Palliative care: is it time for health professionals to talk openly about psychedelic therapy?

Summary

Patients in palliative care often experience 'total pain', which includes existential and psychological distress linked to terminal diagnoses. This type of distress can lead to uncontrolled pain that does not improve with strong opioid medications. The abstract suggests that this existential distress may be related to an overactive default mode network in the brain, particularly involving regions like the medial prefrontal cortex and posterior cingulate cortex.

Study at a glance

Abstract

I’ve always been drawn to specialties where medicine can be practised holistically. It’s one of the reasons I applied for GP training and am currently undertaking a diploma in lifestyle medicine. My last post as a second-year GP trainee was a 6-month placement in palliative medicine at a well-known inner London hospice. While on this rotation, I came across patients who suffered with ‘total pain’, a term which describes the existential, psychological distress that is unique to those facing a terminal diagnosis. These patients were often young, and were understandably struggling to come to terms with their early mortality, leading to a crisis of meaning with thoughts of ‘Why me? Is there any sense to this life, to the universe?’ This distress manifested in uncontrolled pain, for which strong opioid medications would initially be prescribed and uptitrated, often with significant side effects. Yet often their ‘pain’ would not improve. Existential distress at the end of life often bears the hallmarks of other mental health conditions that are associated with an overactive default mode network (DMN). This is the area composed of the medial prefrontal cortex, the medial temporal lobe (amygdala and hippocampus), and the posterior cingulate cortex. These regions in our brains are often associated with the ‘ego’, and are far more developed in humans compared with other species. They are active by …

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