People With Chronic Pain Are Almost Twice As Likely to Smoke

By Pat Anson 

Cigarette smoking in the U.S. has fallen dramatically over the last few decades, from 45% of the adult population in the 1960’s to less than 10% in 2024. The decline was steep and across the board for both men and women, and for every age group.

But while fewer Americans are smoking overall, the rate of decline is much slower for people with chronic pain, according to a new study.

“We know that cigarette smoking rates overall are going down, which is good,” says co-author Jessica Powers, PhD, an Assistant Professor of Psychology at the University of Kansas. “But what these results show is that the decline isn’t happening as fast for people with chronic pain. People with chronic pain are about twice as likely to smoke cigarettes and to use other types of tobacco products, including e-cigarettes, and to use multiple products together.”

Powers and her colleagues analyzed a decade of smoking data from the National Health Interview Survey, which monitors the health of the U.S. population through face-to-face interviews with 27,000 adults every year. 

Their findings, recently published in the American Journal of Preventive Medicine, show that cigarette smoking among individuals with chronic pain declined marginally from 17.7% in 2014 to 13.1% in 2023. Smoking rates actually increased among chronic pain sufferers who use e-cigarettes.

“We’re seeing a lot of data showing that those with chronic pain are much more likely to use tobacco — cigarettes, e-cigarettes and other types of nicotine or tobacco products,” Powers explained in a news release.

The 13.1% smoking rate for people living with chronic pain is almost double the 7.5% rate for people who don’t have pain. The smoking rate is even higher for people with more frequent or disabling pain.

The study did not examine why people with chronic pain are more likely to smoke, but there are two likely reasons: 

One is that smoking provides a pleasurable distraction from pain and serves as a coping mechanism. The other is that nicotine helps reduce pain signalling. 

“We know pain drives tobacco use. Tobacco has short-term pain-relieving properties, so a lot of people find it helpful in the moment, but it actually causes negative effects in the long term. Tobacco smoking can actually make pain worse,” said Powers. “People get caught in this really vicious cycle where pain is driving smoking, smoking makes the pain worse, which makes it really hard to quit.”

Previous studies have also shown a strong association between smoking and chronic pain. A large UK study in 2020 found that smoking has a long-lasting effect on pain, even after people quit. Former smokers reported higher levels of pain than people who never smoked, and their pain levels were similar to current smokers.

Studies have also found that smoking increases your chances of having some chronic pain conditions, such as degenerative disc disease, fibromyalgia, back pain, and neck pain.

Many Women Suffer from Chronic Pain After Mastectomies

By Brett Kelman and Amy Maxmen, KFF Health News

Three weeks after Sophia Bassan’s mastectomy, she felt a stabbing pain beneath her right armpit. In the following months, painful shocks radiated through her chest and back. Her body became so sensitive that at times she couldn’t wear a shirt or lift a fork to her mouth.

Bassan slept sitting up because it hurt to lie down, and she would flinch at the slightest touch.

“I remember thinking I was losing my mind,” said Bassan, 43. “One time I was in so much pain that I had to take off my top, and then my cat’s tail brushed against my back. I screamed.”

Mastectomies are lifesaving surgeries that remove a patient’s breasts to treat breast cancer, which affects 1 in 8 American women over their lifetimes, according to the American Cancer Society.

Some women also undergo mastectomies as a preventive measure after a genetic test shows they have an increased risk for breast cancer.

In the months following surgery, many women are afflicted by post-mastectomy pain syndrome, or PMPS, which spans from uncomfortable to disabling and can last years.

Yet PMPS is inconsistently diagnosed and treated, leaving women like Bassan in agony as they hunt for relief and struggle to find doctors who take their pain seriously, according to a KFF Health News review of peer-reviewed research studies and interviews with pain specialists, surgeons, patients, and patient advocates.

Another problem is that PMPS is poorly defined, which contributes to the wide range of estimates for how common it is, reaching as high as more than 50% of mastectomy patients, according to studies. Even the low-end estimates, around 10%, would amount to tens of thousands of women.

PMPS care could improve if lawmakers pass the Advancing Women’s Health Coverage Act, which was introduced in October to ensure insurance coverage after breast cancer treatment, including preventive mastectomies. 

The bill, which does not mention PMPS by name, covers complications including chronic pain. More research would help, but pain research has long been fractured across several medical specialties and, more recently, has been undermined by the administration of President Donald Trump, who last year proposed deep cuts to research funding at the National Institutes of Health. After Congress rejected those cuts earlier this year, the White House slowed the release of NIH grant money, hindering ongoing and future scientific research.

“I’ve known women who’ve had chronic pain — itching, burning, stabbing pain — for years after mastectomies,” said Kathy Steligo, an author of multiple books on breast cancer who said she has spoken with hundreds of patients. “Of all the problems, that is probably the one least talked about by surgeons.”

Four mastectomy patients interviewed by KFF Health News told similar stories. In separate interviews, patients said their presurgery consultations did not raise the possibility of post-mastectomy pain syndrome, although each said they had signed forms that may have disclosed the chance of this complication. All said that they felt blindsided by the chronic pain, and some said their doctors dismissed their symptoms.

“Women don’t know about this, and when they have complications, the doctors act like it is so rare, like they’re so baffled,” Bassan said. “But this is statistically predictable.”

Jennifer Drubin Clark, 42, struggled with pain after her mastectomy in 2018, and it worsened after reconstructive breast surgery in 2019.

But her surgeon seemed to focus only on the appearance of her breast implants, she said.

“I couldn’t play the piano. I wanted to blow-dry my hair, but I couldn’t hold my arm above my head for more than two seconds. I couldn’t hold my kids,” Clark said. “Everything made me cry.”

Pain Often Dismissed

Breast cancer survival rates have steadily increased since the 1980s thanks to improved cancer screening, genetic testing, better treatments, and a rise in mastectomy surgeries.

Post-mastectomy pain syndrome is a consequence of that success, according to recent research papers from anesthesiologists at Baylor University in Texas and surgeons in Chicago and New York. Both papers called for an increased focus on PMPS so that breast cancer patients can not only live longer but live well.

“In the past, when concern was predominantly on patient survival, this pain was often considered acceptable,” plastic surgeons Jonathan Bank and Maureen Beederman wrote in a 2021 paper, adding that mastectomies and other breast surgeries “should be considered truly successful only if patients are pain-free.”

Treatment for post-mastectomy pain has a long way to go, said anesthesiologist Sean Mackey, who leads the pain medicine division at Stanford University. Mackey said this “undertreated” condition has no consistent definition for diagnosis, no standardized screening, and no treatment approved by the Food and Drug Administration.

Even the name is a misnomer, Mackey said, since the same pain can arise among women who’ve had other procedures, including lumpectomies and lymph node surgeries.

“The condition was historically dismissed,” Mackey said. “Basically women were told: ‘You’re lucky to be alive. Some pain is expected. Suck it up and deal with it.’”

“That attitude has been slow to change,” he said.

Bank, a New York surgeon who founded a clinic focused on post-mastectomy pain, said the pain is believed to be triggered by nerves that are severed during surgery and then left that way.

The nerves can be sutured back together to minimize pain, Bank said, but most breast surgeons haven’t been trained to do this. So it is not surprising, he said, that some patients say their surgeons were dismissive of their pain after mastectomies.

“When doctors don’t have an answer or don’t know the solution, the easiest thing to do is say there is no problem,” Bank said.

PMPS has been documented among cancer patients since the 1970s. Although the condition does not have an official definition, many researchers describe it as frequent pain in the chest, shoulder, arm, or armpit lasting at least three months after surgery.

‘Angelina Jolie Effect’

Mastectomies intended to prevent breast cancer have become more common among women with elevated risks, including genetic mutations and a family history of the disease.

Bassan’s grandmother died of breast cancer when she was 40. After her father died of cancer in 2023, a genetic test showed that she was at risk. Grieving and afraid, Bassan sought a preventive mastectomy without hesitation, she said.

Bassan said she was also inspired by actor Angelina Jolie, who disclosed her own preventive mastectomy in a 2013 column in The New York Times. Her account had such a significant impact on rates of genetic testing and preventive mastectomies that medical researchers have studied what they call the “Angelina Jolie effect.”

“I was really swayed by that,” Bassan said. “She made it sound, in a way, quite effortless.”

The aftermath of Bassan’s surgery was far worse than she expected. Using a computer for hours triggered paralyzing pain, so she lost her job and has been out of work for more than a year.

Prescription pills dulled the pain but left her in a fog, she said. Desperate, she consulted with multiple doctors until one suggested a nerve stimulation machine, which provided fleeting relief.

About nine months after her mastectomy, a breast reconstruction surgery lessened Bassan’s pain, although she said it still returns in occasional waves.

Even though her surgeries were covered by insurance, Bassan estimated her pain has cost her more than $200,000 in lost wages and drained savings.

SOPHIA BASSAN

“I did not expect to pay this price to have this surgery,” Bassan said. “I don’t know if it was worth it.”

Other women have no real choice.

No ‘Gold Standard’ Solution

Jeni Golomb, 48, was diagnosed with stage 2 cancer in both breasts in 2023 and had a double mastectomy as soon as she could.

Doctors made boilerplate disclosures of possible complications, Golomb said, but she never heard the words “post-mastectomy pain syndrome” until after she had it.

Golomb now manages her chronic pain by taking 1,500 milligrams a day of gabapentin, an anti-seizure drug that can also be used to treat nerve pain. Golomb said she expects to take the drug for years. If she misses a dose, her pain comes roaring back.

“It was the worst pain I ever felt,” Golomb said. “I labored to 10 centimeters, unmedicated, with one of my children, and that was not as bad as this. It was excruciating.”

Gabapentin has proved effective at helping some mastectomy patients with stubborn pain, while others have responded to electrodes implanted in their spinal column, according to the Baylor study, published in 2024.

But that study also said there is “no current gold standard” for how to treat post-mastectomy pain and a scarcity of high-level evidence for what treatments are effective.

Baylor anesthesiologist Krishna Shah, who co-authored the report, said many patients eventually find a helpful treatment, but it often takes “a bit of trial and error” to identify what works for each.

And sometimes they never find it.

Susan Dishell, 67, said that after her 2017 mastectomy for breast cancer and reconstruction surgery, she struggled for five years with pain in both shoulders, plus a burning sensation that her medical records identified as nerve pain.

Another surgery swapped out her breast implants to erase her shoulder pain in 2022, Dishell said, but doctors warned her then that her other pain was unlikely to improve.

Since then, she has tried prescription drugs, steroid injections, CBD oil, acupuncture, physical therapy, and chiropractor treatments.

None of it worked, she said, so she stopped trying.

“I have not slept through the night since I’ve had this,” Dishell said. “But it’s OK. It’s not the most terrible price to pay to not have breast cancer.”

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

Can Hypnosis Therapy Treat Chronic Pain?

By Pat Anson

The same academic institution that helped launch a nationwide crackdown on opioid medication has a new suggestion on how to treat chronic pain: hypnosis.

Researchers at the University of Washington enrolled 127 people with moderate to severe pain from spinal cord injuries in a study to see if hypnotic cognitive therapy could reduce their pain levels. 

For one hour every week for six weeks, half the participants met with a psychologist over the telephone or online Zoom calls for instructions on how to practice self-hypnosis. The other half did not get hypnosis and served as a control group. 

Both groups continued to get “usual care” for their pain throughout the study. About 75% of them were taking opioids or another prescription pain medication. 

Patients who received hypnosis were not put into a trance, like you might see on TV or in comedy acts, but received a form of cognitive behavioral therapy. Through hypnotic suggestions, patients were told to relax, breathe deeply, and imagine themselves in a comfortable place without pain. Participants were given recordings of each therapy session, and told to listen to them daily and practice self-hypnosis three times a day.

After six weeks of hypnotic therapy, participants reported that their pain levels dropped by 19.3%. Self-reported pain continued to decrease after the sessions stopped, falling by 24.5% after 12 weeks. Nearly half (46%) said their pain improved meaningfully. There were also significant improvements in sleep and depression, compared to patients in the control group.

The study was completed four years ago, but the findings are only now being published in the journal Neurology. 

“Not only did the study show that this treatment is effective, but unlike most medications used for pain, it is a treatment with many positive side effects, like improved sleep and a greater sense of self-control,” senior author Mark Jensen, PhD, a Professor of Rehabilitation Psychology at UW, said in a press release.

 “I think that, based on the evidence, including the side-effect profile, this is the first treatment that people with chronic pain should be offered.” 

Although Jensen said hypnosis should be the “first treatment” for pain, the published study indicates otherwise. The research team called hypnosis an “adjunctive treatment” for pain – which means it should be used as a secondary treatment, alongside a primary treatment such as pain medication.

Like cognitive therapy, hypnosis helps patients stop thinking that their pain won’t go away and will only become worse.  

“Hypnosis helps patients be more open to ideas about changing their thinking and internalizing those ideas,” said first author Charles Bombardier, PhD, a psychologist and Professor of Rehabilitation Medicine at UW. 

Although there’s a certain amount of stigma about hypnosis, co-author Elena Mendoza, PhD, told The Seattle Times that hypnosis is an effective way to reduce pain and is less risky than opioids.

“Hypnosis is not about what you see on the movies. It is a clinical, therapeutic technique. We use it every day in a clinical context, and it’s working well,” said Mendoza, a Research Assistant Professor at UW who specializes in hypnosis and conducted the study’s therapy sessions. 

“We really want to give people ways to manage their pain that are nonopioids. We hope this research is a step toward that,” she said.

Professors at the University of Washington have a long history of campaigning against the use of opioids. In 2007, several helped develop Washington state’s medical guideline on the use of opioids, one of the first in the country to set dosage limits.   

Professors Jane Ballantyne, MD, Gary Franklin, MD, Mark Sullivan, MD, and David Tauben, MD, were among the original members of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group.

Ballantyne, Franklin and Tauben also helped draft the CDC’s controversial 2016 opioid guideline. Opioid prescribing nationwide has fallen in half since the guideline’s release.

When You Have Chronic Pain, Every Day Is April Fool’s Day

By Crystal Lindell

When you’re a chronic pain patient, every single day can feel like you’re the butt of an April Fool’s Day joke: 

Think your doctor will actually help you? April Fool! 

Think your insurance will cover your medical bills? April Fool! 

Think you’ll be able to get your opioid prescription filled? April Fool! 

It’s never funny when you have these experiences, but they happen all too often.

When you first start enduring chronic pain, you’re hopeful that the medical system will provide answers and solutions. But as you work your way through the system, it eventually becomes clear that many of the things you probably thought were true just… aren’t. 

Think you’ll be able to get an appointment with a specialist in the next 12 months? April Fool!

Think your doctor will continue searching for answers after all your blood work came back “normal”? April Fool!

Think your prescriptions will be affordable? April Fool!

Of course, it’s not just the medical system. Many pain sufferers quickly find out that it’s also April Fool’s Day in the non-medical areas of their life, too. 

Think your job will provide accommodations? April Fool! 

Think your friends will treat you the same after you develop chronic pain? April Fool! 

Think you’ll be able to qualify for disability? April Fool!

Not to mention just trying to exist day to day. 

Think you’ll be able to shower every day? April Fool!

Think you’ll be able to keep your house clean? April Fool!

Think you’ll still be able to work as much as you did before? April Fool!

But the thing about people living chronic pain is that we are fast learners. We’re also resilient – because we don’t have any other choice. That means even when it becomes clear that life with chronic pain is just one cruel joke after another, we still keep going. 

So when you think about it, we’re the ones who really have the last laugh after all. 

Losing My Religion: How Chronic Pain Took My Faith

By Crystal Lindell

Next week is Holy Week, but I won’t be spending any of it in church.

It hasn’t always been that way. Before I developed chronic pain in 2013, I was quite devout.

In fact, in the years right before my health issues, I was even working as a paid youth leader for a Methodist Church.

I taught teens every Sunday; regularly gave sermons to the entire church; and led annual out-of-state mission trips. I was a regular at Bible Study; on the board of a local youth ministry organization; and spent multiple nights a week at church functions.

I read the Bible and prayed every night.

At the time, I assumed nothing could shake my faith in God. I really thought that I’d be part of The Church until I died.

And back then, I would have spent almost every night leading up to Easter at some sort of church service or event.

Not this year though. In fact, not for many years.

When I developed chronic pain, I became too sick to continue working as a youth leader, so I had to quit that role. And then I had to move in with my mom an hour and half away, so I also had to find a new church.

And I did try. I attended multiple churches in multiple denominations. But being in pain all the time made getting to Sunday morning services more trouble than it was worth.

Eventually, church faded from something I did to something I used to do.

I really did grapple with the loss though.

Looking back, two things really stopped me from ever fully going back to church..

The first was that I had felt very let down by the lack of support I received when I developed health problems. There were almost no accommodations made for me at church, and I was honestly a little bitter that they were so quick to accept my resignation from my role as youth leader.

Maybe this is a selfish thing to confess, but the Church as a community felt like it had failed me. I had invested so much into the Church – but when I needed something back, I felt ignored.

It was not just the Church as a community that I could no longer abide. My faith in God Himself was also badly damaged.

And to be honest, one of the things I kept coming back to was my jealousy of Jesus dying on the cross.

My whole life I heard about His great, suffering sacrifice. It was always relayed to me as the worst possible thing anyone could ever go through. Carrying the cross, nails through his hands (or wrists depending on your historical reference), and a literal crown of thorns.

Because Jesus died in pain, we got to live.

But then I developed chronic pain. And suddenly, Jesus being in pain for a day before his death seemed enviable.

My pain had lingered for months, and eventually years. I wasn’t lucky enough to find relief through death. Instead, my body insisted on persisting despite the pain, forcing me to live in Hell while I was still on Earth.  

All of the reverence that pastors had tried to convey via the story of Jesus’ incredible suffering before his death on the cross now fell flat.

Instead of finding something worthy of worship, I was just envious.

After that, the whole idea of faith came crumbling down. I really hit a wall. A lot of people do and ask: How could a loving God allow so much suffering in the world? 

If He existed, He suddenly felt cruel to me. But then, maybe the answer was simple: He didn’t exist. 

To those who don’t have chronic pain, perhaps my reasons for eventually leaving the church and my faith sound self-centered or childish. But chronic pain changes your perspective of the world, whether you want it to or not.

It has shown me the reality of the human condition. And through sheer force of will I have used that new perspective to write about my experiences. I do it so that others, even in their worst moments, know that they are not alone.

Whatever doesn’t kill you can expand your understanding of your fellow human beings. If you are open to it, it can offer you a glimpse of a broader spectrum of what life on this cold planet is actually like.

Yes, I lost my faith, and my church. But I gained new understanding and more empathy. And maybe one day faith will find me again.

How Chronic Pain Makes Childcare Difficult

By Crystal Lindell

I can’t pick up my 21-month-old niece anymore.

Every time I give in to temptation and lift her, I hurt my back and have to take 2-3 days of rest to recover, lest I risk throwing out my back again. And that’s even if I’m just quickly lifting her out of the playpen.

It’s heartbreaking, and it’s just one small way that chronic pain makes it so difficult to care for her.

I’m not a mom, but I have loved and cared for many small children over the years, so I know first-hand just how difficult chronic pain makes childcare. Unfortunately, it’s a burden that is not often acknowledged.

The prevailing attitude tends to be that if you love a child, you should be able to push through any physical pain that you might have to care for them.

Even the companies that make things like cribs and high-chairs seem oblivious to the physical toll that caring for young children can take. As one of my friends, who herself has four children, recently told me: “Imagine lifting weights while bending over a railing and standing on your tip toes.”

No physical trainer in the world would suggest such a move. But if you want to get a baby out of a crib, and you’re even slightly below average height, it’s what you’ll have to do.

These days, my mom and I watch my niece 3-4 days a week because her parents are on overnight work schedules.

Over the last few weeks I had to stop picking her up at all. It’s not just sad because it’s the end of an era, but it’s also logistically difficult to deal with.

Anytime I need her lifted, I have to call for help and put that task on someone else. And toddlers actually need to be lifted all the time! It basically makes it impossible to watch her by myself for long periods.  

It’s just one of the ways having chronic pain impacts my ability to care for her.

Young children are, understandably, very needy. They need breakfast regardless of whether or not you’re dealing with a pain flare. They don’t care if you’re not getting enough sleep. And they want to play outside even if you’re feeling miserable.

Beyond the day-to-day, there’s also the wear and tear that caring for children does to your body. I’m pretty sure that lifting her up so often over the past few months is partly why I reached a place where my back could no longer handle it. 

Even caregivers who are healthy are likely damaging their joints by constantly picking up and holding a toddler.  

Thankfully, I live with other family members who are able to care for my niece when my body won’t allow it. But there are countless single caregivers out there who don’t have another adult around to help out when their body rebels.

It’s why community support is so important when it comes to raising children. My biggest piece of advice to all new parents is, if at all possible, to live within walking distance of someone you trust enough to watch your child.  

The physical toll of caregiving is one of the many reasons pain patients need access to pain medications. They make it possible for us work, do household chores, and help our families.

Some days, a low-dose hydrocodone is the only reason I’m able to physically endure caring for my niece. A lot of people still think people only want opioids so that they can avoid responsibility, but pain patients know the truth: We take them so that we can function.

Sadly though, even opioids can’t give me back the ability to pick up my niece again. My back just won’t allow it. But thankfully, she’s always happy to stand on a chair to give me a great big hug.

Pain and Shame: Workers With Chronic Pain Often Feel Pressured to Perform

By Beth Schinoff and Elana Feldman

Your back pain gets worse as you sit through a long meeting. Your wrist pain flares when you’re typing furiously to meet a tight deadline. During a busy shift at the grocery store, you feel a migraine coming on.

If that sounds familiar, you’ve got plenty of company. About 1 in 4 U.S. adults suffer from chronic pain. The share who say they are in chronic pain either on most days or every day in the past three months is growing: It jumped by nearly 4 percentage points to 23% of U.S. adults in 2023, up from 19% in 2019.

Chronic pain is not only hard on workers trying to do their jobs, but it also takes a toll on employers and the economy as a whole by costing an estimated US$722 billion in lost productivity each year.

As management scholars who study how people feel at work, we wanted to understand why chronic pain so often makes it impossible for employees to do their work – and even to keep their jobs.

Pushing Through the Pain

With this in mind, we teamed up with two other management researchers, Kimberly Rocheville of Creighton University and Njoke Thomas of Boston College, to conduct a study that Academy of Management Journal published online in January 2026 and will include in an upcoming print edition.

We interviewed 66 people between 2019 and 2021. All of them said that they were in chronic pain – meaning pain that lasts for at least three months. They were all U.S. workers and at least 18 years old. They lived all over the country, in relatively more urban than rural areas. Our sample was 78% women because women tend to experience more chronic pain than men and tend to be more open to talking about their pain.

This professionally diverse group included lawyers, grocery store workers, teachers, police officers and health care professionals. They experienced many different kinds of pain, such as back pain, migraines, arthritis and fibromyalgia.

We found that this wide array of workers and white-collar professionals pushed through their pain because they felt pressure to have what we call an “ideal worker body”: a body that is healthy and strong enough to do anything their job requires.

Regardless of what job they had, people described a surprisingly similar pressure to perform despite their pain. From warehouse workers to lawyers, people felt they had no choice but to walk without a limp, lift heavy things and sit still during meetings.

Many of these people felt compelled to be ideal workers who put work before everything else in their lives. Previous research has found that these expectations can harm their mental health. We found that it can harm your physical health too.

Hiding Their Pain

Because they were in chronic pain, all of the participants in our study said their body wasn’t healthy and strong enough to do everything their job required when it required them to do it.

Even though they were more than intellectually capable of doing their work, they felt ashamed that their bodies fell short. This led them to hide their pain. They took the stairs, instead of the elevator, to seem more like their co-workers who felt fine. They avoided managing their pain in ways their colleagues could see, such as by applying ice to areas of their body that were in pain.

Ironically, trying to make it seem like their bodies were ideal worsened pain for all 66 of the people we interviewed. Most of them eventually reached a point where their pain became so intolerable that they could not function at or outside of work.

Some of them ultimately had to leave their jobs and found other ones that were more compatible with their chronic pain symptoms. In a few cases, they exited the workforce entirely.

This is not unusual. Chronic pain is the leading reason for workers becoming eligible for long-term disability benefits.

Breaking the Cycle

A few of the people we interviewed told us that they managed to escape the damaging cycle of shame and pain.

Why were they able to break free?

First, they found doctors who told them their pain was real. Getting a clear diagnosis and having a medical professional recognize their physical limitations helped them understand that they could never look healthy and strong as expected, no matter how hard they tried.

This released them from the pressure of trying to do so.

Second, most of these people had employers who cared more about what they did – the work itself – and less about how their body looked and moved, even if this meant finding a new job or even changing their profession. As a result, they felt free to ask colleagues for help, stretch during meetings, use dictation software instead of typing, or keep the camera off during Zoom calls so they could lie down when their backs were aching.

They also came up with creative ways of working that were more efficient and better for their bodies. For example, an ultrasound technician told us that she learned to scan patients using both her arms instead of constantly using the same arm. A deli worker said she started using a cart to move heavy meats around the store.

Although we focused on how pressure to be strong and healthy can hurt workers with chronic pain, we believe our findings could matter to everyone – no matter their size, strength, age or employment status.

After all, it’s possible to feel social pressure to conceal aches and pain when you’re in public settings of any kind. And failing to move around when needed or take care of your body in other ways can make you vulnerable to more pain.

Beth Schinoff, PhD, is an Assistant Professor of Management in the Alfred Lerner College of Business and Economics at the University of Delaware.

Elana Feldman, PhD, is an Associate Professor of Management in the Manning School of Business at UMass Lowell and a former Visiting Scholar at Harvard Business School.

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

Why Chronic Pain Often Leads to Depression

By Jianfeng Feng, Trevor Robbins and Xiao Xiao

Chronic pain has long been known to be associated with depression.

Among adults with chronic pain, around 40% exhibit clinical symptoms of depression. But why is it that only some people with chronic pain develop depression?

Researchers have long been wondering why this happens – and what goes on in the brain. If we can answer this question, we may be able to prevent depression from developing.

Our recent article, published in Science, suggests the answer to this question does indeed lie in the brain.

To conduct our study, we analysed neuroimaging brain scans from 14,462 participants from the UK Biobank cohort. We compared the following groups of participants: people with chronic pain for at least seven years who did not have symptoms of depression, and people with chronic pain who also developed depressive symptoms.

For the latter, the depressive symptoms were present either for the entire seven-year period, or they developed after two years or four years. This enabled an analysis of the development of depression associated with chronic pain, using brain imaging.

These neuroimaging analyses revealed something surprising was taking place in the brain – specifically in a structure called the hippocampus. The hippocampus has important functions in learning and memory.

In the participants who reported chronic pain without depressive symptoms, they showed modest increases in hippocampal volume and improved memory performance. This is consistent with the brain attempting to cope with the stress of the pain.

In contrast, people experiencing both chronic pain and depression exhibited reduced hippocampal volume and impaired cognitive performance. Further analyses of these scans suggested these changes developed progressively over time. This indicates that the hippocampus may initially adapt to persistent pain, but it gradually becomes vulnerable when pain continues over long periods.

Importantly, similar patterns were observed across multiple categories of chronic pain – including back, stomach, knee and hip pain, as well as headaches. This suggests that the findings were not specific to a single type of chronic pain condition.

We then studied how these brain changes unfolded in people with chronic pain by using rodent animal models. This research found that in animals there was a similar sequence of changes in the volume of the hippocampus, accompanied by increased neural activity. Moderate improvements in cognitive functioning occurred initially, but this was then followed by anxiety-like behaviour, which later transitioned to depressive-like symptoms and poorer memory.

The hippocampus has long been known to be involved in emotional memories and is highly susceptible to chronic stress. The hippocampus’s plasticity (the ability to form new nerve cells) is known to be involved in coping with chronic stress.

Chronic stress has also been implicated in exacerbating apoptosis (nerve cell death) and suppressing adult neurogenesis – the process of producing new nerve cells in the hippocampus.

We found that a region of the hippocampus known as the dentate gyrus – one of the few areas where new brain cells continue to form in adulthood – emerged as the critical regulatory hub and the pivot for the transition from chronic pain to depression.

Early in the pain process, newly generated neurons in the dentate gyrus showed increased activity – suggesting the brain initially mounts a protective response to persistent pain. Over time, however, immune cells, known as microglia, became abnormally activated and disrupted normal neural signalling in the hippocampus.

This abnormal microglial activation appeared to mark the tipping point at which the brain’s initially protective response to pain began to fail.

Importantly, an antibiotic treatment, minocycline, suppressed abnormal microglial activation and reduced depression-like behaviour in the animal models. This treatment also preserved the structure of the hippocampus and cognitive function.

Treating Pain and Depression

Our findings suggest that a treatment such as minocycline could help prevent depression in people living with persistent pain — particularly if treatment is introduced early.

Of course, other psychosocial, socio-economic and genetic factors play a role in the perception of pain. Therefore, it’s likely that in some people these factors will exacerbate chronic stress and the experience of pain.

However, there are other evidence-based ways to reduce the risk of depression. In another collaborative study between Fudan University and the University of Cambridge, it was shown that seven healthy lifestyle factors, including good sleep, exercise and diet, could reduce the risk of depression by 57%. Importantly, these lifestyle factors were also associated with increased hippocampal volume, consistent with our new study.

Mindfulness training may be another strategy. This focuses on being present in the moment and minimising distraction from competing thoughts and memories. The practice is shown to improve working memory and increase hippocampal density.

A recent review showed that mindfulness meditation experts have increased brain grey matter, including the hippocampus. Mindfulness meditation training was also shown to lead to increased hippocampal volume.

Mindfulness practice has also been found to be beneficial for improving quality of life – not only when coping with chronic pain – and for reducing symptoms of stress and depression.

Our discovery has answered an important question that has long puzzled researchers. We showed the key role the brain’s hippocampus plays in why some chronic pain sufferers develop depression. This discovery also points to potential treatments that may prevent depression in people with chronic pain.

The brain’s coping mechanisms that we discovered may also apply more generally to other conditions where the brain has to cope with chronic stress – such as in psychological trauma.

Jianfeng Feng, PhD, is a Professor of Science and Technology for Brain-Inspired Intelligence at Fudan University.

Trevor Robbins, PhD, is a Professor of Neuroscience at the University of Cambridge.

Xiao Xiao, PhD, is an Associate Professor of Science and Technology for Brain-Inspired Intelligence at Fudan University

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

Reflecting on 13 Years of Chronic Pain

By Crystal Lindell

I first developed chronic pain in February 2013. I remember the month because it was Super Bowl weekend and I went to a party to watch the game.

That was the year they had a long blackout delay, so the game ended up running super late. I stayed until the end.

I woke up the next morning with some soreness in my right ribs, and I assumed that I must have just lifted something wrong at some point. It got so bad I went to the ER.

While I had no idea at the time, my life was changed forever that weekend.

I was 29.

Within six months I was celebrating my 30th birthday at my new place: my mom’s house.

I had moved back home, an hour and a half away from my old apartment. I quit my second job, and shifted my full-time job to mostly work-from-home.

I spent the next few years desperately seeking answers, while trying to figure out a medication regimen that actually worked for me.

I also got extremely depressed.

I watched the entire TV series House, hoping to find an episode about a patient with the same symptoms as mine. I never did.

I mostly lingered without a diagnosis.

Eventually, the doctors decided to call it “intercostal neuralgia.” But that basically just meant “rib pain.” And how it had happened or why, they had no clue. They also had no idea how to treat it beyond managing the pain.

My long-term boyfriend – the one I had been with long before I got sick -- cheated on me. We broke up.

I cried a lot. I cried because my heart was broken, but also because my body was broken. I cried because of the physical pain, and I cried because of the emotional pain.

Then, finally, on March 15, 2018, I was diagnosed with hypermobile Ehlers-Danlos Syndrome (hEDS). I remember the date because it was the Ides of March. And the day felt just as ominous to me as I imagine it was for Julius Caesar.

A moment I had long hoped for, one where I finally got some answers, instead turned to extreme grief.  

But that night, I went to a local political event in town and ran into this guy I knew named Chris. A week later we went on a date to see the movie Black Panther, and we have been together ever since.

In fact, we are celebrating our eight-year anniversary this Sunday.

At the time of my hEDS diagnosis, I was so worried that I would never find a man who could love my broken body. But within just a few hours, I was proven wrong.

Lessons Learned

Over the last 13 years of life with chronic pain, I have learned that I was wrong about a lot of things. As it turns out, pain is an extremely strict, rigid teacher. 

I used to believe the government messaging that “all opioids are always bad for you.” But these days I now advocate for patient access to opioid pain medication.

I used to think that if you told a doctor your exact symptoms, that they would be able to find out what was wrong with you and be able to fix it. 

Now I know that if you want to get treated, you have to be your own biggest advocate.

I also honestly believed that I had good health insurance. I truly did think it would cover most of my medical expenses if I ever got sick. 

But after drowning in medical bills for more than a decade, I have come to realize that the only people who like their health insurance are the ones who never need to use it.

I also thought my ex-boyfriend and I could get through anything together. Clearly, that was not the case.

I assumed that my friends would be sympathetic with what I was going through. But in the end, chronic pain left me with a much smaller circle of loved ones. 

I also like to think that chronic pain has made me a more empathetic person. When I meet other people in pain, I do my best to show them empathy and to give them realistic advice that could actually help them.

Today, over a decade since I first woke up with chronic pain, it’s difficult to envision what my life would have been like if I had never gotten sick. 

So many of my life choices have revolved around my pain – from who I live with, to who I love, and to what I do for work.

To be completely honest, I like my life right now. Yes, I wish that I didn’t have to arrange my entire day around my physical pain. But I love what I do, I love the people I spend my days with, and I am content.  

I think that, in a lot of ways, chronic pain forced a contented life onto me. It forced me to evaluate everything I did, to see if it was actually necessary and if it was actually worthy of my time and energy. What was left was only the best parts. 

It is noteworthy that my pain is pretty well managed these days, at least compared to how bad it was in 2013. I still have bad flares, but for the most part, my medications help me get through the day. 

Looking back, there are so many dark nights in my past where I felt like the best choice was to just give up. So many painful hours in bed where I genuinely considered killing myself. 

But now, after 13 years of this life with chronic pain, I am so relieved that I decided to keep living it.

Why I Recommend Living with Family if You Have Chronic Pain

By Crystal Lindell

Last summer my fiancé and I moved in with my mom, my grandma, and my brother. Essentially, I was moving back home – and truth be told, I felt like a failure.

I hadn’t been able to find full-time work after being laid off in 2022, and the bills were just getting to be too much. Actually, let me be more accurate. It’s not that I couldn’t find full-time work, it’s more that I hadn’t been able to bring myself to go back to a corporate job while dealing with burnout and chronic pain.

And so, we made the hard choice to move in with my family in hopes of saving some money and getting our bearings.

Almost every day, we all disagree. There are debates over who needs to do the dishes; discussions about how often the bathroom needs to be cleaned; and lots of arguments about someone in the house being too loud when someone else in the house wants quiet.

Yet, even with all that, my only regret is that we didn’t move in here sooner.

In the United States, it’s still often culturally frowned upon to move back home. It’s often framed as a failure to be an adult living with your parents, regardless of the circumstances. But for most of human history, living with family wasn’t just accepted practice, it was the norm. 

And if you have chronic pain, living with family could be exactly what you need, if that’s an option for you. Especially if stigma is the only thing holding you back.

There are so many practical reasons that it just makes sense to live with family if you have a chronic illness.

First and foremost, chronic pain is expensive in so many ways. There are medical bills, reduced ability to work, and all the convenience fees you have to pay for services because you can’t just go out and do it yourself. Living with family almost always makes life cheaper.

But chronic pain is also draining. And living with family helps fend off the depression that creeps in on bad pain days. Even more so during bad pain months.

It’s hard to wallow in my room all day when someone in the house is always checking on me, keeping me in conversation, and wanting to hang out.

Yes, it can be frustrating to have arguments about who is responsible for vacuuming the hallway, and whether or not we can put the couch on the left side of the living room. But that frustration is more than countered by the benefits of living with family.

If you are at a place where dealing with chronic pain is just draining all the life out of you, then I would highly recommend moving in with relatives, if you can. 

And if you love someone with chronic pain, an invitation to live with you could be the thing that saves their life. 

Every Chronic Pain Patient Should Have Their Hormone Levels Tested

By Dr. Forest Tennant

Periodic hormone panel testing should be a standard procedure in chronic pain care. Why? Some specific hormones are essential for pain control and others for healing and restoration of damaged tissues. 

Unfortunately, both chronic pain and opioid medications can suppress hormones, which the body needs for pain control and tissue healing. Nerve receptors in the brain that control pain, such as the opioid/endorphin, dopamine, GABA, and serotonin receptors, use hormones as energizers – the same way gas is needed to fuel your car. 

One of the first signs that your hormone levels are deficient — and that you’re running out of gas —- is when your pain relief medication seems to be losing its effectiveness. If that is the case, hormone panel testing should be performed and hormone replacement may be necessary. 

Six hormones that you should test for:

• Pregnenolone

• Progesterone

• Dehydroepiandrosterone (DHEA)

• Estradiol

• Testosterone

• Cortisol

Opioids can suppress all of these hormones. Long-acting opioids like oxycodone, morphine, methadone, fentanyl patches, and intrathecal opioids are the worst.

Short-acting opioids like hydrocodone and hydromorphone are less disruptive, because they do not constantly remain in the blood, so they give the pituitary and other hormone-producing glands time to recover. 

Long-acting opioids constantly suppress the pituitary and other glands. Consequently, any person who takes a long-acting opioid needs hormone panel testing at least every 6 months. All deficiencies must be replenished.

Hormone Therapies

Given the importance of hormone testing and hormone replacement therapy, I recently published a new book, “Hormone Therapies in Chronic Pain Care.”

I wrote the book because I strongly believe it is time to incorporate hormonal therapies into the care of essentially every chronic pain patient.  

Despite an imperfect pain care system that admittedly has some supply, regulation, and financial issues, modern pain management has achieved great success.  

Recently developed medications, physical therapies, and surgical procedures have brought pain relief and recovery to millions around the world.  Hormones can and will build on this foundation. 

The book is designed to help both medical practitioners and patients identify hormone therapies that can improve their current treatment. You can’t control pain or acquire healing and restoration with deficient hormone levels.

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 research bulletins here.   

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

Today’s Wounded Troops Are Tomorrow’s Chronic Pain Patients

By Crystal Lindell

This week Reuters reported that as many as 150 U.S.troops have been wounded so far in the War on Iran. Of those, eight were seriously injured.

That’s in addition to the 7 U.S. service members who have been killed in the conflict, which started less than two weeks ago.

Those numbers will continue to rise the longer the war drags on.

It can feel tempting to dismiss wounded soldiers as no big deal, and that’s how the Pentagon is framing it, saying the vast majority of injuries are minor and that 108 of the wounded had already returned to duty.

But many of those who get wounded in conflict zones will experience life-long symptoms, including chronic pain, post-traumatic stress disorder (PTSD) and traumatic brain ​injuries, which are common after exposure to blasts.

According to the National Institutes of Health, about two-thirds of U.S. veterans (65.6%) have  chronic pain, and one in ten (9.1%) live with severe chronic pain. 

Of course, it’s not just U.S. troops who are casualties in the war. Estimates vary, but about 1,200 Iranians have died, 28 Israelis and nearly 600 in Lebanon. The number of injured is well into the thousands.

Even if the war ends tomorrow, its effects will likely linger for generations. Living with chronic pain can impact your life until you die — and enduring it can impact everyone around you, including your children.

It can make you more short-tempered, less productive, and more depressed. It can make you harder to live with emotionally, and harder to live with logistically because you need extra care.

I doubt most of the wounded understand the ramifications. I don’t blame them. It’s almost impossible to understand chronic pain until you suffer through it yourself.

But as a chronic pain patient, I know what their future holds.

It’s years, even decades, of dealing with dismissive doctors; fighting for pain medication; and spending your days and nights in bed because it hurts too much to move.

I think, if they truly understood, many members of the military would tell you it’s not worth it.  

A recent report from the Department of Veterans Affairs found that 6,398 U.S. veterans died by suicide in 2023. While that’s down slightly from 2022, the veteran suicide rate actually increased to 35.2 deaths per 100,000 veterans. That’s about twice the suicide rate of civilians.

It averages out to over 17 suicides by veterans each day. Most of them probably suffered from chronic pain.

It’s easy to skim past headlines about the number of people wounded in the War on Iran. But for the people who are enduring it, and those who love them, nothing about their future will likely be easy.

Bill Expands Pain Care Options and Lowers Cost for Medicare Patients

By Dr. Lynn Webster

Everyone who reads this publication understands chronic pain is often treated as a symptom. However, for tens of millions of Americans, it is a disease state. It reshapes the nervous system, erodes function, and can narrow life experiences to what hurts least.

It’s also becoming more common. Federal survey data show that roughly a quarter of U.S. adults report chronic pain, and a substantial subset report “high-impact” chronic pain severe enough to limit work or daily activities.

The public conversation about pain has been dominated for a decade by opioids, and for good reason. Opioids carry real risks, especially with long-term use, and the nation has paid dearly for indiscriminate prescribing and poor safeguards. But focusing only on opioids can obscure a quieter policy failure. Many patients who are trying to avoid opioids can’t reliably access effective non-opioid options, particularly in Medicare Part D.

That gap is structural, as well as clinical. Medicare Part D plans commonly use utilization management tools, prior authorization and step therapy among them, that can delay or block access to certain medications. For older adults living with neuropathic pain, fibromyalgia, or other chronic pain conditions, delays can mean months of impaired function while paperwork circulates, appeals are filed, and “fail-first” sequences play out.

In practice, these barriers can shape prescribing in ways that have little to do with what a clinician believes is best. When a newer non-opioid medication is placed on a high cost-sharing tier, requiring multiple authorizations, or is only covered after a patient “fails” other therapies, the path of least resistance too often becomes the therapy that is easiest to access — not necessarily the therapy that best matches the patient’s needs.

A bipartisan bill now before Congress is designed to address a narrow but consequential piece of that problem for Medicare beneficiaries: the Relief of Chronic Pain Act of 2025 (S. 3064). Its basic logic is simple: If policymakers want less reliance on opioids, coverage rules should not systematically disadvantage non-opioid alternatives.

The bill would do three things for qualifying non-opioid chronic pain management drugs in Part D plans, beginning in 2026. It would waive the deductible, require plans to place the drug on the lowest cost-sharing tier, and prohibit prior authorization and step therapy, which forces patients to try an opioid first.

Importantly, S. 3064 is not written as an open-ended mandate for all pain treatments. It defines qualifying drugs as FDA-approved non-opioid products for chronic pain conditions that do not act on opioid receptors and, in general, are not simply interchangeable with an existing therapeutically equivalent product.

It also defines “chronic pain condition” with specific examples, including diabetic peripheral neuropathic pain, endometriosis, fibromyalgia, musculoskeletal pain, neuropathic pain, post-herpetic neuralgia, and trigeminal neuralgia.

Why does a target change like this matter? Because pain is not just discomfort; it is an economic and social force. Chronic pain drives health care use, disability claims, and lost productivity on a massive scale, with major national cost estimates in the hundreds of billions of dollars annually.

When coverage delays effective treatment, the downstream costs do not disappear. They shift to more Medicare patients falling, more deconditioning, more depression and isolation, more emergency visits, and -- in some cases -- greater exposure to higher-risk medications.

Coverage policy won’t solve chronic pain by itself. The best care is multimodal: movement, behavioral strategies, physical and occupational therapy, interventional options when appropriate, and medications when they add meaningful benefit. Opioids will remain appropriate for a subset of people with chronic pain. But insurance design can either support alternative therapies or quietly undermine them.

S. 3064 asks Congress to make one pragmatic adjustment: Stop treating certain non-opioid options as luxuries for Medicare beneficiaries and start treating timely access as a basic component of safer pain care.

Unfortunately, since its introduction in Congress last October by Sen. Steve Daines (R-MT) and Sen. Maria Cantwell (D-WA), the bill has languished in the Senate Finance Committee. No hearings on S. 3064 are currently scheduled.

Readers who want to follow the proposal can review the bill text and legislative updates here. A public petition supporting the measure is also circulating for those who wish to add their names. If you want more options that are accessible and affordable, you should consider signing the petition and spreading the word. 

Lynn R. Webster, MD, is a pain and addiction medicine specialist. He writes and lectures on pain policy, patient safety and evidence-based treatment. Webster is currently a Senior Fellow for The Center for U.S. Policy. He is the author of the forthcoming book, “Deconstructing Toxic Narratives: Data, Disparities, and a New Path Forward in the Opioid Crisis.”

Sounds Are More Intense When You Have Chronic Pain

By Crystal Lindell

Throughout the day, whenever I hear something particularly high-pitched or loud, I will often turn to my fiancé and say, “Turn it down. That sound is literally causing me pain.”

He always obliges, but I know he’s skeptical. And I understand that my complaint doesn’t really make sense. 

However, new research seems to support my experience.

A study at the University of Colorado Anschutz School of Medicine, published in the Annals of Neurology, found that people with chronic pain are significantly more sensitive to sound.

For the study, researchers recruited 142 adults with chronic back pain and 51 healthy people who were pain free. While receiving MRI brain imaging, both groups had mechanical pressure put on their bodies to stimulate pain, while being subjected to annoying sounds. Participants were then asked to rate how unpleasant the experience was.

The differences in responses between chronic pain patients and healthy controls was significant. On average, back pain sufferers reacted more strongly than 84% of people without pain.

The researchers also looked at brain activity during the experiments. The MRI scans showed stronger responses in brain regions that process sound (the auditory cortex) and emotional sensations (the insula). There was lower activity in regions that normally help calm or regulate emotions, like the medial prefrontal cortex.

Interestingly, the results overlap with other studies showing how patients with fibromyalgia react to painful stimuli.

"Our findings validate what many patients have been saying for years, that everyday sounds genuinely feel harsher and more intense. Their brains are responding differently, in regions that process both the loudness of sound and its emotional impact,” said senior author Yoni Ashar, PhD, Co-Director of the Pain Science Program at the Anschutz School of Medicine. 

“This tells us chronic back pain isn't just about the back. There's a broader sensory amplification happening in the brain, and that opens the door for treatments that can help turn that volume down." 

The researchers wanted to see which treatments could help reduce the brain’s response to noise. The pain patients were broken up into three groups that received either Pain Reprocessing Therapy (PRT), a placebo saline injection, or the usual care they were already getting for back pain. 

PRT is a type of mindfulness therapy, in which patients are encouraged to think differently about their pain in order to minimize it.

Out of all the treatments, PRT was the most effective. It reduced the heightened brain response to sound and increased activity in brain regions involved in regulating unpleasant experiences. But the effect was only minimal.

"These findings add to growing evidence that chronic back pain is not just a problem in the back. The brain plays a central role in driving chronic pain, by amplifying a range of sensations – such as sensory signals from the back, sounds and likely other sensations as well," said Ashar.

Overall, it’s great to see research like this validating what I know is a common experience for chronic pain patients.  

However, I do think there may be some “chicken and the egg” issues with this study. Which comes first: sensitivity to sound or back pain?

Maybe people who are more sensitive to sound are more likely to develop chronic pain. In other words, does the pain cause sound hypersensitivity, or does hypersensitivity cause the pain? 

Ashar and his research team plan further studies of senses other than hearing — such as light, smell or taste — to see if chronic pain causes sensitivity to those stimuli and how brain regions respond to them.

Tapering Plan Led by Pharmacists Shows No Benefit for Seniors

By Crystal Lindell

If pharmacists helped taper elderly patients off opioids and benzodiazepines, would that reduce their risk of falling?

Turns out, the answer is no. Having pharmacists get involved in a senior’s treatment plan doesn’t significantly reduce fall risk or prescriptions for the medications, according to research recently published in JAMA..

Falling is a significant risk factor for seniors, because their bones fracture more easily and it takes longer for them to recover. Medications that impair balance – such as opioids and anti-anxiety drugs – raise the risk of falling, especially in seniors who take them concurrently. 

Researchers at the University of North Carolina School of Medicine recruited 15 primary care clinics to participate in the study. Nearly 2,100 patients at the clinics met the study criteria, which was being over the age of 65 and having a long-term prescription for opioids and/or benzodiazepines. 

Over 95% of the patients on opioids had chronic pain and about a third of them had a fall in the past year..

Pharmacists for about half the patients were encouraged to “deprescribe” them, when appropriate, by recommending a voluntary taper plan to their doctors  The other patients received usual care from their doctors, without any tapering recommendations, and served as a control group.

A year later, doctors followed the pharmacists’ advice by tapering 21.4% of patients off of opioids. But that was only slightly more than the control group, which saw opioids discontinued for 19.9% of patients. The tapering rates for benzodiazepines were similar and “not statistically significant."

Notably, there was little difference in falls between the two groups, which were essentially “unchanged” by the tapering.

In other words, having a pharmacist make tapering recommendations to doctors had very little, if any, impact. Tapering occurred in both groups, whether a pharmacist was involved or not.

“Although reductions occurred in both groups, the intervention did not significantly reduce prescribing or falls at 1 year. Still, pharmacist recommendations were feasible to implement and accepted more often than rejected, indicating general practitioner receptiveness,” researchers concluded. “These results suggest that a consultant pharmacist–led intervention is feasible to implement in primary care clinics.”

Note the word, "feasible" rather than "effective." Sure, it can be done, but that doesn't mean it should be done.

I would guess that the program did not reduce prescriptions for opioids and benzodiazepines anymore than the control group because prescribing had already been reduced. At the start of the study, the average daily dose of opioids was 23.6 morphine milligram equivalents (MME), which is a low to moderate dose.

Given how much these medications are already being restricted, few patients are getting opioids or benzos if they don’t desperately need them – not even seniors.

Beyond that, I think it’s really important to take a step back when looking at research like this and consider the patient’s perspective. 

How were the tapering plans presented to patients? Were they asked to weigh the pros and cons? Did they have a voice in their treatment?  

I suspect if they were given the option of staying on a medication or reducing their fall risk, many seniors would choose to stay on the medication. 

Unfortunately, the study authors seem to take the wrong lesson from the research, at least in my opinion. Although their study failed to prove much of anything, they concluded there should be “more intensive or sustained deprescribing strategies.”

There are a lot of studies looking at ways to reduce opioid prescriptions — I suspect because those are the easiest to fund — and I’m honestly glad this one failed. 

The biggest problem many seniors face today is that they cannot get access to effective pain and anxiety treatment. If anything, researchers should be working to address that problem, rather than making it worse.

Instead of working on blanket reductions for these types of medications, I wish they would look at finding alternatives that actually work.

If you lost a loved to suicide after a change in their prescription pain medication, please consider participating in a survey to help researchers learn more about these tragic situations. Click here or on the banner below for more information.