Methods
Complete blood count, basic metabolic panel, coagulation values, and inflammatory biomarkers were within normal limits during this period (Appendix A). She began to fall 4-8 times per month as her symptoms progressed. Combinations of antidepressants, antiepileptics, muscle relaxants, opioids, and topical ketamine failed to provide adequate relief. She continued to take Oxcarbazepine which reduced the pain to 4 out of 10 but was discontinued in 2013 due to significant hyponatremia, after which symptoms re-flared.
The patient underwent a spinal cord stimulator (SCS) trial in 2015 with leads at bilateral T7 and T8 levels which brought pain level to 0 to 1 out of 10. Revision was required due to lead migration, but it was ultimately removed in 2018, prompting a return to 9 out of 10 pain.
In 2016, the patient was prescribed ketamine, 300 milligrams of which was administered intravenously every 6-8 weeks and titrated up to 1200 milligrams, resulting in two weeks of transient post-infusion remission. Her pain would return to a baseline of 9 out of 10 before the next dose. In addition, she took 300 milligram capsules three times daily and 100 milligram troches every 3 days during that time. The oral ketamine and ketamine troche were discontinued in 2022. Given the past success of psychedelic treatments, she decided to try guided sessions of psilocybin cubensis dried mushrooms. Visual representation of the case timeline can be found in Figure 1.