Does Not Taking Your Pain Medication Make You a Hero?

By Crystal Lindell

There’s a deeply ingrained belief in American culture that suffering is both cleansing and healing. It’s likely connected to the widespread mythology about the American Dream: With hard work, you can achieve anything – emphasis on the “hard.”

If it’s easy – or even just easier – something must be wrong, and maybe even immoral. In other words, if you’re not in pain, you’re not gaining. 

This belief, sadly, has even permeated healthcare in a number ways. Many doctors act as though suffering is the point when it comes to certain ailments that we’ve moralized, like weight loss, substance use, mental health, and of course, pain.  

This thought process has also seeped into the general population, like a virus. I’ll often hear people brag that they didn’t need any of their prescribed pain medication after a surgery – as though that’s some sort of achievement. 

I’ve also heard patients with chronic ailments imply their own superiority by making it clear that they almost never take pain medication – as if that makes them better than the patients who need it. 

But suffering, in and of itself, does not make you a hero. Denying yourself medication that helps you is not some sort of gold-star achievement. You don’t get a medal because you endured more pain than everyone else. You just get, well, more pain. 

If you truly don’t need your pain medication, then obviously you don’t need to take it – but it’s not something to brag about. 

Especially because one day, as you grow older and your body deteriorates, you may find that you actually do need the very medication you thought you were a hero for avoiding. Then you’ll have the added battle of unpacking all the shame you’ve internalized about using it.

The last thing anyone with pain needs is another battle. 

Pain medications aren’t just for comfort either, and avoiding them out of some moral obligation can quite literally be dangerous to your health. In acute care situations, like post-surgery or after a bone break, you need them so that your body can focus its energy on healing. They also allow you to move more so that you can avoid post-op complications like pneumonia. 

Pain medications are also vital for chronic pain conditions. They help patients maintain their physical health, stay independent, and even do things like work and household chores. Pain meds also make it possible for us to love, laugh and socialize, just like healthy people do.  

Beyond that though, your body was not designed to endure pain every single day. If you don’t treat pain, it will start to impact your brain, and more urgently, your sleep. Without good sleep, your health will deteriorate. 

Ultimately, there is no reward for “pushing through it.” Pain and suffering will not make you a better person. In fact, they are incredibly dangerous. So if you need opioid medication or some other pain reliever, you should take it. 

And if you don’t need it, there’s no reason to brag about it. Pain won’t make you a hero. Only compassion can do that. 

Top 3 Ways I Make Money While Living With Chronic Pain

By Crystal Lindell 

Living with chronic pain can make it difficult to navigate traditional employment, due to the physical challenges and the unpredictability of our symptoms   

Unfortunately, we still need money to exist in our society, so I cobble together a living every month with various side jobs that I try to make into a whole job. Below is a look at some of those jobs, and the pros and cons of doing them if you have chronic pain or any sort of chronic illness.  

One large disclaimer is that none of these jobs offer health insurance. For me, for now, that just means that I don’t have insurance and I pay for medical care with cash. But I know a lot of others in a similar situation who either qualify for government insurance or they are able to purchase insurance on the government marketplace. 

Another disclaimer is that having a bunch of side jobs will make doing your taxes much more difficult, so try to put money away for that throughout the year in preparation for it. 

DoorDash

Pros: Flexible schedule, options for same-day pay, low barrier to entry. 

Cons: Success varies greatly based on where you live; the work can be physically exhausting; customers can be unpredictable and difficult; and there’s wear and tear on your car.

I started doing DoorDash in March after my cat Princess D was diagnosed with feline diabetes, and I needed to come up with some extra money for her treatment fast. 

I had a friend who told me she made $400 in four days doing DoorDash, and that was enough incentive to get me to sign up for the Dasher app. 

I live in a rural area where there are few DoorDash customers, so I drive about 20 minutes to a mid-sized city, where there are more customers and I can easily make $100 in about 4-6 hours of work. I’ve noticed that about 10 percent of my earnings go to gas, so I usually do one extra order each night to cover that. 

While there is the possibility of very low-paying orders of just $2, as long as customers tip, each order is usually at least $5 or as much as $15 in my area. 

There’s also an option to do “shop and deliver” orders, where you basically do someone’s grocery shopping. You don’t get offered those jobs at first, but as you get more experience in the app, they will start to give them to you. I had one that paid $60 for a little over an hour of shopping, because I was shopping three grocery orders simultaneously. That’s a great way to increase your earnings. 

I really, really like how flexible DoorDash is and that they offer a couple different ways to get paid the day you work. So if you need some quick cash for something like a utility bill or even just a fun outing, it’s possible to make the money fast and get paid fast. 

In the beginning, I worked mostly dinner hours and focused on Thursday through Sunday, because that’s when the app is the busiest. But after you earn various status levels, they give you more options for working whatever hours you want. Now I’m able to go out during the day, if that works for me. 

Best of all, if I’m having a bad pain day, I don’t do Doordash or can I work a very short shift. That’s flexibility that most traditional jobs don’t offer. 

Plus, if you need to stay below certain income thresholds to qualify for government benefits, it allows you to work exactly as much as you want/need to. 

If you decide to try it, I highly recommend joining some online DoorDash support groups on places like Facebook and Reddit. They are full of tips for drivers and can help you navigate the app and the job as a whole. 

Obviously, doing gig work like DoorDash will put a lot of wear and tear on your car, so you’ll need to keep up with vehicle maintenance. 

But if you’re looking for quick cash that you can make working your own schedule, then DoorDash and other similar gig work like UberEats can be a great way to do that. 

Freelance Writing

Pros: Some flexibility, can pay well, and can often be done at home

Cons: High barrier to entry; basically have to have connections to get work; and the work can be very unsteady.

I have a lot of professional experience as a writer and editor, so after I got laid off from my full-time journalism job in 2022, I had a few people reach out to me with freelance opportunities. 

This has been one of the better paying ways I make money, with some jobs paying as much as $50/hour or more. 

Even if you don’t have experience, that doesn’t mean you can’t freelance. If you have a special skill of any sort, whether it’s painting, photography or house cleaning, you can usually just post on your social media that you’re looking for work and you may be surprised by how many people reach out. 

My main advice would be to charge by the project rather than by the hour, so that you don’t have to track your hours as you go, and you don’t have to worry about any awkwardness between you and the client regarding how fast you’re working. 

If you’re setting your own rates, you have to factor in taxes and healthcare, so you should aim to make about as much per hour as you’d want to make yearly if you multiplied it by 1,000. So if you want to make $60,000 a year, you’ll want to charge a rate that works out to about $60/hour.

The biggest con to freelancing is that the work can be unsteady, which means you can’t really count on the income from month to month. For me, it’s usually based on what the publication or company I’m writing for needs at any given time. If they don’t need me, there’s no work, and thus, no money. 

Also, in the last few years, Generative AI, like ChapGPT, has dried up some of the writing and marketing work that used to be more plentiful for me. I suspect that trend will continue for my industry and others. 

However, I love writing, and freelancing allows me to be choosy about which writing jobs I want to take, so that I can focus on the things l’m passionate about, like writing for Pain News Network. Plus, making any money at all from my writing always feels like a victory to me. 

Selling Used Lego Online 

Pros: Fully done at home, can lead to a decent daily income stream, immediate pay, and it’s fun.

Cons: Relatively high barrier to entry because you have to invest in Legos and set up your own virtual store. It takes many hours of work to get things off the ground.

My fiance and I also run a virtual store where we sell used Lego. We buy bulk Lego from private sellers, wash them, sort them, inventory what we have, and then sell them by the piece. 

I’m not entirely sure I would really recommend this unless it’s something you’re passionate about, as it has been a LOT of work to run the store. And we have to use multiple rooms in our house to store Lego. 

We’ve also had some generous help from relatives, who have helped front the cost of the bulk Lego purchases we get, which helps a lot. 

But we’ve been running the store for a few years now, and it brings in a very steady stream of daily proceeds. And the more we expand the store, the more we tend to make. 

It’s also great to be able to work on the store at home and on our own schedule. 

There are other ways to make money selling used items online, and I know a lot of people make a living selling things on sites like eBay. But again, I really don’t recommend it unless it’s a product you’re really passionate about. 

For example, if you already love thrifting clothes, you may be able to find some cheap but valuable items that you can resell online. But you’ll quickly grow bored and frustrated with how much work is involved if you don’t love the process of sourcing in the first place. 

I will confess that even with all of these jobs, we are often tight on money. But we are very rich in other ways. We choose our own schedules, we are happy, we are able to rest when our bodies need it, and we get to spend a lot of time with our beloved cats. 

Maybe some day I’ll be healthy enough, both mentally and physically, to work full-time again, but for now, I’m just enjoying this chapter in our lives and all the flexibility it gives us. 

Safer Opioid Supply Helps Reduce Overdoses

By Pat Anson

Should people at high risk of an overdose be prescribed opioids like hydromorphone or should they get methadone to help them cope with opioid addiction?

It’s a controversial question in Canada, where harm reduction programs are being used to give high-risk drug users a “safer supply” of legal pain medications as an alternative to increasingly more toxic and deadly street drugs. Critics say safer opioid supply (SOS) programs don’t reduce overdoses and are a risky alternative to more traditional addiction treatment drugs like methadone.

A new study, however, found that SOS programs are just as effective as methadone and may even be safer in the long run. Researchers in Ontario followed the health outcomes of over 900 people newly enrolled in SOS programs, comparing them with a similar number of drug users who started methadone treatment.  

Their findings, published in The Lancet Public Health, show that people in both the SOS and methadone groups had significant declines in overdoses, emergency department (ED) visits, hospitalizations, severe infections, and health care costs in the year after they started treatment. In both groups, deaths related to opioids or any other cause were uncommon.

ED Visits Fell After High-Risk Drug Users Enrolled in SOS or Methadone Programs

THE LANCET PUBLIC HEALTH

"This is the first population-based study to compare SOS programs with opioid agonist treatment, and to explore how people's outcomes change in the year after initiation," said lead author Tara Gomes, PhD, an epidemiologist and Principal Investigator at the Ontario Drug Policy Research Network (ODPRN).

Gomes and her colleagues found that people on methadone had a slightly lower risk of an overdose or being admitted to hospital, but they were also more likely to discontinue treatment and be at risk of a relapse. The higher dropout rate outweighed most of the benefits of methadone over SOS.

"Neither methadone nor safer supply programs are a one-size-fits-all solution, but our findings show that both are effective at reducing overdose and improving health outcomes," said Gomes. "They are complementary to each other, and for many people who haven't found success with traditional treatments like methadone, safer supply programs offer a lifeline. Our findings show that when safer supply programs are implemented, we see fewer hospital visits, fewer infections, and fewer overdoses."

SOS programs were launched in Ontario and British Columbia to combat a rising tide of overdoses linked to illicit fentanyl. A decade ago, Vancouver was the first major North American city to be hit by a wave of fentanyl overdoses, which led Vancouver to become a laboratory for harm reduction and safe injection sites that provided heroin or prescription opioids to drug users.  

The results have been somewhat mixed. An investigation by the National Post found that hydromorphone pills given to drug users in Vancouver were being sold on the black market, with the sellers then using the money to buy street drugs. Complaints about people selling their safe supply drugs led to British Columbia’s Health Minister recently changing the rules so that the SOS drugs are consumed while under the supervision of a pharmacists or healthcare provider.

A 2024 study in JAMA Internal Medicine found that opioid-related hospitalizations rose sharply in British Columbia after harm reduction programs were launched there, although there was no significant change in overdose deaths. The spike in hospitalizations may have been due to more toxic street drugs and counterfeit pills on the black market.

Drugs Targeting ‘Zombie Cells’ May Reduce Low Back Pain

By Pat Anson

Low back pain is one of the most common and difficult pain conditions to treat. Although it’s the leading cause of disability worldwide, a recent study found that only about 10% of pharmaceutical and non-surgical therapies for low back pain provide relief. More invasive treatments, such as spinal injections and nerve blocks, have also been found to be no more effective than a placebo.

In short, there’s not much evidence to support the use of many treatments commonly used for low back pain -- which makes a preclinical study on two potential treatments all the more interesting.

Low back pain is commonly caused by senescent cells, so-called “zombie cells” that build up in spinal discs as people age or when discs are damaged. Instead of dying off like normal cells, these aging cells linger in the spine, causing pain and inflammation.

In experiments on laboratory mice, researchers at McGill University found that two drugs – o-vanillin and RG-7112 -- can clear zombie cells from the spine, reduce pain and improve bone quality. O-vanillin is a natural compound, while RG-7112 is an FDA-approved cancer drug that shrinks tumors.

“Our findings are exciting because it suggests we might be able to treat back pain in a completely new way, by removing the cells driving the problem, not just masking the pain,” said senior author Lisbet Haglund, PhD, a Professor in McGill’s Department of Surgery and Co-director of the Orthopaedic Research Laboratory at Montreal General Hospital.

Haglund and her colleagues found that o-vanillin and RG-7112 had a beneficial effect when taken separately, but their impact was greatest when they were taken together orally.  After just eight weeks of treatment, the drugs slowed or even reversed disc damage in mice.  

“We were surprised that an oral treatment could reach the spinal discs, which are hard to access and present a major hurdle in treating back pain,” said Haglund. “The big question now is whether these drugs can have the same effect in humans.”

O-vanillin belongs to a family of spicy and pungent natural compounds known as vanilloids, which are found in chili peppers and turmeric. Vanilloids are already used to control inflammation and reduce pain in topical patches like Qutenza.

O-vanillin was not originally intended to be part of the McGill study. But while testing other drugs, researchers decided to include o-vanillin to see whether it might be effective when taken orally. The results offer some of the first evidence that o-vanillin can clear out zombie cells. Analogs of RG-7112 were already known to do this in osteoarthritis and cancer research, but had not previously been used to treat back pain.

The McGill findings are published in the journal Science Advances. In future studies, Haglund’s team hopes to modify o-vanillin to help it stay in the body longer and become more effective. In addition to back pain, they believe the two drugs have the potential to treat other age-related diseases driven by senescent cells, such as arthritis and osteoporosis.

The Silent Opioid Crisis: Seriously Ill Patients Face Frequent Delays in Pain Treatment

By Pat Anson

Shortages of opioid pain medication and insurance obstacles are causing frequent delays and suboptimal treatment for seriously ill patients, according to a new study by researchers at the Icahn School of Medicine at Mount Sinai.

In a survey of 52 palliative care clinicians in Mount Sinai’s New York-based medical system, nearly nine out of ten (88%) reported frequent obstacles in getting opioids for their patients. On average, clinicians spent over an hour each day on the phone with insurance companies and pharmacies trying to gain access to limited opioid supplies. Nearly a third (31%) said this resulted in suboptimal care for their patients.

The survey findings were recently published in NEJM Catalyst Innovations In Care Delivery.

“Prescriptions are written, but patient is not able to get the correct dose or quantity at their pharmacy,” one clinician reported.

“I once had to send an oxycodone prescription to eight pharmacies,” said another.

“I spent the better part of 2 days... trying to figure out a pharmacy that would [fill] the oxycodone. Sometimes I spend more time handling access issues than actually talking to and thinking about the patient,” another palliative care clinician reported.

Patients in palliative or hospice care often have severe pain from cancer, major surgery, or a sudden emergency like a sickle cell crisis. Although they are usually exempt from opioid guidelines that limit the dose or amount, seriously ill or dying patients face many of the same obstacles getting opioids as patients with more moderate pain. Researchers say this “silent opioid crisis” has largely been ignored.

“Taken together, these findings raise alarms about a new crisis in opioid access for people with serious illness, for whom opioids are often essential pain relief medicines,” wrote lead author Rebecca Rodin, MD, Assistant Professor of Geriatrics and Palliative Medicine, Icahn Mount School of Medicine at Mount Sinai.

“Our clinicians reported that the numerous challenges in opioid access led to significant adverse effects on patient outcomes, such as uncontrolled pain, rehospitalization, and opioid withdrawal, and on clinician administrative burden. That burden included time spent contacting pharmacies and insurance companies rather than on direct patient care, which adversely affected clinician job satisfaction.”

In some cases, Rodin said clinicians changed their prescriptions to “less-than-ideal” opioid formulations and doses, a change based on the drugs’ availability rather than what is appropriate for their patients.

To improve patient access, Mount Sinai clinicians started collaborating more closely with pharmacies, finding out which opioids were in stock and improving their documentation to show why a prescription is medically necessary. Outpatient pharmacies also started delivering opioids to oncology patients before they were discharged, which helps ensure there is no disruption in pain care when they go home.  

Knowing which pharmacies have opioids in stock proved to be a critical time-saver for doctors and helped Mount Sinai develop a list of preferred pharmacies that is updated in real time.  

“Our strategies have been effective within the Mount Sinai ecosystem, but they do not address root causes of barriers which can include a number of factors, such as much broader supply chain shortages at the regional and national level, public and private coverage policies, and pharmacy stocking and dispensing practices. We need to do more to address these barriers,” said Rodin.

CDC to Lose Nearly Half Its Funding in 2026 Budget Proposal

By Pat Anson

The Centers for Disease Control and Prevention and other federal health programs face severe cuts under a 2026 budget proposal drafted by the White House Office of Management and Budget (OMB).

The Department of Health and Human Services (HHS) could lose about a third of its funding for discretionary programs outside of Medicare and Medicaid. Among the dozens of programs being eliminated or downsized is the CDC’s National Center for Injury Prevention and Control, which developed the agency’s controversial opioid prescribing guideline.

Under the OMB’s budget proposal – known as a “passback” -- the CDC’s funding would be cut by about 44 percent, from $9.2 billion to nearly $5.2 billion.

“President Trump has committed to balancing the budget,” the leaked OMB document states. “Reaching balance requires resetting the proper balance between federal and state responsibilities with a renewed emphasis on federalism; eliminating the federal government’s support of woke ideology; protecting the American people by deconstructing a wasteful and weaponized bureaucracy; and identifying and eliminating wasteful spending.

“Passback levels reflect the reforms necessary to enable agencies to fulfill their statutory responsibilities in the most cost-effective manner possible. Many difficult decisions were necessary to reach the funding levels provided in this Passback.”   

The OMB budget for the CDC is intended to refocus the agency on its original core mission of monitoring public health and fighting infectious diseases, a long-sought goal of conservative activists.

Project 2025, a wish-list for the Trump Administration written by the Heritage Foundation, calls the CDC “perhaps the most incompetent and arrogant agency in the federal government.” The conservative think tank wants the CDC’s ability to set public health policy “severely confined” — a goal that the OMB budget would largely achieve if it is implemented in its current form.    

“The Budget reforms the Centers for Disease Control and Prevention to refocus CDC on emerging and infectious disease surveillance, outbreak investigations, preparedness and response, and maintaining the Nation’s public health infrastructure,” the OMB said.         

The CDC Injury Center was initially created in 1993 to improve workplace safety, but its duties have expanded over the years to include other public health issues outside of its original mission, such as drug overdoses, opioid prescribing, suicides, child abuse, and community violence. The Center’s budget for fiscal year 2024 was over $761 million.

Dr. Debra Houry, a former director of the Injury Center who is currently the CDC’s chief medical officer, advised staff last week to begin planning for the splintering of the agency.

It’s unclear what would happen to the CDC opioid guideline if the Injury Center is abolished. Although voluntary, the guideline’s recommendation to reduce the use of opioid pain medication was widely adopted by states, insurers, doctors and law enforcement, causing millions of patients to be taken off opioids or tapered to lower doses.

Patients and their advocates have long called for the guideline to be revoked. In a 2022 PNN survey of patients, providers and caregivers, 84% said the CDC overstepped its authority and shouldn’t be involved in opioid prescribing or pain management.

The CDC has already seen its workforce reduced by as many as 4,000 positions due to layoffs and early retirements in the second Trump administration. Many of those who were fired have formed an advocacy group called Fired But Fighting to get their jobs back and to demand more transparency from the administration on the downsizing of the CDC.

In addition to the Injury Center, other federal health programs targeted for elimination include the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Agency for Healthcare Research and Quality (AHRQ). Some of the core functions of those agencies, such as those involved in overdose and suicide prevention, are being transferred to the Administration for a Healthy America (AHA), a new centralized agency in HHS under the direct control of Secretary Robert F. Kennedy Jr.

Under the Biden administration, the HHS budget increased by 38% and its staffing increased by 17%. The Trump administration plans to reduce the HHS workforce from 82,000 full-time employees to 62,000.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said in a statement last month. "This Department will do more — a lot more — at a lower cost to the taxpayer."

The OMB budget proposal has not been finalized and needs the approval of Congress to be implemented. 

Researchers Replicate Human Pain in Lab Dish

By Crystal Lindell

Researchers have replicated part of the human nervous system in a lab dish, a method they hope will allow them to study pain and potential treatments without having to inflict pain on humans. 

The research was shared in a study published in Nature, and led by Sergiu Pasca, MD, a Professor of Psychiatry and Behavioral Sciences at Stanford University.

Pasca and his colleagues used stem cells to recreate the four key neurons involved in the “pain pathway” that processes pain in humans. Specifically, they made sensory neurons, spinal cord neurons, thalamic neurons, and cortical neurons, and put them all together. Then they added capsaicin, which is present in hot chili peppers, to see how the neurons respond to painful stimuli. 

They found that the lab dish neurons will sense the pain through specialized receptors and emit electrical signals throughout the pain pathway, just as they do in humans. 

“That makes us believe that we have actually reconstructed the basic component of this pain circuit,” Pasca explains. 

In a video about the findings, Pasca describes how they did the research and why it matters. 

The findings could allow researchers to study pain in humans in a way that doesn’t cause actual pain to humans or research animals. Human pain has often proven tough to study in laboratory animals.

“Their pain pathways are in some respects different from ours,” Pasca said. “Yet these animals experience pain. Our dish-based construct doesn’t.”

The hope is that being able to reconstruct or to build this pain pathway in the lab will allow researchers to study human genetic disorders and other conditions that cause pain, and then eventually to start testing drugs for alleviating pain. 

“This neural circuit in a dish offers us an exciting way to study disease and to speed up drug discovery and therapeutic applications -- essentially providing us with a working model of a very important part of our human nervous system,” Pasca said. 

How I Learned to Sleep Better and Keep My Mobility

By Madora Pennington

What do you lose when lose your ability to get up, walk, move about, and do things for yourself?

Independence.

Moving your body around requires muscles, stability, balance, good joints, and brain function. If that is lost, you need others to help you do things.

You may not be able to do your own cooking and cleaning. Getting groceries yourself might be too difficult. Even if you get them delivered, you might not be able to put them away. You risk falling and getting injured or not being able to get up. You miss out on social events. You may find yourself isolated and depressed. You’ll need more healthcare services. You might even end up in assisted living.

The number one cause of disability in the United States is loss of mobility, affecting 13% of adults. Many chronic conditions can lead to it: Parkinson's, multiple sclerosis, diabetes, arthritis.

One thing has been shown to slow the loss of mobility for all of them: good sleep.

A 2024 study followed over 70,000 women for eight years. Those that slept enough kept their ability to move and use their bodies. Those that didn’t reported being very sleepy during the day and lost mobility over time.

It seems that no matter what your chronic condition is — or even if you have none – sleeping too little may speed you towards disability.

These results are not surprising. A healthy diet, exercise, and good sleep are accepted as pillars of good health. Improving diet and exercise can be hard, requiring time, effort and education. But solving poor sleep can be a nightmare.

Here are some things I learned from a therapist years ago, when I was having night terrors every night. I would awaken in a state of hyper-arousal, confused about where I was and very afraid. I was diagnosed with PTSD, which is thought to be a disorder of circadian rhythm.

My body, I was told, had lost its sense of when it was time to rest and rejuvenate, and when it was time to be in action and face challenges. The therapist recommended fixing my dysregulated internal clock.

You do that by making sure the bedroom is used for sleep only. That means you avoid hanging out in bed or the bedroom — no eating, no watching TV, no knitting, reading, whatever.

“Can I fold the laundry on the bed?” I asked.

“It would be better to do it elsewhere,” the therapist said. “Stay out of your bedroom during the day as much as possible, so the bedroom itself signals sleepy time.”

Another tip was to avoid bright lights in the hours before bedtime. And to get some red lights to mimic the sun setting.

If you lie in bed feeling anxious and frustrated, you risk training your brain and body that the bed is a stressful place and not for sleep.

If you can’t sleep or go back to sleep, get out of bed and leave the bedroom. Keep the lights low, or even better, make them red. Move around. Unload the dishwasher. Pet the cat. Get right back in bed when drowsiness returns.

Get into bed at the same time every night, before 10 p.m. Set an alarm and get out of bed after eight hours, no matter what. No naps. Don’t confuse the body.

As odd as they seemed at the time, these simple suggestions went a long way in improving my sleep and my whole PTSD phenomena. I still stick to them. I don’t read, relax or watch TV in bed, unless I’m doing it as part of my bedtime routine. If I am sick, I rest elsewhere during the day.

I’ll admit, I do love a weekend nap sometimes. But I only take one if it’s before 2 p.m. Any later than that, and I might not fall asleep easily at night, a habit I do not want to promote.

When I do take a nap, I sleep upright on a bean bag or the couch, with the curtains open and a video playing. That way, my body understands this is a shallow nap – I have not entered a different time zone.

To wake up refreshed and rested is a gift to yourself and those around you. Many issues can prevent regular, deep, restorative sleep. Pain is a sleep interrupter. Antihistamines, benzodiazepines, opioids and alcohol may help put you to sleep, but keep you out of the REM stages of sleep that are needed for repair.

Find knowledgeable practitioners and good advice to help. The right solutions for good sleep are the ones that work for you.

Physical Therapy Coverage Often Ends When Patients Still Need It

By Jordan Rau, KFF Health News

Mari Villar was slammed by a car that jumped the curb, breaking her legs and collapsing a lung. Amy Paulo was in pain from a femur surgery that wasn’t healing properly. Katie Kriegshauser suffered organ failure during pregnancy, weakening her so much that she couldn’t lift her baby daughter.

All went to physical therapy, but their health insurers stopped paying before any could walk without assistance. Paulo spent nearly $1,500 out of her own pocket for more sessions.

Millions of Americans rely on physical and occupational therapists to regain strength and motor skills after operations, diseases, and injuries. But recoveries are routinely stymied by a widespread constraint in health insurance policies: rigid caps on therapy sessions.

Insurers frequently limit such sessions to as few as 20 a year, a KFF Health News examination finds, even for people with severe damage such as spinal cord injuries and strokes, who may need months of treatment, multiple times a week. Patients can face a bind: Without therapy, they can’t return to work, but without working, they can’t afford the therapy.

Paulo said she pressed her insurer for more sessions, to no avail. “I said, ‘I’m in pain. I need the services. Is there anything I can do?’” she recalled. “They said, no, they can’t override the hard limit for the plan.”

A typical physical therapy session for a privately insured patient to improve daily functioning costs $192 on average, according to the Health Care Cost Institute. Most run from a half hour to an hour.

Insurers say annual visit limits help keep down costs, and therefore premiums, and are intended to prevent therapists from continuing treatment when patients are no longer improving. They say most injuries can be addressed in a dozen or fewer sessions and that people and employers who bought insurance could have purchased policies with better therapy benefits if it was a priority.

Atul Patel, a physiatrist in Overland Park, Kansas, and the treasurer of the American Academy of Physical Medicine and Rehabilitation, said insurers’ desire to prevent gratuitous therapy is understandable but has “gone too far.”

“Most patients get way less therapy than they would actually benefit from,” he said.

Hard caps on rehab endure in part because of an omission in the Affordable Care Act. While that law required insurers to cover rehab and barred them from setting spending restrictions on a patient’s medical care, it did not prohibit establishing a maximum number of therapy sessions a year.

More than 29,000 ACA health plans — nearly 4 in 5 — limit the annual number of physical therapy sessions, according to a KFF Health News analysis of plans sold last year to individuals and small businesses. Caps generally ranged from 20 to 60 visits; the most common was 20 a year.

Health plans provided by employers often have limits of 20 or 30 sessions as well, said Cori Uccello, senior health fellow at the American Academy of Actuaries.

“It’s the gross reality in America right now,” said Sam Porritt, chairman of the Falling Forward Foundation, a Kansas-based philanthropy that has paid for therapy for about 200 patients who exhausted their insurance over the past decade. “No one knows about this except people in the industry. You find out about it when tragedy hits.”

Even in plans with no caps, patients are not guaranteed unlimited treatment. Therapists say insurers repeatedly require prior authorization, demanding a new request every two or three visits. Insurers frequently deny additional sessions if they believe there hasn’t been improvement.

“We’re seeing a lot of arbitrary denials just to see if you’ll appeal,” said Gwen Simons, a lawyer in Scarborough, Maine, who represents therapy practices. “That’s the point where the therapist throws up their hands.”

‘Couldn’t Pick Her Up’

Katie Kriegshauser, a 37-year-old psychologist from Kansas City, Missouri, developed pregnancy complications that shut down her liver, pancreas, and kidneys in November 2023.

After giving birth to her daughter, she spent more than three months in a hospital, undergoing multiple surgeries and losing more than 40 pounds so quickly that doctors suspected her nerves became damaged from compression. Her neurologist told her he doubted she would ever walk again.

Kriegshauser’s UnitedHealthcare insurance plan allowed 30 visits at Ability KC, a rehabilitation clinic in Kansas City. She burned through them in six weeks in 2024 because she needed both physical therapy, to regain her mobility, and occupational therapy, for daily tasks such as getting dressed.

“At that point I was starting to use the walker from being completely in the wheelchair,” Kriegshauser recalled. She said she wasn’t strong enough to change her daughter’s diaper. “I couldn’t pick her up out of her crib or put her down to sleep,” she said.

The Falling Forward Foundation paid for additional sessions that enabled her to walk independently and hold her daughter in her arms. “A huge amount of progress happened in that period after my insurance ran out,” she said.

In an unsigned statement, UnitedHealthcare said it covered the services that were included in Kriegshauser’s health plan. The company declined to permit an official to discuss its policies on the record because of security concerns.

A Shattered Teenager

Patients who need therapy near the start of a health plan’s year are more likely to run out of visits. Mari Villar was 15 and had been walking with high school friends to get a bite to eat in May 2023 when a car leaped over a curb and smashed into her before the driver sped away.

The accident broke both her legs, lacerated her liver, damaged her colon, severed an artery in her right leg, and collapsed her lung. She has undergone 11 operations, including emergency exploratory surgery to stop internal bleeding, four angioplasties, and the installation of screws and plates to hold her leg bones together.

Villar spent nearly a month in Shirley Ryan AbilityLab’s hospital in Chicago. She was discharged after her mother’s insurer, Blue Cross and Blue Shield of Illinois, denied her physician’s request for five more days, making her more reliant on outpatient therapy, according to records shared by her mother, Megan Bracamontes.

Villar began going to one of Shirley Ryan’s outpatient clinics, but by the end of 2023, she had used up the 30 physical therapy and 30 occupational therapy visits the Blue Cross plan allowed.

Because the plan ran from July to June, she had no sessions left for the first half of 2024.

MARI VILLAR AND HER THERAPIST

“I couldn't do much,” Villar said. “I made lots of progress there, but I was still on crutches.”

Dave Van de Walle, a Blue Cross spokesperson, said in an email that the insurer does not comment on individual cases. Razia Hashmi, vice president for clinical affairs at the Blue Cross Blue Shield Association, said in a written statement that patients who have run out of sessions should “explore alternative treatment plans” including home exercises.

Villar received some extra sessions from the Falling Forward Foundation. While her plan year has reset, Villar is postponing most therapy sessions until after her next surgery so she will be less likely to run out again. Bracamontes said her daughter still can’t feel or move her right foot and needs three more operations: one to relieve nerve pain, and two to try to restore mobility in her foot by lengthening her Achilles tendon and transferring a tendon in her left leg into her right.

“Therapy caps are very unfair because everyone’s situation is different,” Villar said. “I really depend on my sessions to get me to a new normalcy. And not having that and going through all these procedures is scary to think about.”

Rationing Therapy

Most people who use all their sessions either stop going or pay out-of-pocket for extra therapy.

Amy Paulo, a 34-year-old Massachusetts woman recovering from two operations on her left leg, maxed out the 40 visits covered by Blue Cross Blue Shield of Massachusetts in 2024, so she spent $1,445 out-of-pocket for 17 therapy sessions.

Paulo needed physical therapy to recover from several surgeries to shorten her left leg to the length of her right leg — the difference a consequence of juvenile arthritis. Her recovery was prolonged, she said, because her femur didn’t heal properly after one of the operations, in which surgeons cut out the middle of her femur and put a rod in its place.

“I went ballistic on Blue Cross many, many times,” said Paulo, who works with developmentally delayed children.”

Amy McHugh, a Blue Cross spokesperson, declined to discuss Paulo’s case. In an email, she said most employers who hire Blue Cross to administer their health benefits choose plans with “our standard” 60-visit limit, which she said is more generous than most insurers offer, but some employers “choose to allow for more or fewer visits per year.”

Paulo said she expects to restrict her therapy sessions to once a week instead of the recommended twice a week because she’ll need more help after an upcoming operation on her leg.

“We had to plan to save my visits for this surgery, as ridiculous as it sounds,” she said.

Medicare Is More Generous

People with commercial insurance plans face more hurdles than those on Medicare, which sets dollar thresholds on therapy each year but allows therapists to continue providing services if they document medical necessity. This year the limits are $2,410 for physical and speech therapy and $2,410 for occupational therapy.

Private Medicare Advantage plans don’t have visit or dollar caps, but they often require prior authorization every few visits. The U.S. Senate Permanent Subcommittee on Investigations found last year that MA plans deny requests for physical and occupational therapy at hospitals and nursing homes at higher rates than they reject other medical services.

Therapists say many commercial plans require prior authorization and mete out approvals parsimoniously. Insurers often make therapists submit detailed notes, sometimes for each session, documenting patients’ treatment plans, goals, and test results showing how well they perform each exercise.

“It’s a battle of getting visits,” said Jackee Ndwaru, an occupational therapist in Jacksonville, Florida. “If you can’t show progress they’re not going to approve.”

An Insurer Overruled

Marjorie Haney’s insurance plan covered 20 therapy sessions a year, but Anthem Blue Cross Blue Shield approved only a few visits at a time for the rotator cuff she tore in a bike accident in Maine. After 13 visits in 2021, Anthem refused to approve more, writing that her medical records “do not show you made progress with specific daily tasks,” according to the denial letter.

Haney, a physical therapist herself, said the decision made no sense because at that stage of her recovery, the therapy was focused on preventing her shoulder from freezing up and gradually expanding its range of motion.

“I went through those visits like they were water,” Haney, now 57, said. “My range was getting better, but functionally I couldn’t use my arm to lift things.”

Haney appealed to Maine’s insurance bureau for an independent review. In its report overturning Anthem’s decision, the bureau’s physician consultant, William Barreto, concluded that Haney had made “substantial improvement” — she no longer needed a shoulder sling and was able to return to work with restrictions. Barreto also noted that nothing in Anthem’s policy required progress with specific daily tasks, which was the basis for Anthem’s refusal.

“Given the member’s substantial restriction in active range of motion and inability to begin strengthening exercises, there is remaining deficit that requires the skills and training of a qualified physical therapist,” the report said.

Anthem said it requires repeated assessments before authorizing additional visits “to ensure the member is receiving the right care for the right period of time based on his or her care needs.” In the statement provided by Stephanie DuBois, an Anthem spokesperson, the insurer said this process “also helps prevent members from using up all their covered treatment benefits too quickly, especially if they don’t end up needing the maximum number of therapy visits.”

In 2023, Maine passed a law banning prior authorization for the first 12 rehab visits, making it one of the few states to curb insurer limitations on physical therapy. The law doesn’t protect residents with plans based in other states or plans from a Maine employer who self-insures.

Haney said after she won her appeal, she spaced out the sessions her plan permitted by going once weekly. “I got another month,” she said, “and I stretched it out to six weeks.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues.

What Not To Say in the Emergency Room

By Carol Levy

Many years ago, I was a clerk in an emergency room ward. Often the people who came in didn't seem to understand how an emergency room works. Unfortunately, those same misunderstandings exist today.

I have seen a number of online posts and comments by chronic pain patients about their experiences in emergency rooms. The posts tend to be very negative about ERs, often angry, and full of frustration over the way they were treated.

My intention when I started this column was to write about the emergency room experience, and what to expect when you make the choice to go there. I did some research to ensure my facts would still be current, such as how ER departments are configured today.

I found several articles on what not to say to your pain management doctor. To my surprise, the answers mimicked what you should not say in the ER, such as “I just need painkillers” or “I know what I need, just prescribe it.”

Saying that gives the impression that you’re just looking for medication, rather than treatment. It’s not advisable to say that to any doctor, regardless of the situation.  

At the ER, you will first see the receptionist or ward clerk. The next step for most hospitals is the triage person, usually a nurse.  When they ask “What is the reason for your visit?” saying, “I have pain” is not sufficient.

They will inquire about when, where and for how long you’ve had pain, to get a better idea of why you are there. That will help them decide what level of an emergency you are.

It’s important not to expect ER staff to know everything about rare disorders, such as CRPS, trigeminal neuralgia or Ehlers-Danlos syndrome. The chances they have seen or even heard of them are slim. Unfortunately, for many rare disorders, we have to be the ones to educate the staff.

Even if you are in extreme pain, shouting “I have pain!” will not help get what you need. Calmly explaining, as best you can, the cause and level of your pain gives them a better understanding of why you are there, and will help get you seen sooner.

Another “don’t” is asking for a specific opioid, as it can make you appear to be a drug seeker. That’s not fair, I know, but that’s just the way it is in the current anti- opioid environment.

Exaggerating your pain can also be seen as the behavior of someone looking to get drugs. Screaming or yelling “I am in horrible pain! Give me something now!” won't get you what you need. Ultimately, the doctor or nurse will decide if you're exaggerating your pain. If they decide that’s the case, you may get nothing at all.

You also shouldn’t question your doctor's expertise. After all, he is the expert (or at least thinks he is). Asking for clarification is fine, but asking for a second opinion may backfire. It’s another way of saying you don't trust or have faith in the doctor. In the ER, you won't be able to get a second opinion. Whichever doctor sees you is the one you’re stuck with.

The wait in the ER may be a long one. The doctors and nurses may seem to be walking around aimlessly, but they may actually be busy, dealing with patients who have suffered a heart attack, stroke, or severe trauma.

If you are a chronic pain patient, your pain may not be seen as an immediate concern. To ER staff, acute pain could be a sign of a life threatening situation that needs immediate attention.

Many ERs now have private rooms, but some still have ward-like areas. It is nice to have privacy, but they may put you in the ward area because that is the only space available.

These unwritten rules apply to everyone on how to act in the ER. But for those of us with chronic pain, we need to to be extra careful about what lines not to cross.

What lessons have you learned in the ER?

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here. 

Alarming Study Tries to Automate Labeling of Patients with Opioid Use Disorder

By Crystal Lindell

An alarming new study attempts to automate the process of labeling chronic pain patients with Opioid Use Disorder (OUD), by using a computer to scan doctors’ clinical notes. 

A team of researchers analyzed medical records for over 8,000 patients with chronic pain, and then used an automated process to scan clinical notes from doctors, patient demographics, and diagnostic codes. The automated process was then compared to whether patients had already been given a diagnostic code for OUD. 

The researchers claim that their automated approach out-performed diagnostic codes when it came to finding patients with OUD. The codes are a key part of healthcare and are used by doctors not only to make a diagnosis, but to get reimbursed by insurers for treating patients.  

The authors say the diagnostic codes are “unreliable and underused,” and claim that their automated approach will do a better job predicting which patients are at risk for OUD and which once already have it.

“This automated data extraction technique may facilitate earlier identification of people at risk for and who are experiencing problematic opioid use, and create new opportunities for studying long-term sequelae of opioid pain management,” wrote lead author Alvin Jeffery, PhD, an Assistant Professor in the Department of Biomedical Informatics at Vanderbilt University Medical Center.

Jefferey and his colleagues say chronic pain patients treated with opioids are “at high risk of developing an opioid use disorder,” and cite a single study estimating the risk is as high as 18%. Most research puts the probability much lower, at about 1%.  

There are a number of other alarming things about this research. 

First and foremost, using any sort of automated process to label patients as having opioid use disorder is incredibly dangerous. Especially if that automated process applies the label to more patients than doctors already are. 

Also, the researchers used the “Addictions Behaviors Checklist” to determine if patients have OUD. Unfortunately, that checklist is known for lumping in a lot of patients who simply have untreated or under-treated pain. 

For example, one of the items on the checklist is “patient running out of medications early” – which means anyone who isn’t being prescribed enough pain medication could qualify as having OUD. 

Another criteria on the list is “patient expressing concern about future availability of narcotics” – a normal thing to be worried about when opioid shortages are widespread and opioid-phobia is rampant in the medical community. 

Other red flag terms they search for in doctors’ notes are “hoard,” “stash,” “left over” and “storing.” This also overlooks the fact that prescription opioids can be difficult to get, causing  many patients to keep leftover ones, just in case they needed them in the future. A recent PNN survey found that 32% of patients hoarded unused opioids. 

Once a patient gets labeled with OUD, it can quite literally ruin their lives by making it more difficult for them to get their pain adequately treated. That doesn’t just apply to patients with chronic pain. If a surgical patient experiencing post-op pain (as nearly all do) has “possible OUD” in their chart, doctors are much less likely to prescribe opioid pain medication. 

I genuinely worry that we are reaching a point where computers and artificial intelligence will be used en masse to label patients with damaging mental health diagnoses like OUD. And if that takes root, there won’t be any way for patients to counter the diagnosis. 

In fact, one of the biggest problems in healthcare is that there is no right to due process. Once you are given a medical verdict, so to speak, you are often stuck with it. 

We should all be worried that these types of automated diagnostic tools will also be expanded beyond opioid users to label other patients with stigmatizing mental health conditions that impact the quality of the medical care they receive going forward.

At this point, I’m not sure what patients can even do to stop this from happening, but my hope is that bringing more awareness to the issue will at least slow its progression. 

I personally would judge any doctors who would rely on any sort of automated process to give a patient a dangerous label like OUD, even if such a process is mandated by the hospital they work for, or even the government. 

I hope that doctors will have the moral fortitude to fight back on these types of things. Although if the medical community’s recent history with opioids is an indication, I’m not convinced most of them will stand up for their patients. 

Misinformation About Fentanyl Threatens To Undermine Overdose Response

By Henry Larweh, KFF Health News

Fentanyl, the deadly synthetic opioid driving the nation’s high drug overdose rates, is also caught up in another increasingly serious problem: misinformation.

False and misleading narratives on social media, in news reports, and even in popular television dramas suggesting people can overdose from touching fentanyl — rather than ingesting it — are now informing policy and spending decisions.

In an episode of the CBS cop drama “Blue Bloods,” for instance, Detective Maria Baez becomes comatose after accidentally touching powdered fentanyl. In another drama, “S.W.A.T.,” Sgt. Daniel “Hondo” Harrelson warns his co-workers: “You touch the pure stuff without wearing gloves, say good night.”

While fentanyl-related deaths have drastically risen over the past decade, no evidence suggests any resulted from incidentally touching or inhaling it, and little to no evidence that any resulted from consuming it in marijuana products. (Recent data indicates that fentanyl-related deaths have begun to drop.)

There is also almost no evidence that law enforcement personnel are at heightened risk of accidental overdoses due to such exposures. Still, there is a steady stream of reports — which generally turn out to be false — of officers allegedly becoming ill after handling fentanyl.

“It’s only in the TV dramas” where that happens, said Brandon del Pozo, a retired Burlington, Vermont, police chief who researches policing and public health policies and practices at Brown University.

In fact, fentanyl overdoses are commonly caused by ingesting the drug illicitly as a pill or powder. And most accidental exposures occur when people who use drugs, even those who do not use opioids, unknowingly consume fentanyl because it is so often used to “cut” street drugs such as heroin and cocaine.

Despite what scientific evidence suggests about fentanyl and its risks, misinformation can persist in public discourse and among first responders on the front lines of the crisis. Daniel Meloy, a senior community engagement specialist at the drug recovery organizations Operation 2 Save Lives and QRT National, said he thinks of misinformation as “more of an unknown than it is an anxiety or a fear.”

“We’re experiencing it often before the information” can be understood and shared by public health and addiction medicine practitioners, Meloy said.

Some state and local governments are investing money from their share of the billions in opioid settlement funds in efforts to protect first responders from purported risks perpetuated through fentanyl misinformation.

In 2022 and 2023, 19 cities, towns, and counties across eight states used settlement funds to purchase drug detection devices for law enforcement agencies, spending just over $1 million altogether. Two mass spectrometers were purchased for at least $136,000 for the Greeley, Colorado, police department, “to protect those who are tasked with handling those substances.”

Del Pozo, the retired police chief, said fentanyl is present in most illicit opioids found at the scene of an arrest. But that “doesn’t mean you need to spend a lot of money on fentanyl detection for officer safety,” he said. If that spending decision is motivated by officer safety concerns, then it’s “misspent money,” del Pozo said.

Fentanyl misinformation is affecting policy in other ways, too.

Florida, for instance, has on the books a law that makes it a second-degree felony to cause an overdose or bodily injury to a first responder through this kind of secondhand fentanyl exposure. Similar legislation has been considered by states such as Tennessee and West Virginia, the latter stipulating a penalty of 15 years to life imprisonment if the exposure results in death.

Public health advocates worry these laws will make people shy away from seeking help for people who are overdosing.

“A lot of people leave overdose scenes because they don’t want to interact with police,” said Erin Russell, a principal with Health Management Associates, a health care industry research and consulting firm. Florida does include a caveat in its statute that any person “acting in good faith” to seek medical assistance for someone they believe to be overdosing “may not” be arrested, charged, or prosecuted.

‘You Can Get It Through Your Fingers’

And even when public policy is crafted to protect first responders as well as regular people, misinformation can undermine a program’s messaging.

Take Mississippi’s One Pill Can Kill initiative. Led by the state attorney general, Lynn Fitch, the initiative aims to provide resources and education to Mississippi residents about fentanyl and its risks.

While it promotes the availability and use of harm reduction tools, such as naloxone and fentanyl test strips, Fitch has also propped up misinformation.

At the 2024 Mississippi Coalition of Bail Sureties conference, Fitch said, “If you figure out that pill’s got fentanyl, you better be ready to dispose of it, because you can get it through your fingers,” based on the repeatedly debunked belief that a person can overdose by simply touching fentanyl.

Officers on the ground, meanwhile, sometimes are warned to proceed with caution in providing lifesaving interventions at overdose scenes because of these alleged accidental exposure risks. This caution is often evidenced in a push to provide first responders with masks and other personal protective equipment.

Fitch told the crowd at the conference: “You can’t just go out and give CPR like you did before.”

However, as with other secondhand exposures, the risk for a fentanyl overdose from applying mouth-to-mouth is negligible, with no clinical evidence to suggest it has occurred.

Her comments underscore growing concerns, often not supported by science, that officers and first responders increasingly face exposure risks during overdose responses. Her office did not respond to questions about these comments.

Health care experts say they are not against providing first responders with protective equipment, but that fentanyl misinformation is clouding policy and risks delaying critical interventions such as CPR and rescue breathing.

“People are afraid to do rescue breathing because they’re like, ‘Well, what if there’s fentanyl in the person’s mouth,’” Russell said. Hesitating for even a moment because of fentanyl misinformation could delay a technique that “is incredibly important in an overdose response.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues.

Poor Oral Health Linked to Fibromyalgia and Migraines

By Crystal Lindell

Poor oral health is significantly associated with body pain, headaches, and abdominal distress in women, according to a new study published in Frontiers in Pain Research. The research highlights the importance of dental hygiene and its role in fibromyalgia and other chronic pain conditions. 

Australian researchers looked at the oral health of 158 women by using the World Health Organization's oral health questionnaire. Over two thirds of the women (67%) had fibromyalgia, a chronic pain condition that causes fatigue, body pain and sleep disturbances. 

Researchers also evaluated saliva samples from the women to look for four oral microbe species that have previously been associated with migraines.

They found that poor oral health scores, higher pain scores, and high microbe levels were significantly associated with each other. That suggests a potential role for the microbes as a cause of the pain experienced by the women. 

“This is the first study to investigate oral health, oral microbiota and pain commonly experienced in women with fibromyalgia, with our study showing a clear and significant association between poor oral health and pain,” said lead investigator Joanna Harnett, PhD, an Associate Professor at the University of Sydney. 

Women with the poorest oral health were more likely to suffer from higher pain scores. Sixty percent experienced moderate to severe body pain, and 49 percent were more likely to experience migraine headaches. Poor oral health was also a significant predictor of frequent and chronic migraine.

Researchers say it’s entirely plausible that poor oral health leads to gum disease and oral dysbiosis, an imbalance of microorganisms that can spread throughout the body. The bacteria then trigger more pain signalling, thus increasing widespread body pain. 

“Our findings are particularly important to fibromyalgia, which, despite being a common rheumatological condition, is often underrecognized,” added first author Sharon Erdrich, a Doctorate Student and Research Assistant at the University of Sydney.

The research is especially interesting because dental health is often cordoned off from the rest of healthcare, at least in the United States. Dental insurance is usually completely separate from regular health insurance, and most doctors will not evaluate your teeth during an appointment. 

Dental care is still often viewed as a cosmetic issue, despite the fact that dental pain is some of the worst pain imaginable. Studies like these show why trying to separate teeth off from the rest of healthcare is a failing strategy. 

Mindfulness and Cognitive Behavioral Therapy Reduce Chronic Low Back Pain

By Pat Anson

Have you tried cognitive behavioral therapy (CBT) or mindfulness? Did they help relieve your pain?

Chronic pain sufferers have been telling us for years that neither form of psychotherapy worked for them. Yet many physicians continue to recommend CBT and/or mindfulness as a safer alternative to opioids and other pain medications.

Does either therapy actually work? And, if so, which one works better?

In the largest head-to-head study of its kind, a team of researchers compared the effectiveness of CBT with mindfulness in 770 patients with chronic low back pain. Unlike previous studies, these patients had fairly high pain levels (an average of 6.1 on a zero to 10 pain scale) and they were taking opioids for at least three months.

The study wasn’t short-term either. Participants were regularly surveyed about their pain levels, physical function, quality of life, and opioid use for up to a year.     

“The people in this study had quite severe back pain that interfered with their life and was bad enough to need opioid medication. Usually, in that condition, people don’t really get better over time on their own,” said co-lead author Bruce Barrett, MD, a Professor of Family Medicine and Community Health at the University of Wisconsin-Madison.

Participants were divided into two groups and trained by experienced therapists in either mindfulness or CBT, before being told to practice them at home daily for at least 30 minutes. Patients trained in mindfulness learned how to “deconstruct” their pain to make it seem less important, while those trained in CBT learned coping, behavioral and relaxation skills.

The study findings, published in JAMA Network Open, show that CBT and mindfulness were equally effective, leading to modest improvements in pain, function and quality of life. The benefits persisted and grew stronger over 12 months, with most participants reducing or even stopping their opioid use.

After a year, the average pain level in the mindfulness group fell to 5.4, while those in the CBT group were reduced to 5.5 on the zero to 10 scale. That’s about a 10% improvement.

“Both mindfulness and cognitive behavioral therapy were shown to be safe, effective treatments, providing lasting benefits for people with opioid-treated chronic back pain. These evidence-based behavioral therapies should be standard of care available to our patients,” wrote lead author Aleksandra Zgierska, MD, a Professor of Family and Community Medicine at Penn State College of Medicine.

Although participants were not explicitly encouraged to reduce their use of opioids, patients in both groups did. Researchers say that was a direct result of their training, which taught them how to cope better with pain and decrease their opioid use on their own.

“These therapies aren’t a total cure, but they teach people how to develop the inner resources they need to cope with chronic pain and to live a better life,” said co-author Eric Garland, PhD, a Psychiatry Professor at the University of California San Diego. “Mindfulness is a self-regulated tool that comes from within, unlike surgery or medication where something is being done to you from the outside. By learning these techniques, patients continue to experience lasting benefit,”

A recent study at UC San Diego using advanced brain imaging found some of the first physical evidence that mindfulness lowers pain intensity by reducing neural activity in parts of the brain associated with pain and negative emotions.

New Guideline Cautions Against Use of Medical Cannabis for Chronic Pain

By Pat Anson

One of the nation’s largest medical organizations has released a cautious new guideline that recommends against the use of medical cannabis for most patients with chronic noncancer pain. The American College of Physicians (ACP) represents over 160,000 internal medicine doctors and medical students in the United States.

The ACP’s “Best Practice Advice,” recently published in the Annals of Internal Medicine, is based on a review of medical cannabis in over three dozen randomized controlled trials and observational studies.

It urges physicians to warn patients that the harms of cannabis and cannabinoid use outweigh their potential benefits. Medical cannabis may produce small improvements in pain, function and disability, but potential harms include addiction and cognitive issues, as well as cardiovascular, gastrointestinal and pulmonary problems.

“This Best Practice Advice is important for practicing physicians when counseling our patients on the potential use of cannabis and cannabinoids to treat their chronic noncancer pain,” said Isaac Opole, MD, President of the ACP.

“As the use of cannabis for medicinal purposes grows it’s critical to open that dialogue and review the emerging evidence related to benefits and harms. We need to raise awareness and get the word out to ensure that patients have the information they need to make informed decisions.” 

The use of cannabis has steadily grown in recent years, with polls showing that nearly one in four U.S. adults have used medical or recreational cannabis at least once in the past year. Although chronic pain is the most common reason patients use medical cannabis, most have never discussed it with their physicians. Many get their information about cannabis from dispensary workers, who typically do not have any medical training.

The ACP recommends against the use of cannabis for chronic pain by young adults and adolescents, patients with substance use disorders, patients with a serious mental illness, patients who are pregnant or breastfeeding, and frail patients at risk of falling. Inhaled cannabis is not recommended for any patients.

There is some evidence that patients with painful neuropathy may benefit from using cannabis products that contain equal amounts of CBD and THC. 

“Evidence shows that in patients primarily with chronic noncancer neuropathic pain, a cannabis formulation with comparable THC–CBD ratio probably results in small improvements in pain severity (about 0.5 to 1.0 points on a zero to 10 pain scale) and function or disability (about 0.4-point improvement on the pain scale),” the ACP said.

“However, the evidence is insufficient to show benefit for other types of chronic noncancer pain. High THC–CBD ratio synthetic or purified products may result in small improvements in pain severity (about 0.5- to 1.0-point on the pain scale) but no change in overall function or disability.”

Currently, 24 states in the District of Columbia have legalized cannabis for adult recreational and medical use. It is legal for medical use only in an another 14 states. 

Research into the pain-relieving benefits of cannabis has been slow in the U.S., largely due to marijuana’s status as a Schedule 1 controlled substance, the same category as LSD and heroin. The DEA dragged its feet on implementing a request from the Biden Administration to reclassify marijuana as a Schedule 3 controlled substance that could be used for medical purposes. Rescheduling marijuana does not appear to be a priority for the Trump Administration.

There are only three cannabis-based medicines approved for use by the FDA: dronabinol and nabilone, which are used to treat nausea and loss of appetite, and a concentrated form of CBD used to control seizures from childhood epilepsy.

A German biotech company is in preliminary talks with the FDA about approving an experimental cannabis extract for chronic low back pain. A recent study in Australia found patients with chronic pain and other health conditions showed significant improvement in their quality of life, fatigue and sleep after taking cannabis oil over a one-year period. There were also small improvements in pain, anxiety and depression.