How Chronic Pain Kills Your Independence

By Crystal Lindell

There’s a myth that I heard a lot as a little girl. That when I grow up and become a woman, the ultimate goal should be full independence.

Or as Destiny's Child famously sang in their 2000 anthem, Independent Woman: "I depend on me / All the women, who independent / Throw your hands up at me.”

But if you have a chronic illness or chronic pain, the reality is actually: I depend on me… and my fiancé, my mom, my grandma, my siblings, and my friends.

I have Ehlers-Danlos Syndrome (EDS). It’s a connective tissue disorder that I was born with, although I was not officially diagnosed until 2018. The only reason I was diagnosed then was because five years earlier, in 2013, I developed debilitating pain in my right ribs that would later be labeled by doctors as intercostal neuralgia.

Despite living most of my life without a diagnosis, the EDS has always been there, impacting my life. I just didn’t know that it was the cause of my clumsiness — and the countless injuries, sprained ankles, and crushing fatigue.

I remember when the symptoms made my life feel impossible to handle. Like the time I sprained my ankle in college. I remember going home after a long day of hobbling on crutches around campus, and having to drag myself up a flight of stairs to my walk-up studio. 

When I finally got into bed, I remember crying myself to sleep in pain and frustration, just begging the universe for help. 

These days, I recently started working outside the home again, a cashier job at a local gas station. Because of my chronic pain, there’s absolutely no way I could manage my life independently while also working there. I need help to pull it off.

My fiancé handles so many of the day-to-day tasks required to keep me functioning. Without him doing laundry, washing dishes, cleaning the bathroom, feeding the cats, cleaning the litter boxes, doing yard work, and countless other chores, I would never have enough energy to do  my job and handle the rest of my life.

At the end of the day, we all need people like that. And when you have a chronic illness or chronic pain, you need them even more urgently.  

I don’t even get to pretend I live an independent life. A dependent life was forced on me by my broken body. 

Over the years, I have come to realize that the ultimate goal is not independence. The ultimate goal is surrounding yourself with people who you can trust to help take care of you -- and who you love enough to take care of in return.

More Non-Opioid Drugs Recommended for ER Pain Relief

By Pat Anson

Would you take an anti-depressant for back pain? 

An anti-psychotic medication for headache?

What about an anti-anxiety drug for stomach pain? 

Those are some of the non-opioid alternatives being recommended for pain relief in emergency rooms, as the healthcare industry continues to move away from using opioids.

The latest example is a study by researchers at University of California, San Francisco (UCSF), who recommend over a dozen non-opioid medications for five acute pain conditions commonly treated in emergency departments: back pain, abdominal pain, chest pain, fracture pain and headache. 

The findings are published in the Western Journal of Emergency Medicine.  

Researchers initially screened 246 clinical studies to prepare their non-opioid list, but narrowed it down to 23 of the most promising studies. First author Akash Shanmugam, a UCSF medical student, told The Guardian that the goal was to “create a very targeted list for specific pain conditions” to be utilized by ER physicians.

Many of the drugs that made the list, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are already widely used for acute pain. But some of the selections are puzzling, as they are psychotropic drugs not typically used to treat pain and are not fast-acting.

For example, the anti-psychotic drug haloperidol is recommended for both headaches and abdominal pain. Haloperidol is usually prescribed for schizophrenia or acute agitation, and is sometimes used off-label for conditions like psychosis and Tourette's syndrome.

Venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), is typically used to treat depression and anxiety, but UCSF researchers think it could be used for back pain.

Other oddities that made the non-opioid list are ketamine for chest pain, abdominal pain and headache; benzodiazepines for abdominal pain; and the anti-nausea drug metoclopramide for headaches. 

Gabapentin would have made the list of non-opioid alternatives, but researchers decided the evidence was too weak to support its use for the five conditions they evaluated.  

“Our findings hold significant implications for pain management approaches in the ED and public health efforts aiming to address the opioid epidemic. By providing alternatives to opioid prescriptions, this review supports efforts to reduce opioid overexposure in the ED while helping to manage patient pain,” researchers said.

“Encouraging the use of these alternatives aligns with broader initiatives aimed at optimizing pain management practices, improving patient outcomes, and contributing to the overall mitigation of the ED’s contribution to the opioid crisis.” 

‘Made Me Feel Worse’

But are the drugs effective for pain? Posters on Reddit are skeptical that antidepressants and anti-psychotics would be helpful.

“This is ironic because codeine does a better job of making my brain quiet than any antidepressant I've tried so far,” said one poster. “I've never developed an addiction to codeine and it's also never induced suicidal thoughts, unlike a couple of the antidepressants I've tried. It also didn't make me so physically sick that I almost went to hospital, unlike the SNRI I stopped taking.”

“Tried tons of antidepressants for pain and depression, nothing worked in fact many made me suicidal. And then had tramadol prescribed for my back pain, low dose but my depression also improved a huge amount,” wrote another.

“These types of medications have made me feel worse than anything else I’ve ever taken. If I had to choose between pain and feeling like that again, I would choose the pain. But maybe that’s what they’re after since doctors don’t like prescribing pain medicine anyway,” said another Reddit poster.

“That's just ridiculous. Antidepressants and antipsychotics are not going to do anything at all to relieve pain,” said another. “The war on drugs has gone too far.”

But researchers say there’s frequently an overlap between physical and emotional pain that justifies the use of psychotropic drugs.

“Chronic pain is often linked to things like poor sleep, depression, anxiety, fatigue,” co-author Kathy LeSaint, MD, Associate Professor of Emergency Medicine at UCSF, told The Guardian. “In chronic pain conditions, the nervous system can become highly sensitive, and it’s thought that antidepressants and antipsychotics can maybe reduce this heightened sensitivity in the brain.”

Although the risk of addiction and overdose are often cited as reasons to avoid using opioids, that risk is often exaggerated. A 2024 study found that the risk of long-term opioid use after being treated with intravenous opioids in the ER is quite low – less than two-tenths of one percent (0.19%).

That mirrors the findings of a 2017 Mayo Clinic study, which found that the risk of long-term opioid use is only 1.1% for ER patients — less than it is for patients treated in other medical settings.

Nevertheless, some pharmaceutical companies are betting that non-opioids are the future of pain relief. Eli Lilly today announced the purchase of 4E Therapeutics, a biotechnology company that’s developing MNK inhibitors, which interfere with pain signals by blocking enzymes in the peripheral nervous system. 4E is the second non-opioid drug developer to be acquired by Lilly in a little over a year.

People Who Live Without Pain Rarely Think or Care About Those Who Do

By Ann Marie Gaudon

As I crawl into bed early at night, so grateful for the bed I have, I strategically place two separate heating pads for pain relief. Simultaneously, I strategically place two ice packs for pain relief. 

What’s one to do? “A” and “B” require heat for relief, and “C” and “D” require ice for relief. 

Such is my life.

What is it like to not have pain? To just go to bed at a regular adult time, slip into your sheets, and drift off? I have no idea, and so I can only imagine this. I would have to go back at least four decades in time and I just cannot remember that far back.

It’s ironic that I am so high maintenance, but not as you might think. I couldn’t be less of a diva. The days of hair, make-up, and stylish clothes are long gone. I care nothing for those things because they don’t do anything to make me feel better. 

I putter along with regular haircuts, minimal make-up on days I can manage it, and that’s about it.

I have no fear of what any pain may or may not mean. I do not have a cascade of stress hormones flooding my system daily out of fear. That is not in my life, and is what I have achieved from a healthy dose of self-care and chronic pain management. 

What it cannot do, however, is stop a body from deteriorating, stop pain from increasing, or stop the course of disease.  

As a young person, I can assure you I never saw this coming. There are other illnesses in my family of origin, but not chronic pain as I have experienced for 40+ years.

Unfortunately, there is not a lot of help out there. Health Canada, which is the Canadian agency responsible for “helping Canadians maintain and improve their health,” claims to ensure that everyone has access to high-quality health services. 

But from all that I have read and meetings I have attended, Health Canada remains essentially clueless to the plight of a person in pain. They have always drunk the Kool-Aid of anti-opioid zealots, and believe the endless published rubbish about those medications. 

As sickening as that is (no pun intended), I was never able to find anyone with any type of power that actually was a person in pain. That’s a big problem. 

Just to be clear, this is not a column about opioids or any other type of medication. It’s about the sheer ugliness of chronic pain. For some of us, the diagnoses just keep rollin’ along. I have officially lost count. 

There are two new ones that I can tell you about. One is Baxter’s nerve entrapment, which feels like a razor sliding up into your heel with every step. For a long time, I thought it was a very stubborn case of plantar fasciitis in both feet. However, I have since learned there’s a different diagnosis entirely in my right heel. 

The second newer diagnosis is something called costochondritis. No, I hadn’t heard of it either. I thought I was having a massive heart attack when I awoke in the middle of the night in severe chest pain. I resigned myself and just felt ready to go unconscious. However, that didn’t happen. 

I was advised over the next three days to go to the emergency department, but having care-avoidant health anxiety, I refused to go. 

I was in tremendous pain and could hardly move at all, but on the third day, someone said to me that I might have pneumonia. That word is what got me to the emergency department, because I could not forgive myself if I ever infected someone else. 

It wasn’t pneumonia, it wasn’t a heart attack, and it wasn’t a pulmonary embolism. It was costochondritis, which the Mayo Clinic advises can feel much like a heart attack. Now the chest pain comes and goes.

At times I feel angry and sad for myself, but where my heart really lies is for younger people. What’s to become of the young at the beginning of their chronic pain or not quite there yet? I shudder at the thought of it. 

I recently had a young client with painful rheumatoid arthritis who was especially suffering with pain in one hip that was causing mobility issues. Practically begging her neurologist for pain relief, the response was: “No one with rheumatoid arthritis should expect to live a pain-free life.” 

They were gutted by those words. 

Is this what to expect? “Don’t expect to live a pain-free life” when there are scores of medications out there developed for just that? What is wrong with people? 

I can tell you my unscientific theory about this. People who do not live in pain rarely think or care about others that do.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 40 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.     

Tell Me Who the Real Criminals Are

By Cathy Kean 

Close your eyes. Go back to the worst pain you have ever known. A broken bone. A car wreck. Surgery. Childbirth without relief. Stay there for fifteen seconds. 

Feel the desperation. The begging. The need for it to stop.

Now imagine never leaving that place. You feel that pain every second. Every day. No break. Not in sleep. Not ever.

That is my life. Millions of us live here.

There is something that helps. Prescription opioids do not erase my pain, but they turn down the volume enough for me to be able to shower. To work. To keep my home. To hug my grand child without screaming inside.

Then they took them away. They said it was for my own good.

Before my chronic pain worsened after the release of the CDC opioid guideline, I worked as a real estate agent and special education advocate. 

Now I cannot walk. I have lost my job. My home of 32 years is in foreclosure. Friends stopped calling. I need help to use the bathroom. My independence is a corpse they are still kicking.

And the final cruelty? The people who did this lied to you.

CATHY KEAN

The Lies Behind the ‘Opioid Crisis’

You have been told prescription opioids are killing America. In 2021, the CDC reported a 1,040% increase in overdose deaths involving synthetic opioids from 2013 to 2019. They said those deaths were largely caused by illicitly manufactured fentanyl.

Here is what they didn’t tell you in that report: For many years, CDC misclassified most of those overdoses as prescription opioid deaths, and those deaths were used to help justify the agency’s 2016 opioid guideline, which led to wholesale restrictions on opioid prescribing. 

Not until 2018 was the error quietly acknowledged by four CDC researchers. And that tens of thousands of illicit fentanyl deaths were misclassified for years as prescription opioid deaths. 

The error was so serious that in 2016 alone, over 15,000 deaths caused by illicit fentanyl were mistakenly attributed to prescription opioids. Millions of Americans were misled by these and other errors that inflated the overdose numbers.

The White House told you prescription painkillers were the enemy. The media screamed it. Meanwhile, the real causes – illicit fentanyl, heroin and methadone – were hidden inside the CDC's overdose numbers.

The Death Toll They Won't Count

Because of the CDC guideline, thousands of chronic pain patients killed themselves. 

Not because they wanted to die, but because they could no longer get the prescription opioids that made life bearable. The pain became more than they could endure. And suicide offered a way out.

Others died slowly. From heart failure. Stroke. Organ collapse. The brutal physics of untreated pain grinding a body into dust.

No one in power keeps track of those deaths or says a word about them. No government agency. No major news outlet. No one with a microphone stands up and says, "We made a mistake. We are killing innocent people."

Instead, they push Suboxone and “alternative treatments.” For money. Not thy fellow man.

We have lost our First Amendment rights in the doctor's office. If you speak up about your pain, you are labeled a drug seeker and abandoned as a patient. I would rather die at home than face contempt again in the ER.

What I Want You to Do

Now imagine those 15 seconds of the worst pain you’ve ever felt. Really do them. Feel that pain.

Could you live like that? For one week? One year?

I am not asking for your pity. I am demanding your understanding. Your voice. Your outrage.

We are not criminals. We are not drug seekers. We are not addicts. We are not statistics on a CDC spreadsheet.

We are mothers and fathers. Veterans who served you. Construction workers who built your cities. Nurses who held your hand. Grandparents who babysat your children.

And we are dying. Some by suicide. And some by the slow, grinding destruction of our lives and bodies.

So here is what I need from you:

Do not look away. Say our names. Help us get our lives back.

Because if you could spend fifteen seconds in my body — really spent them — you would not need to be asked twice. You would be screaming with us.

Cathy Kean lives in California. She is a grandmother of 9 and mother of 4. Cathy lives with intractable pain from a botched surgery, along with fibromyalgia, arachnoiditis, stiff person syndrome, lupus, Parkinson's disease and insomnia. 

Cathy is the creator and administrator of the Facebook pages Chronic Illness Awareness and Advocacy Coalition and Pain is Pain. She writes to give a voice to the millions of chronic pain patients who have been silenced, stigmatized, and left to suffer—and to ensure her grandchildren never have to ask why Grandma couldn't be there. 

Chronic Pain Shouldn’t Be Diagnosed With Brain Scans

By Jan Vollert

In 2006, Carl Koch sued his employer for damages after burn injuries during a workplace accident left him with chronic pain. The employer accused him of malingering, so the judge admitted a neuroscientist as an expert witness, who testified that he could see Koch’s pain on a brain scan. The case was settled for more than ten times the amount the employer initially offered.

This case is not unusual, as chronic pain can be severely debilitating. It can make it impossible to work, exercise and have a social life. It can make you depressed and anxious.

Having pain recognised by insurers, employers and government agencies can mean the difference between receiving benefits and being left without support. So it’s understandable that a judge wants to see objective evidence, such as a brain scan, showing chronic pain.

The problem is that it doesn’t work. However, as Koch’s case shows, it is used anyway. Good for Mr. Koch, in this case, but what if the neuroscientist had told the judge that he is faking his pain?

Who Is Believed?

Chronic pain is invisible, and everyone living with it has stories to tell about the time someone did not believe them: employers, friends, family, partners and doctors. Is it really that bad? Are you sure it’s not just in your head? Have you tried to toughen up a bit?

Who we believe and who faces more scepticism is not random either: women, people of colour, poor people and the less educated are far less likely to be believed that their pain is real. The cruelty is doubled as these are the groups most likely to experience chronic pain in the first place.

With modern brain scanners and AI, it seems tempting to develop what is effectively a pain-lie detector test. The pictures brain scanners show have been too complex to fully understand before, but AI can often solve such problems of complexity. Two studies published in Nature Neuroscience and Nature Medicine seemed to promise to be a first step towards a pain lie detector.

In the US, AI tools are already used to decide who should be prescribed opioids for their pain and who is probably an addict pretending to be in pain. An article in the technology magazine Wired uncovered how flawed the system was, and that it had a tendency to distrust all the groups mentioned above.

This is a problem with AI: even when it seems to work, it does not tell you how. This makes it dangerous to put too much confidence in it.

There can be no such thing as a pain lie detector for the same reasons that regular lie detectors do not measure if you lie; they measure if you are nervous – but you might be nervous telling the truth in a high-stakes situation.

It is similar for measuring pain. Pain causes distress, so any brain pattern of pain will also be a pattern of stress – and often anxiety. We cannot factor that into our pain lie detector: when we develop it, it will be with curious participants volunteering for a scientific study (not very stressful).

When we use it, it will be for the patient who has been disbelieved for years and knows if the scan does not “prove” their pain, no one will ever believe them, and they will not get compensation or benefits (as stressful as it gets). It will always be a catch-22, as explained in The Conversation in 2025.

A Private Experience

Pain is a personal and very private experience. It depends on your history with it, and on the context, meaning everyone’s pain is different, and your pain today can be different from your pain tomorrow. Some pain can even be pleasurable – spicy food being an obvious everyday example. This means that your brain scan of pain may look very different from mine. Until we have measured both, we cannot know.

It is for these reasons that the International Association for the Study of Pain has stated that pain lie detectors are useless. In a new article in Nature Neuroscience, my colleagues and I discuss technical and fundamental problems with the idea and ask the scientific community to abandon the idea.

So what does this mean for you? If someone tells you about their chronic pain, put all scepticism aside. Remember that most forms of chronic pain are invisible. Back pain, for example, is the biggest cause of disability worldwide, according to the World Health Organization, and a physical cause can rarely be found.

Keep in mind that machines make mistakes as well, and that they have the same stereotypes as we do. That is especially true for AI.

A pain scan will not tell us who is suffering and who is lying. But it may tell us something else: how easily we mistake technological confidence for truth. In medicine, insurance and law, that mistake could make already invisible pain even harder to prove – and easier to dismiss.

Jan Vollert, PhD, is chronic pain researcher and lecturer at the University of Exeter.

This article originally appeared in The Conversation and is republished with permission.  

A Letter to My Younger Self on Living With Chronic Pain

By Crystal Lindell

This is a letter to myself. A letter I wish I had been able to write 13 years ago, when I first developed chronic pain at age 29. Hopefully, my fellow chronic pain survivors will find practical advice mixed with some hope in the words below.  

Dear Crystal,

I have some bad news. The pain you have in your ribs is not going to go away. 

It’s going to linger and spike, and sometimes it will make you want to slit your wrists in the bathtub. It’s going to completely change your entire life. 

In fact, the stabbing pain you’re now dealing with is going to alter your very soul.

Your entire life is going to change so dramatically, that 13 years later, it’ll be difficult for me to even put myself back in your shoes.

While I vividly remember the hopelessness, confusion and fear that’s crushing you right now, it’s difficult for me today, at age 42, to even remember your world view in 2013.

So much of what you think about the world around you, the people in it, and even of yourself is going to change. That change is going to be forced onto you by this new physical pain, which in 2026 will still have no cure. 

However, over time, and through lots of trial and error, you will eventually find a medication regime that mostly works for you. You will also finally find a doctor who believes you, and treats your pain as seriously as it demands.

There is so much other good stuff in store for you too. I promise. 

I know the concept of “good stuff” feels impossible right now, but I swear that good things will happen to you in the years to come. And so many of those good things will only happen because of the very pain that currently feels like it’s ruining your life.

For starters, the pain you’re feeling is eventually going to lead you to the love of your life.

Yes, I know you’re currently dating someone. But he is not the love of your life. Over the next few years, as your body betrays you, he will do the same. 

I know that since he is more than a decade older than you, you expect to help him through his health problems as he ages – but he is not expecting the same in return. He does not like that you now have a chronic illness, and he does not want to take care of you. He will even say this to you directly at one point. 

He is very selfish. But you’ll linger with him longer than you should because even selfish support feels like support with everything else that you’re going through. It’s ok. You’ll need time to process the loss of him in your life. And you need to play it all out – so that when you do finally meet your true love, you’ll understand what makes him so important.

The two of you will meet at a political event. You’ll both be there to advocate for pain patients to have better access to opioids. That’s right, the love of your life has chronic pain too. It’s the kind of double bad luck that almost cancels out, when you realize that it’s the very thing that brings the two of you into each other’s lives in the first place.

He’s handsome, he’s funny, and best of all, he doesn’t mind taking care of you for the rest of his life. 

You’re also going to move. And I don’t mean across town.  

Eventually you will realize that living with family is the only way you can endure all of this. But that is something you’ve already begun to realize. It will take you less than six months to decide to move in with your mom.

Yes, this means losing your part-time job as a youth leader that you love so much. It will be a heartbreaking loss. A loss you don’t deserve. There is not much good to say about this loss, other than the fact that you will survive it. And through that loss, your ability to empathize will expand. 

And while you will be able to maintain your career and even your current full-time job for the next nine years, eventually you will lose that too. That loss is only partly because of the chronic pain though. It’s more because of the burn out, which the chronic pain doesn’t exactly help with.

But it’s ok. You will still find other ways to write, and even ways to get paid a little to do it. And you will be happier without your former corporate overlords making you so miserable.

Plus, writing about all of your experiences will help countless people endure their own chronic pain. Many of them will even reach out to you to thank you for the many ways you helped them cope. Your pain will go out into the world and make it a slightly better place.

Also, in a few years, you’re going to get a cat. And that cat will lead to three more cats. I know, I know. It sounds impossible right now, but for some reason your cat allergies will fade, and those cats will eventually come to help you get through the especially bad pain flares.

For now, my most practical advice is to talk to your doctor about a prescription sleeping pill so that you can finally get some real rest. He will give it to you, I promise. 

Also, remember that doctors are not gods. They will get a lot of stuff wrong in the years to come, and you’re going to have to advocate for yourself if you want to survive. The confidence to do that will come to you first as a necessity, and then as something that’s part of your very being. You’ll wonder how you ever navigated the world without it.

One last thing – and this is especially important – I really need you to keep going. 

I need you to survive each long day – and each even longer night – so that we can make it to 2026. I need you to stay alive long enough to start to see that even a life with debilitating chronic pain is worth living. Because it very much is.

I wish that I was writing to tell you that your pain will be cured, and that everything will go back to how it was before your ribs started to feel like someone was stabbing them with a butcher knife every night.

But I really believe that your actual future is even better. Nothing goes back to the way it was before the pain started. And that’s the very best part.

Inflation Is Especially Hard on Chronic Pain Patients

By Crystal Lindell

These days it feels like just walking into a grocery store costs $100. And topping off your gas tank is the kind of thing you have to start a savings plan to achieve.

It’s not your imagination. Everything has gotten outrageously more expensive, and it’s only getting worse.

According to a recent PBS article, overall food prices are up 3.2% in the last year, with foods like beef (+15%), coffee (+18.5%), and fresh tomatoes (+40%) rising even more.

Gas prices have soared to a nationwide average of $4.49 a gallon – up from $2.98 just before the Iran war began at the end of February.

Rent and utilities are also going up, and consumer confidence is so gloomy that two-thirds of Americans are cutting back on spending.

There seems to be no aspect of life where people can catch a break financially these days, but it’s especially difficult for chronic pain patients.

Many of us live on fixed incomes, and rely on aid programs like food stamps and Medicaid.

Unfortunately, the government is not increasing the amount of money recipients get from those programs to account for inflation. So as prices go up, the only choice is to live on less.

Of course, it’s not really a choice, because many patients are already living on a bare bones budget to begin with. You can’t shift down by going to a food pantry if you’ve already been going to a food pantry for the last three years.  

So what actually happens is that we end up cutting back on essentials. We’re eating less, moving in with relatives to save money, and never turn on the A/C to keep the electric bill down. 

There’s also the fact that patients have ongoing medical expenses to contend with, like prescriptions, insurance premiums, and co-pays. Those have all increased as well.

Those of us who are able to work can’t physically endure working more hours or taking a second job to help with the constant price increases.

It also means that we have less money for the types of services that are considered a “convenience” by healthy people, but are necessities when you have a chronic illness and can’t get around well. Things like grocery and restaurant delivery services become extravagances.

On the other side of that, jobs with DoorDash and Uber used to be good side gigs, because you can choose your own hours, and take a day off when you’re having a pain flare.

I personally spent the last year earning extra cash that way, but had to give it up when gas prices spiked because DoorDash refused to increase driver pay to cover the higher cost. It was costing me more to make deliveries than I was earning. 

With all the constant financial pressure, it just feels important to lay everything out in one place, and to validate what many patients are struggling with these days. 

When you’re already dealing with chronic pain that makes it painful to live, it’s easy for the whole situation to make you feel depressed, despondent, and lose hope. 

Making it worse is that there doesn’t seem to be any sort of path or plan to make any of this better. Sure, maybe gas prices will inch down a few cents, and maybe you’ll be able to find a good two-for-one deal on beans at the grocery store. 

But in the grand scheme of things, when your health is bad and your financial health is worse, it’s difficult to keep going.

But keep going is exactly what you need to do. Because if you’re still here, then the world still needs you in it. And you have no idea how much you may be helping others to endure all this as well.

Maybe one day, the government will finally start working for the people again, and we can start to dig our way out of this. Crazier things have happened.

What If Medical Marijuana Was Free?

By Pat Anson

Chronic pain patients in the U.S. who are curious about trying medical marijuana are often turned off by the cost. Depending on where they live and how much legal marijuana is taxed, an ounce of medium-quality cannabis costs about $250; a one-ounce tincture bottle can cost up to $80; and a package of edibles might range from $20 to as high as $60.

Consulting with a doctor and getting a prescription for medical marijuana costs $40 to $150, and getting a medical marijuana card from your state could be another $100.  

All of these are out-of-pocket expenses, since health insurers don’t cover cannabis, although that could be changing now that the DEA has reclassified medical marijuana as a Schedule 3 controlled substance, which allows for some medical use. That opens the door to insurance coverage, but private insurers, Medicare and Medicaid have yet to take that step. 

In short, medical marijuana is currently out of reach financially for many patients.

But imagine if it was free. Would pain sufferers benefit if the cost of cannabis was no longer an issue?

The short answer is yes, according to a small new study in the Cureus Journal of Medical Science.

Researchers at the University of Pennsylvania’s Perelman School of Medicine found 29 patients with long-term chronic pain who wanted to reduce their opioid use and try medical marijuana, but considered cost a “major barrier.” With advice from a medical cannabis pharmacist, patients selected from a variety of no-cost cannabis products and started on a personalized opioid tapering plan.

“To our knowledge, this is the first prospective study evaluating whether medical cannabis can be used as an alternative to opioids in patients with chronic pain for whom cost has been a primary barrier to access,” wrote lead author Franklin Caldera, DO, who specializes in Physical Medicine and Rehabilitation at Hospital of the University of Pennsylvania.

At the start of the study, the average daily dose of opioids for participants was 46.8 morphine milligram equivalents (MMEs). Most had been taking opioids for over a decade to treat chronic back pain caused by degenerative disc disease or lumbar radiculopathy.

After five weeks of daily medical marijuana use, the average pain score for patients fell from 7 (on the zero to 10 pain scale), to a little less than 6 – a 16% reduction. Participants also reported improvements in their physical functioning, fatigue, general health, social functioning, and emotional well-being.

Even more impressively, patients reduced their average daily opioid dose to 16.2 MME – a 65% reduction. Seven participants were able to completely discontinue opioid therapy. Researchers say the reductions were sustained after a five month follow-up period.

“The findings of this study add to the growing body of literature supporting the safety profile and potential therapeutic role of cannabis. These data may help inform future considerations regarding reclassification, which could reduce financial barriers to access and help destigmatize its use for pain management and other medical indications,” said Caldera. 

“When used under appropriate medical supervision, medical cannabis may represent an effective adjunctive strategy for reducing opioid use among patients receiving long-term opioid therapy.” 

An obvious weakness of the study is its small size. Participants also wanted to reduce or stop their opioid use, which may have influenced the results.

We know nothing about the dose or type of medical marijuana they consumed, since patients selected their own cannabis products, the dose, and frequency of use. Without a standardized dose and method of delivery, we don’t know whether vaping or smoking were more effective, or if tinctures provided better pain relief than edibles. That’s unfortunate.

Previous studies have found that medical cannabis can help reduce the use of opioids and other medications. A recent survey of over 3,500 cannabis users in Germany found that most were able to reduce their use of painkillers, sleep medications, anti-depressants and other prescription drugs once they started using medical cannabis.

A similar survey of medical cannabis users in Florida found that many who have chronic pain were able to reduce or stop their use of opioids. Patients also reported less pain, and better physical and social functioning.  

Managing Expectations Is Often Key to Chronic Pain Treatment

By Chris Seenan

In a 2026 study I conducted with colleagues on people with peripheral arterial disease, one participant described how leg pain had disrupted his golf for years. It forced him to stop mid-round, shake his leg and apologise to his playing partners while he waited for the pain to pass. He found it mortifying. 

Then he tried a small electrical device that delivered gentle pulses through pads stuck to his skin. He still had pain. But he could get round the course.

When we measured his walking on a treadmill, we found no improvement. He had not noticed. That was not the outcome that mattered to him. Before the study ended, he had already gone out and ordered his own device.

A different participant reached the opposite conclusion. The pain was still there when he used the device, he said. It had not done him any good. And he was right, in a narrow sense. The device had not eliminated his pain. 

What it had done was reduce its intensity and delay its onset, allowing him to walk measurably further. His expectation of complete relief meant that genuine, partial relief felt like failure. He concluded the treatment did not work.

The study did not tell a simple story of success or failure. For some participants, standard treadmill measures did not capture what had changed in daily life. For others, measurable improvements still failed to feel meaningful because they fell short of what the person had hoped for. 

The difference was not only the treatment, or the severity of their condition. It was what each person had been led to expect.

Recognising Relief

Both men were living with peripheral arterial disease, a condition caused by a build-up of fatty deposits inside the arteries that supply the legs. It affects an estimated 236 million people worldwide. 

Its hallmark symptom is a cramping pain in the calf during walking that eases with rest. Over time, it can shrink a person’s world, limiting independence and increasing the risk of serious cardiovascular problems.

The recommended first-line treatment is supervised exercise therapy: structured exercise sessions led by trained professionals. But in many countries, access to supervised exercise therapy remains patchy and under-resourced. That gap is fertile territory for the wellness market.

Transcutaneous electrical nerve stimulation (TENS) delivers small electrical impulses through electrode pads on the skin to interfere with pain signals travelling to the brain. There is evidence that it can help with some kinds of pain, and it is used in hospital pain management settings. It is not a wellness product. 

In our study, we explored what happened when people with peripheral arterial disease used TENS independently at home, outside the controlled conditions of a clinical trial.

The findings point to something standard clinical tests rarely capture. Expectation can shape whether useful relief is recognised as useful.

That finding matters well beyond this particular device or condition. The global wellness industry is worth over a trillion dollars and operates with minimal regulatory oversight. People living with painful long-term conditions are among its most heavily targeted consumers. 

Companies sell electrical stimulation devices, supplements and wearable gadgets to people in chronic pain, using influencer testimonials in place of evidence and social media algorithms to reach people who are frightened, frustrated or in pain.

When a product fails to deliver the transformation it promised, patients rarely conclude they were misled. They conclude that nothing can help them. In conditions where reduced physical activity carries real health consequences, that conclusion is not merely disappointing. It is dangerous.

Poor Communication Hinders Treatment 

This is where the study speaks to a much wider problem. Whether a person is using a clinical device, a wearable gadget or a supplement sold online, they are often asked to judge it against expectations they did not set for themselves. Even legitimate, clinically tested treatments can be undermined by poor communication about what to expect.

The golfer’s experience illustrates this clearly. He valued an outcome that no clinical trial had thought to measure: the ability to play a round of golf without humiliation. Once he understood the device could offer that, it worked for him. His fellow participant was never given the chance to find his equivalent.

A market built around selling hope is poorly equipped for that kind of honesty. But the same danger can appear even when the person giving advice has medical credentials.

Research shows that even medically qualified doctors who become prominent wellness influencers on social media are subject to many of the same pressures as their unqualified counterparts: to build a personal brand, produce content constantly, stand out from competitors and make advice sound more certain than it really is. 

Having a medical degree does not make someone’s Instagram post better at managing a patient’s expectations. It just makes it more convincing.

What actually helps requires something platforms cannot provide: time, a genuine clinical relationship and communication that is not contingent on making a sale. 

It requires asking a patient not just whether their pain has reduced, but what they were hoping to do that pain had been stopping them from doing. It requires explaining that partial relief is still relief and that the outcome worth measuring might not be the one on the form.

That kind of honesty does not feature in any influencer’s discount code, medical degree or otherwise. But for the person who just wants to get round the golf course, it might be the most important part of the treatment.

Chris Seenan, PhD, Senior Lecturer in Physiotherapy at the University of Stirling 

His research focuses on the lived experiences of people with long-term conditions, particularly Peripheral Arterial Disease (PAD), Diabetes, and Chronic Pain. 

This article originally appeared in The Conversation and is republished with permission.  

What Is the Worst Pain Imaginable?

By Dr. Forest Tennant

In the 1970’s, when I first started treating intractable pain, my first cases were the bone pain of metastatic cancer, usually melanoma, breast, or prostate cancer. In those days, chemotherapy and radiation were just hopeful treatments, so pain management with opioids was essential. 

Interestingly, a second group of patients that I treated had post-polio neuropathies – not unlike today’s neuropathies of HIV and Covid.

A third group had adhesive arachnoiditis (AA), which can be caused by the toxic dyes used in myelograms during epidural injections.

Clinically, the patients with AA had pain as severe as the bone cancer patients. This was a revolutionary finding since, in those days, metastatic bone cancer pain was believed to be the “worst” pain imaginable. Left untreated, persons afflicted with AA suffered the severest of pain, debilitation, wasting, a bed-bound state, and premature death.

Other pain conditions thought to be the “worst” include small fiber neuropathy, late-stage degenerative arthritis, Complex Regional Pain Syndrome (CRPS), trigeminal neuralgia, and Ehlers-Danlos Syndrome (EDS).

Today, most pain patients are dumped into a waste basket with only the diagnosis of “chronic pain” and given some assembly line symptomatic treatment.

Few pain clinics even attempt to determine the underlying cause of pain. Fibromyalgia is treated the same as AA or pudendal neuropathy. Dosages of opioids and other pain relievers are based on a pain scale, rather than a determination as to the underlying disease. 

This sorry state has led some doctors to believe they will be prosecuted if they prescribe even low potency Norco for AA or CRPS. Another unfortunate consequence is that many parties now automatically view a “pain patient” as an addict with opioid use disorder.

Why AA Is So Painful 

AA pain will occur when a spinal nerve is damaged and prohibits the normal flow of bioelectricity. Consequently, bioelectricity will accumulate around the nerve damage.

The cauda equina nerve roots are major carriers of bioelectricity. When they are damaged, clumped or scarred, there is substantial accumulation of bioelectricity and the pain is profound. 

To keep bioelectricity and pain under control in AA, one needs a combination of medical and physical measures to prevent bioelectricity from accumulating.

My latest book, “Building a Life With Adhesive Arachnoiditis and Stories of Hope,”  describes these new clinical protocols and measures for the treatment of AA. 

Patients, family members, and medical practitioners can all benefit from the book’s information on this rare disease. Included are chapters on medical management, pain control, restorative measures, physical therapies, and electromedical administration. 

Stories from patients are also included in the book, not only to recognize the survivorship of the patients, but to share the measures they took to “build a life” with adhesive arachnoiditis. 

Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis. Readers interested in learning more about his research should visit the Tennant Foundation’s website, Arachnoiditis Hope. You can subscribe to his research bulletins here.   

The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section. 

We Need To Talk About Suicide Risk From Untreated Chronic Pain

By Neen Monty

Doctors, policymakers, journalists, and pain experts endlessly warn about the risk of overdose from long term opioid therapy.

But almost nobody talks about the risk of suicide from untreated pain.

Why is this being ignored? Swept under the rug?

Refusing to treat severe pain is not a neutral decision. It is not “playing it safe.” It is not “erring on the side of caution.”

It is a clinical decision that elevates one small risk, while pretending the other barely exists. 

Even when that risk is significantly larger, and not even remotely comparable.

Let’s look at the actual numbers. The annual overdose death rate for chronic pain patients prescribed long-term opioid therapy is estimated at:

• 0.017% to 0.256% per year

• Around 0.014% annually at lower doses

• Roughly 0.25% annually at high doses (>100 MME/day)

• Roughtly 0.75% annually at very high doses (>200 MME/day)

Look at those numbers. Take them in. Understand how small that risk is.

And those numbers are from recent, large scale, well designed studies. That is what the evidence says. Not the rhetoric.

Yet overdose risk is the only risk anyone talks about. The risk used to justify forced tapers. The risk used to deny prescriptions. The risk used to terrify doctors into abandoning pain patients.

Now let’s compare it to the suicide risk associated with chronic pain.

Studies suggest:

• 5–14% of chronic pain patients attempt suicide

• Chronic pain patients have a suicide risk 2–3 times higher than the general population

• Around 9% of all suicides in the United States involve chronic pain

Take a good look.

It’s not 0.014 percent. Or 0.25 percent.

It’s five to fourteen percent.

Unlike the overdose rhetoric, this is not a theoretical or hypothetical “what if.”

And the suicide numbers are going up, as more and more people are force tapered off their opioid pain medications.

The cruel irony is that the pain management providers often treat opioid overdose as the worst possible outcome, while treating suicide is an unfortunate but unrelated side issue.

But uncontrolled pain is devastating. It destroys lives.

This is not hard to understand. Think about the worst pain you’ve ever experienced. Now, imagine it did not go away. Imagine you have to live with it every single day for the rest of your life. How long could you handle that?

Uncontrolled pain causes:

• hopelessness

• isolation

• sleep deprivation

• loss of identity

• financial collapse

• disability

• relationship breakdown

• depression

• fear of the future

And if a person expresses any of these fears, they are often deemed as “catastrophising.” The psychological harm caused by uncontrolled pain is substituted as the cause of that pain.

And patients get psychological treatment, when what they really need is pain relief.

They are not the same thing. You cannot switch cause and effect and expect a good outcome. You cannot make physical pain go away with psychological therapies. 

The best you can hope for is improved coping skills. But no one can cope with 8+ pain on a daily basis.

No one.

Not for very long, anyway. Not when you know that pain is never going away. How long could you cope with that?

Eventually, for some people, it causes the desire to escape. And there is only one way to escape, when doctors refuse to treat the pain.

Not because people living with severe, untreated pain are weak. Not because they are “catastrophising.” Not because they need a mindfulness workshop or some grounding.

Because severe, relentless pain changes human psychology.

That should not be hard to understand. If you put your hand on a hot stove, your nervous system screams at you to escape. Take your hand off the stove!

What exactly do people think happens when that signal never stops?

For years? Or decades?

I know that many clinicians choose to believe this kind of pain does not exist. That no one has pain that is a constant and severe 8+. 

That is not true. That’s what we call denial. And it does a lot of patient harm.

My pain is an 8+ every day, for much of the day. My pain is not amplified by psychological issues. My pain is purely physical. I have been in pain for 20 years. If you think I haven’t learned about pain and coping skills, then you are doing me a grave disservice.

And here is the part nobody wants to say out loud:

When a clinician refuses to adequately treat severe pain, they are making a risk calculation.

They are deciding that preventing a comparatively rare overdose death is more important than preventing the far more common risk of suicide.

It makes no sense, not logically, not medically.

But it is true.

Every medical decision involves risk trade-offs. Medicine is all about risks vs benefits.

We accept bleeding risks to prevent stroke. We accept infection risks during surgery. We accept chemotherapy toxicity to treat cancer.

But somehow, in pain medicine, only one risk counts: Overdose.

Nothing else matters. Everything else disappears. The suffering disappears. The suicide risk disappears. And the patient disappears.

But the pain does not disappear.

Even worse, pain patients are often blamed for the emotional consequences of living in agony.

If they become distressed, hopeless, fearful, withdrawn, anxious or depressed, that is now framed as a psychological problem, a mental illness that requires psychotherapy, rather than an understandable and normal response to relieve their physical suffering.

Imagine applying that logic anywhere else in medicine.

An amputee becomes depressed and hopeless because they can no longer walk.

Would we respond by saying: “Have you tried reframing your thoughts?”

Or would we offer them treatment? Prosthetics? A wheelchair? The ability to regain some of what they have lost?

A person loses their hearing, and becomes depressed and hopeless because they can no longer communicate.

Would we respond by saying: “Have you tried learning about how hearing works?”

Or would we teach them lip reading and sign language, and introduce them to the deaf community?

I could list a million examples. The point is, we should treat the problem. In no other forum do we withhold treatment and offer psychological therapies that are inappropriate and ineffective, rather than treat the actual pain.

None of this means that opioids are risk-free. They are not.

Opioids can absolutely cause harm, especially when combined with sedatives, are used recklessly, or prescribed without appropriate monitoring.

But pretending that untreated pain is safer than treating with opioids is not evidence-based medicine.

It is ideology.

And the people paying the price are patients trapped in severe pain with fewer and fewer options.

Medicine loves the phrase: “First, do no harm.”

But untreated and undertreated pain is doing harm.

Patient abandonment is harmful. Forcing people to suffer while congratulating yourself for reducing opioid prescribing is harmful.

Sometimes, it is simply choosing a different kind of death for your patient. 

An earlier death.

One that happens quieter.

One that is easier to ignore.

One that can be separated from lack of treatment.

One that can be attributed to poor mental health, instead of pain.

One that leaves no scandalous headline.

One that policymakers do not have to feel responsible for.

Perhaps that is the real issue. Overdose deaths are visible, while pain patients are invisible.

So only one becomes politically inconvenient.

Neen Monty is a patient advocate in Australia who lives with rheumatoid arthritis and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), a progressive neurological disease that attacks the nerves.

Neen is dedicated to challenging misinformation and promoting access to safe, effective pain relief. For more information on chronic pain, the science, the politics and the lived experience, got to Pain Patient Advocacy Australia. You can also subscribe to Neen’s free newsletter on Substack, “Arthritic Chick on Chronic Pain.”

Does Depression Screening Work for Chronic Pain Patients?

By Crystal Lindell

For many patients with a chronic illness, every time they go to the doctor they have to fill out the infamous depression questionnaire – even if the reason for their visit has absolutely nothing to do with their mental health.

Formally known as “Patient Health Questionnaire-8 (PHQ-8),” it starts with this question:

"Over the last 2 weeks, how often have you been bothered by any of the following problems?"

It then lists things like "Little interest or pleasure in doing things" or if you are feeling tired, have trouble sleeping, or have a poor appetite.

Patients are then asked to rank their responses on a scale that goes from "Not at all" to "Nearly every day."

Over the years, I have often scored poorly on this questionnaire, which means I ranked very high for clinical depression during those times in my life. 

Looking back, I’m pretty sure what it really measured was whether I was so depressed that I just didn’t care about trying to hide anything. But regardless, I do think that when I scored high, I actually was very depressed.

However, there has long been a belief that the questions don’t work well for chronic pain patients, who often have sound physical reasons for their poor sleep, appetite, and other symptoms. This would inflate their depression scores. 

For example, "Feeling tired or having little energy" as well as "Trouble falling or staying asleep, or sleeping too much" and "Trouble concentrating on things" are all symptoms that can be greatly impacted by physical pain, regardless of your mental health.

Now, a new study claims to prove the questions are an accurate way to measure clinical depression – even in patients with chronic pain. Published in the Journal of Affective Disorders, the research analyzed how reliable the questions are for people with and without chronic pain.

In a news release about the study published by the University of Arizona, lead author Jennifer De La Rosa, PhD, discussed the motivation for her research.

"Could pain symptoms artificially inflate depression screening scores among those with chronic pain? It's a reasonable question, but it had not yet been definitively answered," said De La Rosa, who also serves as Director of Strategy at the school’s Comprehensive Center for Pain and Addiction.

"Using nationally representative population data, we rigorously evaluated this question and found no evidence to support this long-standing concern."

De La Rosa and her team analyzed data from nearly 32,000 U.S. adults who participated in the 2019 National Health Interview Survey. They found that the questionnaire achieved an excellent level of consistency for people with chronic pain and those without. They concluded that the consistency equaled reliability.

"Clinicians need to know that a positive depression screening is just as reliable in their patients with chronic pain as patients without chronic pain, and they should not hesitate to offer mental health supports to any patient with unmet mental health needs," De La Rosa said. "These conversations require sensitivity to ensure patients feel supported by these conversations rather than stigmatized.”

She also lamented that many clinical trials for depression exclude chronic pain patients. De La Rosa hopes that will change.

"This study provides robust evidence that there would be no scientific problem with including folks living with chronic pain in depression research to help develop treatments capable of meeting the needs of this uniquely underserved population," she said.

The study reinforces De La Rosa's previous research, which found that while 1 in 5 people with chronic pain have depression, more than half of those with clinically significant depression also have chronic pain.

Another recent study estimated that about 40% of chronic pain patients have clinical symptoms of depression or anxiety. The depression rate is even higher for those who have fibromyalgia or chronic pelvic pain.

Why Chronic Pain Patients Often Pretend to Be Healthy

By Crystal Lindell

Whenever I meet new people, I like to spend a little time in that magical in-between land where they don’t yet know I have chronic pain.

It’s a place that only exists in fantasy, but it lets me play pretend. 

I get to pretend that I’m just a regular person whose entire life does not revolve around my pain.  

How long I get to stay in that fantasy land with new people depends on a few factors. Namely, how often I have to see them, how effectively my medication is currently working, and how often my pain is flaring. 

Of course, because I write about my health issues online, it’s also greatly dependent on them not Googling my name.

But it’s fun while it lasts.

Look at me! I’m just a regular person! I don’t need 15 hours of recovery time after activities! Rainy days don’t render me incapable of getting out of bed! I can definitely skip sleep to get more work done!

I’m TOTALLY HEALTHY!

In essence, I’m socially masking. But instead of trying to mask my true personality to fit in, I’m trying to mask my physical pain.   

Eventually, my body always betrays my charade though, and I have to reveal at least some of my health issues. It usually happens because I have to cancel plans due to a pain flare, or because I get an injury.

Even then, I still only like to reveal small bits of information. I don’t give an entire back story and list of diagnoses right away. I only share what I need to.

I don’t have Ehlers-Danlos Syndrome, I have “a genetic condition.” I don’t have intercostal neuralgia, I have “some pain in my ribs sometimes.”

There’s a common trope that people with chronic health issues like to let it define their entire identity. Doctors often point to this as a reason why people might be claiming to be sicker than they actually are. Like it’s a fun fad.

But that’s not my experience at all. Yes, my chronic health issues do define my entire identity – but I do not like it. In fact, I hate it. 

I want to be a regular person so badly – even if it’s just in the minds of casual acquaintances. I want to be who I remember I was before I started having chronic pain. I want to be reliable, bubbly, and sober.

Of course, there’s one major downside to always trying to hide my chronic pain and my health issues from new people: It makes it that much harder for others to ask me for help.

That’s why I chose to write online about my chronic pain so openly. I want people to know that they are not alone, and I want to share things with them that have helped me survive in this broken body.

I just don’t always want that experience in real life, with real people, in real situations.

That said, over the years, I have found that when my health issues do eventually come up in-person, many people are often quick to confide that they are also hiding their own ailments, and their own need for help.

When I share my health-related secrets, theirs usually come flooding out as well. And if not theirs, then the struggles of loved ones and those they care for.

Then, once that bridge is crossed, we can commiserate. More importantly, we can share the secret ways in which we cope.

As the fantasy of being healthy dies, true friendship blooms. But that doesn’t mean the fantasy wasn’t magical while it lasted.

In the end, the truth is most people aren’t going around pretending to be sicker than they actually are. Rather, a lot of people are trying to pretend that they are healthier than they ever could be – myself included.

How Emotional Distress Makes Chronic Pain Worse

By Pat Anson

Many chronic pain sufferers bristle at the notion that pain is “all in their head” or that it has psychological origins.

They’re not going to like some recent headlines in the news:

“Chronic pain is not just in your head, but it is in your brain”

“Mental defeat can worsen chronic pain, researchers say”

“This Common Mental Disorder Has a Strange Link to Severe Chronic Pain”

“New Study Finds Link Between Difficulty Identifying Emotions and High Chronic Pain Levels”

Yikes. It’s almost like the headline writers wanted to insult pain patients, as much as they want to inform them.

I found the last headline intriguing though, if only because it introduced me to a new word: alexithymia.

Alexithymia is a personality trait characterized by difficulty in identifying or describing emotions. If someone is always “at a loss for words” and can’t express their feelings to others, it could mean they have alexithymia. 

About 10% of the population has alexithymia, which is more common in men (no surprise there), and people who have autism, post-traumatic stress, or depression.

Researchers at Johns Hopkins Medicine wondered if there was a connection between alexithymia and chronic pain. They enrolled over 1,450 people with various chronic pain conditions in a two-year study to answer a chicken-and-egg question: Does chronic pain cause alexithymia or does alexithymia make chronic pain worse? 

“Prior studies have shown that alexithymia tends to be higher in people who have chronic pain. However, we did not know whether alexithymia leads to worse pain, or whether worse pain leads to alexithymia. We also have not had a good understanding of why these two distinct processes were related,” said senior author Rachel Aaron, PhD, Associate Professor of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine.

Aaron and her colleagues had patients fill out questionnaires to see how well they identified their feelings and described their emotions. They also asked participants about their pain, anxiety and depression levels.

The research team then used statistical modeling methods to see if emotional difficulties could predict pain outcomes.

The study’s findings, recently published in the journal American Psychological Association, show that patients with higher levels of alexithymia at the start of the study developed greater psychological distress one year later. That emotional stress had a profound impact. After two years, those same patients had greater pain interference – meaning their daily functioning and quality of life were worse. 

Alternatively, researchers found that chronic pain did not predict or cause alexithymia. That supports evidence that emotional processing difficulties are a risk factor, but not a consequence of chronic pain.

“Greater difficulties identifying one’s own feelings can lead to greater symptoms of psychological distress, including symptoms of depression and anxiety,” says Aaron. “This in turn can lead to greater difficulties managing chronic pain. These findings highlight the role of considering alexithymia in psychological treatment for chronic pain, and how it might lead to psychological distress.”

Aaron led a previous study, which found that 40% of adults with chronic pain have clinical symptoms of depression or anxiety.

How do you treat alexithymia? Various types of psychotherapy can be used, such as Cognitive Behavioral Therapy (CBT) or Emotion-Focused Therapy (EFT), to help patients recognize and express their emotions in healthier ways. Creative therapies can also be used to help people express their feelings through journaling, art, music and dancing. 

There are no drugs that specifically treat alexithymia, although antidepressants and anti-anxiety medications can treat co-occurring conditions like depression or PTSD, which may help improve emotional processing. 

Physical Therapy Provides Only Modest Relief For Chronic Lower Back Pain

By Pat Anson

Physical therapy, cognitive behavioral therapy (CBT), and mindfulness are often recommended as non-pharmacological treatments for chronic lower back pain. The World Health Organization even calls them first-line treatments in a 2023 guideline for low back pain that discourages the use of most pain medications. 

But which therapy works better?

A new study, published in the Annals of Internal Medicine, found that physical therapy provides minor improvement in physical function for patients with chronic low back pain, but no change in pain intensity compared to CBT and mindfulness.

A research team led by the University of Utah enrolled 749 adults with chronic low back pain (cLBP) to compare the effectiveness of physical therapy with other non-pharmacological treatments.

Participants were randomly assigned to 8 weeks of either physical therapy or CBT. Those who did not improve were reassigned to a second treatment, either switching therapies or trying mindfulness-based care for another 8 weeks.

The physical therapy was provided by licensed therapists, while mental health care professionals provided CBT and mindfulness training. CBT is a form of psychotherapy, in which a therapist works with a patient to reduce unhelpful thinking and behavior; while mindfulness focuses on increasing awareness and acceptance of physical discomfort to minimize its impact on daily life.

After 10 weeks, participants who started with physical therapy showed a small improvement in function, while pain levels were similar between groups. After one year, no meaningful differences were seen among the second-stage treatments. 

The findings suggest physical therapy (PT) may be a reasonable first option for chronic low back pain, but switching or adding other psychological therapies may not change long-term outcomes.

“We found some benefits to PT as the first treatment offered to patients, but we could not detect subgroup differences and effect sizes were small. Our results support PT as a first-line option for cLBP and no differences in potential benefits of second-line care with mindfulness or switching for nonresponders,” researchers concluded.

The study does not mean that CBT and/or mindfulness are ineffective, just that their impact is minor. That finding is similar to another recent study of patients with chronic low back pain, which found that CBT and mindfulness reduced pain levels by about 10% after a year. 

That’s nice, but not the kind of pain relief most people are looking for. 

Chronic low back pain is the leading cause of disability worldwide. It usually begins with acute pain caused by muscle strain or musculoskeletal injuries, and becomes chronic over time when it fails to resolve. Chronic low back pain mostly affects adults of working age in lower socioeconomic groups, who often have physically demanding jobs.  

For such a common disorder, affecting about 500 million people at any given time, there is little consensus on how to treat it. 

A 2018 review in The Lancet by an international team of researchers found that cLBP is often treated with bad advice, inappropriate tests, risky surgeries and painkillers. The authors said there was limited evidence to support the use of opioids for chronic low back pain, and epidural steroid injections and acetaminophen (paracetamol) were not recommended at all.