-specific effects; comorbid pain conditions complicate attribution of effects to FM; selection bias may have influenced prevalence estimates and outcome reports given recruitment via social and condition-specific channels; the illicit nature of substances means reported identities and purity may be inaccurate; and the sample was demographically homogeneous (>90% female and white), reducing generalisability. The authors conclude that despite these limitations, the findings demonstrate substantial interest in psychedelics among people with FM and support the need for controlled research to evaluate therapeutic and mechanistic effects of psychedelic-assisted approaches for FM symptoms.