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Court Wing was riding high as a pistol-squattin', kettlebell-swingin' fitness pro until chronic pain and depression nearly broke him. Then a single psilocybin session at NYU erased years of mental and physical agony overnight. That eureka moment launched him from patient to pioneer in the emerging field of psychedelic pain medicine.

We asked Court what's happening in the brain when psychedelics treat chronic pain, which types of conditions respond best, and how his rehabilitation protocols differ from traditional psychedelic therapy.

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Tell us about your experience participating in an NYU psilocybin clinical trial? What happened?

I was a participant in the Usona’s psilocybin trial for major depressive disorder in March 2020. After five years of increasingly treatment-resistant depression with consistent suicidal ideation, I was in full remission by the end of the day. My MADRS score dropped from the low forties to zero. I was shocked. It was a qualitatively different experience of remission compared to standard psychotropics, which had previously kind of plasticized my personality.

But here's what really caught my attention: the next day I was also in complete remission from 5+ years of chronic pain. I had an extensive 30+ year background in performance and pain coaching and was known for treating hard-to-treat chronic pain issues. The secret was I was also in chronic pain myself. My whole body ached, and all my resources had stopped working. I’d pretty much stopped exercising because it wasn't helpful anymore.

The morning after dosing, the pain was completely gone. I could suddenly do kettlebell moves and stretches I'd lost the ability to do. It was as if all the shooting pains and crunchiness in my joints had been blowtorched away. I was literally popping one-legged squats in the kitchen. And then as I thought about one of my past clients who’d lost a leg to complex regional pain syndrome (CRPS), it hit me: why couldn't you combine high-dose psilocybin with mirror box therapy to treat phantom limb pain?

Ten days later, NYC went into pandemic lockdown. I spent weeks researching online and eventually found a 1962 Japanese study treating phantom limb pain with low-dose LSD. Seven out of eight participants had total remission or clinically significant relief by end of day. Two months later, I learned through Dr. Joel Castellanos about Albert Lin's case study. Lin had lost his leg and tried everything for phantom limb pain, but when he combined high-dose psilocybin with mirror box therapy, he got 24 hours of complete pain relief. Within five weeks, he was in total remission. I started reaching out to every researcher I could find, eventually forming REMAP Therapeutics in November 2020. Later, I approached Bob Wold from Clusterbusters and Joe Moore from Psychedelics Today, and we founded the Psychedelics & Pain Association.

What's actually happening in the brain and body when we use psilocybin or other psychedelics to treat chronic pain?

Psychedelics work through multiple mechanisms simultaneously, while traditional pain meds typically target single pathways. Classical psychedelics act on the 5-HT2A receptor, which we largely suspect is responsible for “persisting descending inhibition.” That is, signals come down from your brain that inhibit “pain” (nociceptive signals) traveling up through the spine. This effect persists even across nerve damage because many of the 5-HT2A receptors are located inside the cell body, not just out on the axon that might be severed.

Standard opioids, on the other hand, block noxious signals by activating opioid receptors throughout the body. Unfortunately, they come with severe spillover effects, including addiction potential, respiratory risks, emotional blunting.

It’s worth mentioning that chronic pain can exist completely in the absence of injury. Most people think pain is a sensation received by receptors that travels up the spine, but that's not always true. Pain is actually a perceptual output of the central nervous system based on prior experiences and current context.

Chronic pain also involves structural “nociplastic” changes. People with low back pain have a 5-11% reduction in brain volume in the dorsal lateral prefrontal cortex because the brain's been hijacked for pain processing. There's this "use it or lose it" principle where pathways not receiving normal input diminish. Psychedelics cause rapid structural neuroplasticity and can regrow those lost neural connections.

Psychedelics are also potently anti-inflammatory. Some of these compounds are significantly more potent than corticosteroids, even at sub-psychoactive levels. They're homeostatic auto-regulators that bring inflammation down to where it's supposed to be normally, but not below baseline like we see with steroids. If you want to talk about “inner healing intelligence,” that's one physiological explanation.

Are there certain types of chronic pain conditions that seem to respond better to psychedelic therapy than others?

We typically see psychedelics being most useful for chronic pain versus acute pain. The conditions that respond best are conditions of central sensitization, such as fibromyalgia, phantom limb pain, complex regional pain syndrome, and non-specific low back pain. These are conditions where the nervous system is misinterpreting signals, where pain can exist without actual tissue damage.

Inflammatory conditions like arthritis show strong responses. Cluster headaches respond incredibly well. We've seen remarkable results with infection-acquired chronic illnesses like Lyme disease, long COVID, and autoimmune conditions. There's a case study from Oregon where someone went in for "enlightenment," and their lupus went into complete remission for over a year.

What's interesting is the bidirectional comorbidity we see. Most people with severe PTSD also have chronic pain. In the MAPS MDMA trial for PTSD, people with the most severe chronic pain had significant relief by trial end, even though pain wasn't a stated outcome. These systems are deeply interconnected.

How do you design a psychedelic rehabilitation session specifically for pain versus depression? Is the protocol very different?

It's a real loss if you treat chronic pain like it's just repressed trauma. That can be a component, but it's usually a sub-component. I've seen well-meaning facilitators who are ignorant of pain neurology dose someone with little preparation for what's happening in the body. The client gets this analgesic neuroplastic window where they suddenly don’t hurt, and the facilitator says "dance, jump, be free!". But this person has been deconditioned. They haven’t loaded their joints that way in years, and they re-injure themselves.

You have to spend significant time doing individual assessment through qualitative and quantitative sensory testing. You're looking for visual, vestibular, and proprioceptive deficits. Most people with chronic pain have areas of hypersensitivity, but also clear areas of hyposensitivity where they've lost sensation somewhere. That's an alarm bell to the nervous system.

Ideally, you're going down to dermal distribution and nerve layers with tests like sharp-dull discrimination across specific body regions. You identify three to five high-payoff interventions, such as nerve glides or neurovisual drills, that they're responsive to before the session. During the session, once you get that analgesic window, now is the time to make hay. You still have to adapt to their degree of conditioning, though. It's like jazz; you have some structure, but you're playing within it.

What's the most promising research direction right now for psychedelic pain therapy? Where do you think we'll see breakthroughs first?

The Psychedelics & Pain Association is completing what we hope will be the largest psychedelics and pain survey. We want to understand contexts, conditions, dosing, frequency, and what other other therapeutic modalities people use alongside psychedelics.

The biggest questions are around how psychedelics combine with those adjunctive therapies. For instance, a woman in a 2022 study would dose and pain would go to zero, but it always wore off. When she combined it in real time with her previously ineffective home physiotherapy routine, pain relief lasted two weeks solidly.

There may be transdiagnostic mechanisms underlying these conditions that psychedelics uniquely target. Why would psilocybin work for phantom limb pain, fibromyalgia, and Lyme disease in similar ways? Usually these are multi-symptom diseases requiring different specialists for each symptom.

At the same time, treatment models need to be condition-specific. Cluster headache patients don't need two psychotherapists for eight hours. They need a safe supply with a trusted caregiver. But someone with accumulated issues on 15 medications needs extensive preparation with pain neuroscience education, thorough assessments, and adjunctive therapy.

The breakthroughs will come when we have expanded care teams who can speak a common language. Underground practitioners need to learn pain neurology, and clinicians should learn transpersonal psychology so they can dialogue when trauma surfaces. Single-factor thinking is the enemy, whether you believe everything is trauma or everything is biomechanical. We need broad, open-tent approaches that strive to be unbiased but very scrutinizing.

Want more from Court?

Take 20% off tickets to the 2025 Psychedelics & Pain Symposium with code PPS20, or apply for the next REMAP Therapeutics retreat.

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.