Banning 7-OH Will Ruin My Life

 By Crystal Lindell

When I got the news that 7-OH will likely be illegal in the United States within the next month, I was on a break at the new job I was able to get because of 7-OH.

I opened my texts to see a message from PNN editor Pat Anson:

“7-OH to be banned nationwide in early August according to DEA filings.”

He’s always been great at breaking news. 

When I saw the words though, I wanted to throw up. I started shaking and was overcome by a cold sweat. Then I fought back tears because I had to get back to work.  

I had to get over the shock and dissociate to get through the rest of my shift at the gas station where I work. I spent the next few hours legally selling customers cigarettes, beer, and lottery tickets. 

Then I went into my car and cried.  

7-OH has truly been a life-changing drug for me and many people I know and love.

I have intercostal neuralgia, which is nerve damage in my ribs. When you have the same thing in your face it’s called trigeminal neuralgia – which is colloquially called the “suicide disease” because so many people who have it kill themselves or want to.

As someone with the intercostal variety, I’m here to tell you that having that kind of pain in your ribs doesn’t make it any less horrible. I have long considered suicide as a potential treatment option.

For many years I was able to find some semblance of stability with a cocktail of opioid and OTC pain medications. I know how lucky I am to be among those who can still get an opioid prescription. But while the opioids have kept the suicidal-level pain at bay, they have never allowed me to actually live.

7-OH does that.

It’s not an exaggeration to say that it has given me my life back. It’s been even more effective than hydrocodone or morphine for me. It instantly treats my pain while also combating fatigue. 

Losing access to 7-OH will be devastating for me. 

I am worried I will no longer be able to work full-time, and that I will then lose the health insurance I only just got. Without work and insurance, I will be back to living below the poverty line, and relying on food pantries. 

But none of that has anything to do with why I think 7-OH should remain legal.

7-OH should remain legal because – as an adult – I should have the legal right to put whatever I want into my own body, and it is no one else’s business how I do that.

That’s it. That’s the only reason needed. Anything else is irrelevant.

This is a bodily autonomy issue. I should be the only one who controls my own body, especially my own medical decisions. 

Not to mention the fact that nicotine and alcohol are legal despite the fact that they are both very addictive and sometimes deadly. Why single 7-OH out? Especially considering how safe it is in comparison to those drugs. 

AKA Betrayal

What’s worse is the outright glee from some leaf kratom advocates, who think banning 7-OH will somehow let them be seen as the golden child.

I feel so betrayed by them. The American Kratom Association in particular pushed for this and they have made a deal with the devil. When 7-OH is banned nationwide, it’s likely that leaf kratom is next. It’s already happened in several states.

I will never again use a single kratom product from any of the companies that support the AKA.

For now, I plan to taper down and hopefully get off 7-OH without going into withdrawal. And I am going to look into different substances that may give me a similar effect. 

I’m also hopeful that the 7-OH manufacturers are working on new formulations of kratom alkaloids that will still be available after the ban. 

And I am clinging to the 1% chance that the DEA backtracks on this, as they did in 2016, after initially announcing plans to make mitragynine and 7-hydroxymitragynine illegal Schedule One drugs. 

I know we cannot count on that though.

Honestly, writing this column feels futile. I know it won’t do anything to stop the ban on 7-OH from coming. But I do feel it’s important to at least create a record of my objections. 

I want it plainly stated that a ban on 7-OH will be detrimental to my life, and to the lives of thousands of others who have found relief from this drug.

But how do I convince people to care about my life? Why do I even have to do so? Shouldn’t caring about other people’s well-being be something that comes naturally?

It’s degrading that I have to beg the world for pain relief. That I have to plead for a medication that allows me to live my life, work a job, care for my cats, love my fiancé, and aid my elderly relatives.

It disgusts and depresses me that we live in a country that would deny me those things.

Chronic Pain Made Kathie Lee Gifford Suicidal

By Crystal Lindell

Kathie Lee Gifford has revealed to People that while struggling with chronic pain, she wanted to die.

The retired singer and talk show host told the magazine that she remembers praying: "Lord, if this is all you have left for me, I want to go home.”

“I wanted to die a few times. I wasn't going to hurt myself. I wasn't going to kill myself. I just didn't want to be here — as blessed as I am," she said.

The 72-year old Gifford struggled with chronic pain due to a slew of health issues over the last couple years, including a total hip replacement. 

After that procedure, she then had to have another surgery after she fractured her hip again trying to play with her grandchildren.

There’s more. Gifford also broke her arm after rolling over it awkwardly one night. She had yet another bone break when she fell on uneven pavement. Then she realized her depth perception was off, so she had cataract surgery on her eyes.

Based on the types of injuries she had — including multiple broken bones — it sounds like she may have been struggling with accepting her aging body’s limitations.

It is crushing to realize that as our bodies age and deteriorate, we can’t do all the things we used to do when we were healthy.

Gifford said her pain made her self-isolate by staying home more, which made her remember something her late husband, NFL and broadcasting legend Frank Gifford, said before he died at age 84 in 2015.

"Frank said to me before he passed, 'When I go somewhere, I know what people are expecting from me. I want to be Frank Gifford when I go out,'" she recalled. "I want to be Kathie Lee, the person they expect. I don't want to disappoint people. But when you're in pain, it's so debilitating, and everything's a grimace.”

Indeed, as many chronic pain patients can relate, pain will turn you into a different person. It will  chip away at your personality, and all the things that you assumed made you who you were. Deciding it’s easier to just stay home and isolate themselves is an all too common reaction. 

“I've had emotional pain many times in my life, but never this chronic physical pain where you literally want to go home to Jesus," Gifford said about her darkest days.

That comparison of emotional pain to physical pain was especially interesting to read, and something I have definitely thought myself multiple times over the years. There is something about never ending physical pain that will make suicide feel almost welcome.

The way Gifford described her suicidal thoughts as a desire to “go home to Jesus” makes it seem like she gave it serious thought.

Gifford also talked about how chronic pain impacted her ability to be a grandmother, after she welcomed five grandchildren in three years.

"I couldn't carry them, I couldn't love on them, I couldn't run and play with them," she explained. "All I could do was sit there and sing and write silly songs with them."

As a chronic pain sufferer myself, it’s validating to hear that even the rich and famous are no match for the absolute hell that comes with daily pain.

You would think that having a net worth of tens of millions of dollars, as well as access to any treatment possible, would be enough to insulate them. But chronic pain will humble anyone it touches.

Gifford did say she was doing better these days, thanks to her surgeries, 6 days-a-week physical therapy, and stem cell therapy. She’s now able to run "all over the place" with her grandkids.

"They're all fantastic," she says. "I'm hoping, Lord willing, that I have many, many years with them."

Of course, many of us don’t have access to things like stem cells, physical therapy, or joint replacement surgery. Aside from how expensive all of those things are, they also require the ability to take time off work and lots of support from loved ones.

That’s why it is so inhumane for doctors and the government to withhold the one inexpensive treatment that works for many of us: opioids.  

Part of the thought process for refusing to prescribe opioids is basically that pain patients should just suck it up and deal with their pain. But even rich and famous celebrities -- with all the advantages in the world -- struggle with chronic pain.

We need to remember that chronic pain can have life-threatening consequences to our health, and it should be treated with the same urgency as heart disease, cancer or any other potentially fatal condition. 

Gifford is fortunate that she didn’t succumb to suicidal thoughts, but she also had endless resources to help her through it. The rest of us are not so lucky. Which is why we need access to treatments that actually work. 

Melatonin Can Help Reduce Chronic Pain

By Pat Anson

Many chronic pain sufferers know how beneficial a good night’s sleep can be. Restorative sleep reduces pain levels, along with fatigue, anxiety and stress.

A new study in Australia suggests that melatonin not only helps with sleep, but is just as effective at reducing chronic musculoskeletal pain as non-steroidal anti-inflammatory drugs (NSAIDs). 

The study, published in the journal PAIN, looked at health data for over 2,000 patients in 23 controlled trials who took melatonin supplements. Participants included people with low back pain, osteoarthritis and fibromyalgia, as well as those recovering from joint replacements and spinal surgeries. 

“For many patients, pain doesn’t exist in isolation and is closely tied to poor sleep,” said lead author and PhD student Kangchao Wu in the Musculoskeletal Research Hub at the University of Sydney. “Melatonin appears to target both, which makes it particularly useful for people managing chronic pain.

Using a zero to 100 pain scale, researchers say melatonin modestly reduced musculoskeletal pain by about nine points, with the most rigorous studies showing pain levels dropping nearly 10 points, a level similar to those of NSAIDs. Melatonin was not as effective in reducing post-operative pain.

Notably, researchers did not find evidence of a dose-response relationship, meaning no single “best” dose of melatonin can be recommended. 

“The level of pain relief we observed is comparable to some conventional treatments, but this does not mean melatonin should replace them,” Wu said. “Rather, it may offer a safer additional option within a broader pain management plan.”

Melatonin is a natural hormone produced by the pineal gland in the brain. During the day the pineal gland is inactive, but at night it begins to produce melatonin and helps us sleep.

Melatonin supplements are widely promoted as sleep aids. However, their role in reducing inflammation – a major contributor to chronic pain – may be just as important. Melatonin has antioxidant and anti-inflammatory properties, which may reduce the central sensitization and inflammation underlying chronic pain.

In Europe and Australia, melatonin requires a prescription, while in the United States melatonin supplements can be purchased over-the-counter.

“Melatonin is already in people’s homes, it’s inexpensive, and we know it’s safe,” says Wu. “What’s exciting is that melatonin may also help manage chronic pain, opening the door to reducing reliance on medications that come with more risks.”

Melatonin is generally well tolerated, with mild, short-term side effects such as nausea, dizziness and headaches. Melatonin is considered safe for short-term use of less than three months. 

A recent study found that adults with insomnia who used melatonin for at least a year were more likely to be diagnosed with heart failure, be hospitalized, or die from any cause. The study did not establish a cause-and-effect relationship, meaning health conditions raising the risk may have already been present. 

The ‘Skunky’ Smell of Cannabis May Help Treat Fibromyalgia

By Pat Anson

THC and CBD get all the attention, but there’s another compound in cannabis that could someday be harnessed to treat chronic pain: terpenes.

Terpenes are the aromatic compounds that give plants like lavender, sage and eucalyptus their distinctive smells. In cannabis, terpenes give the plant its “skunky” aroma.

Researchers at the University of Arizona Health Sciences have identified four terpenes in cannabis sativa that may offer a new way to treat chronic pain: geraniol, linalool, beta-caryophyllene, and alpha-humulene.

In studies on laboratory mice modeled to simulate fibromyalgia and post-operative pain, all four compounds produced substantial pain-relieving effects. Geraniol delivered the strongest results, followed by linalool, beta-caryophyllene, and alpha-humulene.

The findings, published in Pharmacological Reports, builds on previous research at the U of A that showed the pain-relieving potential of cannabis terpenes in treating inflammation and chemotherapy-induced neuropathic pain. 

“Our research is showing that terpenes are not a good option for reducing acute pain resulting from an injury, such as stubbing your toe or touching a hot stove; however, we are seeing significant reductions in pain when terpenes are used for chronic or pathological pain,” said John Streicher, PhD,  Professor of Neuroscience in the U of A College of Medicine Pharmacology. 

“This study was the first to investigate the impact of terpenes in preclinical models of fibromyalgia and post-operative pain and expand the scope of potential pain-relieving treatments using terpenes.”

Fibromyalgia is a poorly understood musculoskeletal disorder that causes widespread body aches, brain fog, chronic fatigue, and anxiety. There are only four FDA-approved drugs for fibromylagia, which many patients consider ineffective or have too many side effects.. 

“With fibromyalgia, there isn’t much understanding of what the pain state is, and there are not a lot of great options for treating it,” Streicher said. “Our findings show that terpenes may be a viable treatment option for fibromyalgia pain, which could potentially have a large impact and make a difference for an undertreated population.” 

Post-surgical pain straddles the line between short-term acute pain and chronic pain that lasts at least 30 days. When poorly treated, post-operative pain can cause physiological changes that sensitizes the body’s pain signalling system and causes other side effects.

“Opioids do a good job controlling post-surgical pain, but they can cause constipation that can increase the chances of post-surgical complications such as adhesions,” Streicher said. “We are always looking for better options, and this study suggests that terpenes could be a novel therapeutic for post-operative pain.” 

Terpenes are already used in essential oils to promote relaxation or reduce pain and inflammation. Scientists still have much to learn about their therapeutic benefits.

“Nature is incredible at making unique chemical structures, and many of these chemicals are unknowns when it comes to their abilities to aid in human health, diseases and disorders,” said said Todd Vanderah, PhD, director of the U of A’s Comprehensive Center for Pain & Addiction 

“A great current example is medication semaglutide, sold under the brand name Ozempic, which has a chemical structure that was isolated not from a plant, but from an animal that is prevalent in the Southwest, the Gila monster. These discoveries from natural products through research such as Dr. Streicher’s can result in very useful medications.”

Terpenes derived from cannabis are an essential ingredient in Exilby, a cannabis extract developed by a German biopharmaceutical company. Exilby was recently approved by European regulators as a treatment for chronic low back pain. It has also been given a Breakthrough Therapy designation by the FDA, which will speed up its development and review in the U.S.

3 Tips for Surviving Summer Heat with Chronic Pain

By Crystal Lindell

While the official summer season started June 21, here in northern Illinois it has definitely felt like summer for almost three months already.

And with summer weather comes lots of heat, humidity, and thunderstorms – all of which can be tough to deal with when you live with chronic pain.

But there are some things you can do that make surviving the hottest months of the year a little more bearable, even if your body is doing its best to make your life miserable.

1. Learn How Weather Impacts You

I can always feel when a summer thunderstorm is coming. All of my joints hurt more, and the intercostal neuralgia pain in my ribs becomes so intense that it’s difficult for me to stay upright. 

But then, when the rain finally falls, there’s a relief that often envelops my body, as though the swelling is being released.

One thing I have noticed is that when I talk to fellow chronic pain sufferers, many of them don’t even realize that their pain is flaring because storms are coming. The flare may begin when the sky is bright and clear, and the storm itself is still a few hours away.

Learning how weather impacts your body can be very helpful when it comes to predicting and navigating flare ups. Try keeping a diary, either digitally or on paper, of your pain flares. Then compare local weather patterns to the flares to see if they are storm-related. You can look up past weather patterns for your area on Weather Underground. 

When you get really confident in the patterns, you can start to look at the weekly weather forecast as a sort-of pain forecast, which can then help you better plan out your commitments. 

For example, perhaps you’ll schedule your lunch with friends when you know it’s not going to rain for a few days. Or you can reschedule your dentist appointment if you see a storm coming.

2. Embrace Rest on Sunny Days

I’m not sure how things go in the rest of the country, but here in the Midwest everyone feels the need to be as active as possible whenever the weather heats up. It’s because we spend most of the year dealing with freezing temperatures and snow.

There’s a Midwest guilt that comes over us if we ever feel like we are wasting a good weather day. It’s like we are worried that if we don’t show enough appreciation for 80 degrees, we’ll face the punishment of an early winter.

When you have chronic pain though, summer can be especially difficult to deal with. Changes in pressure and humidity can cause inflammation and increased pain, while the heat can be more difficult to tolerate.

So, even if it’s sunny outside, try to remember that rest is both helpful and necessary. It’s good to “waste” a sunny day inside with air conditioning, if that’s what you need to feel your best. 

3. Wear Compression Socks

Personally, I’m a fan of compression socks all year round, but when the temperatures get past about 75 degrees Fahrenheit, they become a staple in my outfits.

Heat is one of the main causes of fluid buildup in your ankles, which in turn causes swelling. It’s more likely to happen if you have certain health conditions, or take medications like gabapentin and NSAIDs.

Compression socks can make a world of difference, by reducing the amount of swelling you’ll experience on the days when you need to be on your feet more or when it’s just especially hot outside.

Plus, keeping your foot and ankle swelling down with compression socks also makes the recovery cycle easier to get ahead of. The less swelling you have, the faster it will go away.

Summertime isn’t always a day at the beach for chronic pain patients, but with a little bit of planning and a few accommodations, it can still offer lots of fun!

What tips do you use to survive the hot summer months? Is your pain better or worse when the weather heats up? We’d love to hear from you in the comments below!

Tiny Injectable Implant Could Revolutionize Neuromodulation

By Pat Anson

Scientists in Abu Dhabi have developed a tiny neuromodulation device that can treat chronic nerve pain without the need for invasive surgery. 

The experimental device is so small – about the size of a small seed – that it can be injected into the body with a standard needle. It is powered wirelessly from outside the body, allowing doctors or patients to adjust its neuromodulation levels in real time.

“This work represents a shift in how we think about treating nerve-related conditions,” said Khalil Ramadi, PhD, an Assistant Professor of Bioengineering at NYU Abu Dhabi and senior author of a research paper published in Science Advances. 

“By creating a device that can be injected rather than surgically implanted, we are making these therapies simpler, safer, and more accessible, while still maintaining precise control over nerve activity.”

Current neuromodulation methods, such as spinal cord stimulation and transcutaneous electrical nerve stimulation (TENS), have their limits. 

TENS units are not invasive and easy to operate, but can cause uncomfortable tingling sensations for patients. They also stimulate a wide area, activating nerves and muscles that don’t need treatment. 

Spinal cord stimulators require invasive surgeries near the spine, and come with implanted wires and batteries that can malfunction, need replacement, and cause infections.

Because the SEED (Stimulating Electrode for Electroceutical Delivery) implant is injected, it can be placed and tracked with standard medical imaging, such as ultrasound and CT scans, allowing it to target a specific nerve. 

Once implanted, it delivers mild electric signals that can be programmed and tailored for each individual patient. Power for the device is delivered wirelessly from an external battery that can be worn on the wrist.

SCIENCE ADVANCES

The SEED device is in the preclinical stage and has only been tested on the peripheral nerves of laboratory rats. Researchers say the device demonstrated precise control over nerve stimulation and performed consistently.

“This technology has the potential to bridge the gap between non-invasive therapies and traditional implants,” said first author Mohamed Elsherif, PhD, Research Associate at NYU Abu Dhabi. “It opens the door to treatments that are both effective and easy to deliver, which could significantly improve patient care.”

The SEED implant will likely need to be tested on larger animals, such as pigs or sheep, before human trials can begin. Clinical use of the device will require FDA approval and is at least 5 to 10 years away. 

Researchers at Rice University are developing a similar device – about the size of a grain of rice – to treat neuropathic pain. Like the SEED implant, the device has not been fully tested on humans.   

You Don’t Really Know What Chronic Pain Is Like Until You Have It

By Crystal Lindell

I was recently talking to two people who asked me about various pain treatments. One was an older woman and the other was a young man. 

When I mentioned kratom – because I could tell that at least one of them was desperate for help – they had two very different reactions. 

One was receptive, while the other was adamantly against it. But it may not be the ones you’d expect.The older woman immediately wanted to know more, while the young man – the much more stereotypical kratom user – was immediately against the idea.

And from their reactions, I could immediately discern which of the two was actually suffering from chronic pain – the older woman.

Because when you have pain that never goes away, you will try anything to find relief. It’s one of the many truths I have come to learn first-hand as a long-time chronic pain sufferer myself.

In fact, there is a lot about living with chronic pain that’s difficult to understand unless you have been through it.

The way it wears you down and damages every aspect of your life. How expensive it is. How much it impacts your relationships.

The special type of despair that comes from the fear that you might never get better.

I have learned just how hard it is for someone with chronic pain just to get out of bed everyday. How much of an accomplishment that is.  

I know that my fellow chronic pain sufferers have likely struggled with doctors and pharmacists and health insurance companies. That they have tried every medication and treatment they could access. And that they have probably contemplated even the most extreme “solution.”

I know that they probably never feel truly rested, because of the way chronic pain even infects your sacred sleep.

And I know what it’s like when loved ones become much less helpful, as they have to keep helping you into eternity. How quickly they lose patience with the situation. 

Or, as French author and chronic pain sufferer Alphonse Daudet once wrote, "Pain is always new to the sufferer, but loses its originality for those around him.”

There’s a bond that comes from the unique experience of shared suffering. A special level of empathy. Which is why I have such a special place in my heart for anyone else enduring chronic pain. 

But it’s nearly impossible to fully grasp life with chronic pain from the outside. 

My theory is that our brains are not set up to process even the concept of chronic pain in the abstract, because recognizing that it could happen to us would be too devastating to accept.

People who have had acute pain, from an injury, accident or surgery, might assume they know what it would be like. But they can only understand so much.

A lot of people like to pretend that if they had chronic pain, they would somehow manage it better than you can. 

They’d yoga their way out of it, or simply go to a chiropractor. They’d be more stoic, and less tired. They would never get frustrated, and they would still do all the activities they did before the chronic pain started.

They’d be wrong though.

You never know how you’ll actually handle chronic pain until you’re enduring it. It has a way of humbling you faster than you expect. Opening you up to trying treatments you thought you’d never consider, like kratom. 

In the end, none of us are as strong as we like to pretend we are. But when we are forced to confront our own weaknesses, we do have the opportunity to see just how strong others have been the whole time.

How Neurosteroids Made Their Debut in Chronic Pain Care

By Dr. Forest Tennant and Ingrid Hollis

In 1981, some neuroscience researchers discovered a group of hormones being made in the brain and spinal cord.  Some are also made in the gonads, the primary reproductive glands. 

Initially, the scientists didn’t know why the central nervous system (CNS) produces these hormones, but they soon learned that they protect, energize, and heal CNS tissues, such as nerves and glial cells that may be injured or damaged. They also found that these hormones control pain. 

The hormones were named neurosteroids because their chemical structure resembled that of the corticosteroids, such as prednisone and hydrocortisone.

A main function of neurosteroids is to heal injured nerve tissue and relieve pain. This includes the glial cells that cause neuroinflammation, central sensitivity, and constant pain. Neurosteroids are potent anti-neuroinflammatory hormones. 

The main neurosteroids are:

• Pregnenolone

• Allopregnanolone

• Estradiol (estrogen)

• Testosterone

• Progesterone

• Nandrolone

• Dehydroepiandrosterone (DHEA)

You will note that some neurosteroids such as estrogen have biologic effects outside the spine, controlling mood, cognition and neurological health.

Neurosteroid Research

Animal research into neurosteroids is large, well done, and compelling, in that the studies clearly show that these hormones will benefit pain care. For example, rats that had their spinal cords damaged totally recovered when given neurosteroids. 

Glial cell inflammation -- which causes central pain -- was also controlled by neurosteroids, which are potent suppressors of neuroinflammation. Researchers found that if there was a tissue tear, injury or inflammation in the cells, neurosteroids immediately restored them to their normal state. 

Once the functions of neurosteroids were better understood, it was widely believed among neuroscientists that they could be a powerful therapeutic tool to treat severe chronic and intractable pain. 

Like many great scientific discoveries, the main clinical constituency didn’t know and didn’t care about these findings.  Fortunately, two clinical innovators figured out that neurosteroids can be utilized for treating two severe painful conditions: burning mouth syndrome and adhesive arachnoiditis (AA).  Treatment of the latter utilizes pregnenolone, DHEA, and palmitoylethanolamide (PEA).

The Transition from Animals to Humans 

The transition from giving a drug to laboratory animals to using them safely and effectively in humans takes a lot of time and experimentation.   Factors that have to be considered include dosage, formulation, and various combinations of neurosteroids. 

The first physician to make the transition is Dr. Susan Sklar, who has developed a neurosteroid protocol for the previously untreatable intractable pain condition known as burning mouth syndrome. 

Learning to great extent from Dr. Sklar’s success, I and my associates developed a neurosteroid protocol for adhesive arachnoiditis.  Results to date are gratifying and correlate with the therapeutic improvements seen in animal research.

In summary, neurosteroids are a group of hormones produced in the CNS that protect and heal nerve tissues.  Animal studies show they heal injured spinal cord nerves and glial cells, and suppress inflammation, regenerate tissues, and reduce pain.

Neurosteroids are not a substitute for pain treatment with opioids and neuropathic agents, but an additional resource that greatly enhances pain relief.  Experience to date should be a motivator to expand the use of neurosteroids for all intractable and chronic pain conditions.

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 its bulletins here.

Ingrid Hollis is a person in pain, patient advocate, and advisor to the Tennant Foundation.

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

I Hate When Doctors Insist on Physical Therapy for Chronic Pain

By Crystal Lindell

There is definitely an over-prescription crisis in this country, but it’s not about pills – it’s physical therapy referrals. 

While many doctors see it as an “easy” way to reduce their opioid prescribing, the only thing easy about it is how easy it is for them to write the referral and then immediately blame the patient for any lack of progress. 

In fact, I recently stumbled onto a discussion about physical therapy in the “Family Medicine” subreddit, where medical professionals, who’ve confirmed their credentials, were discussing just how much they love to push PT on patients and why. 

In the thread, a poster who claims to be a new physical therapist asked providers when they typically will prescribe it. 

A nurse practitioner responded with, "I only prescribe PT on days that end with Y." 

A physician's assistant said they prescribe physical therapy "as soon as [patients] open the door."

A medical doctor lamented, "I wish my patients took [physical therapy] more seriously because recovery for a lot of [musculoskeletal] and chronic pain takes work and they want the one shot fix."

Ironically, it really seems that it’s the doctors who are looking for a one-shot fix with their physical therapy referrals. As another doctor on the thread admits, they prescribe PT "for any pain, gait, chronic respiratory, chronic pulmonary, or weakness complaints."

As a long-time pain patient, the thread confirmed everything I assumed doctors thought about pain patients and physical therapy. But unless you’re recovering from a specific injury, like a bone break or surgery, physical therapy can be a huge waste of time and money. 

For patients, the reality is that physical therapy is a massive time commitment and a huge financial expense.

Way back before I even developed intercostal neuralgia in my ribs, I started having pain in my wrists, likely caused by years of undiagnosed Ehlers Danlos syndrome and typing for a living. The official diagnosis for me at the time was “tendonitis.”

As someone who writes for work, dealing with sudden wrist pain was causing me massive issues. There were days when the pain was so intense that I couldn’t even type up a column.

I was also younger and more naïve then, so at the time my only goal was to do everything my doctor told me to do. I genuinely believed that that was my best chance at getting better, and that he had my best interest at heart. 

So when he told me to take Advil and go to physical therapy three times a week, I happily agreed.

The only issue was that I had to miss a ton of work, use a bunch of gas to get to the appointments, pay for parking, and then also come up with the $30-per-session co-pay, which added up to almost $100 a week! Times that by four weeks, and suddenly you’re looking at a car payment, easy.

God forbid, you have a job where you can’t get time off during the limited business hours offered by physical therapists. Plus, there’s the issue of finding a babysitter if you have kids.

Maybe that’s not a lot of money to doctors, but to many patients it’s enough to put you into crushing debt and maybe even lead to you losing your job for missing too much work.

The worst part was that physical therapy did almost nothing to relieve my pain. The appointments themselves mostly consisted of the therapist massaging my wrists, which only helped in the moment. In truth, the most effective part was the wrist braces they gave me to sleep in, something my primary care doctor could have easily given me himself.

Many doctors seem to think that if a patient is “really” in pain, they will try anything to get better. And thus, if a patient is reluctant to spend a bunch of time and money on physical therapy, then the only logical conclusion is that they must be a drug-seeking junkie looking to get high.

But there’s a reason that pain medication, especially opioids, are so popular. They are known to be immediately effective, and they are very cheap compared to physical therapy. Plus, instead of forcing you to miss work, they actually allow you to go to work despite the pain.

Looking back, I do not think that I needed opioid medication for my wrist pain, so I’m not arguing for that. I’m just saying that I also did not need physical therapy. But, like many of the doctors on that Reddit thread, my physician had gotten into the habit of prescribing PT for almost anything. 

Unfortunately, that would not be the last time a doctor tried to push physical therapy onto me. It happened to me and my loved ones many times over the years. While I have seen it work for family members who had just had a major operation or an acute injury, I have rarely seen it help much with chronic pain.

Of course, there are certainly patients who have benefited from it, and physical therapy should definitely be an “easy” option for them. Unfortunately, insurance coverage of PT is often limited. My fiancé can’t get insurance to cover any more physical therapy for him, despite the fact that he does find the sessions to be beneficial for his chronic pain.

In essence, doctors will happily prescribe physical therapy, but that’s about where their concern ends. After that, you need to figure out the health insurance requirements, assuming you even have insurance. Then you have to come up with co-pays, transportation, time off work, potential babysitters, and the energy to go to PT appointments while also maintaining the rest of your responsibilities. 

That last one is something doctors often fail to consider. If you’re working one or more jobs, running a household, and trying to get through the week, adding in the time and emotional energy to go to physical therapy a few times a week can be almost impossible.

In short, there’s a long list of negative side effects that come with physical therapy. They start with the referral by your doctor. Physical therapy should not be used by them as a secret test that patients have to pass just to prove they’re not trying to score some hydrocodone. It also shouldn’t be used as a first-line treatment for patients who may greatly benefit from other treatments.

There were a couple people on that Reddit thread attempting to stick up for patients. One doctor said this: 

"To be fair, it's financially out of reach for many (most of my) patients. My low income patients can get 4 visits/year but finding a PT who can provide the low income service can be challenging. These same patients are getting a maximum income support of $1787/month (a 700 square foot basement apartment rents for about $1500/mo right now in our city, if you can find one).

Sometimes people don't make bad choices, they fail to have good choices to make."

The only problem with that response is that it still assumes that physical therapy is a “good” choice. As a patient, I’m not convinced that it is. In fact, sometimes it’s a bad one. 

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.