Five Strategies to Support Chronic Pain Caregivers

By Mara Baer

As someone who has lived with chronic pain for ten years, I worry about my health and future. I also worry about my ability to be fully present for my kids and spouse, and the load that he carries in our family life.

When my pain first became chronic, my husband’s expanded role became critical. He did more driving, more cooking, and more laundry. There was always more for him to do. When my pain became so persistent that it impacted my mental health, his responsibilities grew even more.

Fifty million people in America live with chronic pain. We are five times more likely to experience depression and anxiety, and our risk of suicide is twice as high as people without pain. Isolation, elevated stress, and loneliness are also common. Because the healthcare system does not typically address the biopsychosocial nature of pain – the biological, psychological and social factors behind it -- these problems persist and have deep impacts on our relationships and caregivers.

When I was at my darkest times with chronic pain, I felt helpless. Feeling helpless lead to acting helpless, which added to the caregiving burdens of my spouse. Many days I could not get myself out of bed, as the pain and my sadness about it were too great. I avoided family and social activities, and doing chores around the house.

I thought I was allowing my body the rest it needed, but I’ve since learned that avoiding movement and isolating oneself can exacerbate pain, and deepen depression and anxiety. This created a vicious cycle, where lack of activity leads to more pain and worsens mental health.  

My husband watched as I declined and kept picking up the pieces. We spent years like this, but we didn't have to. I now have five key strategies that can help caregivers and their loved ones:

1. Learn about the biopsychosocial nature of pain: The complex nature of pain involves many factors, including the brain’s capacity to become hardwired to pain, as well as social and emotional issues. "The Pain Management Workbook" by Rachel Zoffness provides an excellent tutorial on the biopsychosocial aspects of pain and is a useful tool for caregivers and those living with pain. As caregivers learn more about the multi-faceted nature of pain, it becomes easier find ways to improve pain care.

2. Explore pain reprocessing and other therapies: In "The Way Out" by Alan Gordon, readers can learn about the neuroscience of chronic pain and how Pain Reprocessing Therapy (PRT) can teach the brain to “unlearn” chronic pain. Several pain therapy programs are grounded in this model, which has been found to provide significant pain relief. Caregivers should also evaluate other therapies that can help manage pain, including Cognitive Behavioral Therapy and Acceptance Commitment Therapy.

3. Evaluate healthcare stigma: People living with chronic pain often face stigma in the healthcare system. This impacts their access to care and mental health. Caregivers should evaluate whether stigma is occurring, which may result in the undertreatment of pain by providers and skepticism about patient suffering.

4. Assess your own pain and mental health: Like other caregivers, chronic pain caregivers can experience stress, isolation and burnout. That burden is often correlated with a patient’s pain, anxiety, depression, and lower self-efficacy. Over half of caregivers’ struggle with their own pain, which impacts their mental health and ability to serve in the caregiving role. Self-evaluation is important for caregivers to assess their own medical and mental health, and to seek support when needed.

5. Join a support group: Chronic pain is isolating, not only for people living with pain but also their caregivers. Connecting with others who understand these challenges can be incredibly healing and supportive. There are many support groups online. The U.S. Pain Foundation hosts a regular free support group for caregivers, providing opportunities to share challenges and coping strategies.

When I finally became aware of the evidence around the biopsychosocial nature of pain, it was a turning point for me and my spouse. After learning that nearly all chronic pain conditions have a psychological component, I sought mental health support, coaching and counseling. This helped me see that the way I coped with pain would never work, and that moving my body, avoiding isolation and acknowledging my emotions would help me feel better and engage more fully in family life.

There are times my husband may still carry a heavier load, especially when I am having a pain flare, but his caregiving responsibilities are more manageable now. And I am certainly more present in our family and relationship.

Mara Baer has lived with Neurogenic Thoracic Outlet Syndrome for over 10 years. She is a writer, speaker, and health policy consultant offering services through her women-owned small business, AgoHealth. Mara is a member of the National Pain Advocacy Center’s Science and Policy Council and recently launched a newsletter called Chronic Pain Chats.

How Western Diets Can Trigger Rheumatoid Arthritis

By Pat Anson

Researchers are learning more about how some foods and drinks affect our gut bacteria -- and potentially trigger an immune system response that leads to rheumatoid arthritis (RA) and other inflammatory chronic conditions.

The latest example is a review, published in the journal Nutrients, that examines how harmful bacteria can cause a phenomenon known as “gut dysbiosis,” an imbalance of intestinal microorganisms associated with the development of inflammation and autoimmune diseases like RA.

Previous studies have shown that RA patients don’t consume enough dietary fiber, which can cause gut dysbiosis. Fiber helps restore balance by acting as fuel for hungry – and beneficial -- gut bacteria.

“Overall, the current evidence suggests that gut dysbiosis is involved in the pathogenesis of RA,” wrote lead author Andrzej Pawlik, MD, a Professor in the Department of Physiology at Pomeranian Medical University in Poland. “The diversity and richness of the gut microbiome seems to be reduced in RA.

“Diet is an essential dietary factor, but it also acts as environmental trigger. Researchers have reported a dramatic increase in the frequency of autoimmune diseases in developed countries, and some of them suggest that the Western diet could contribute to this phenomenon.”

Western diets typically have more saturated fats and are often low in dietary fiber, which is why RA patients are often told to increase their fiber consumption. One study found that RA patients who ate high-fiber bars and cereals for 28 days showed significant improvement in their physical and mental quality of life. High fiber intake also reduces the risk of obesity, diabetes, hypertension and other cardiovascular diseases.

Vegetarian and Mediterranean diets also promote the growth of healthy bacteria, slowing the progression of RA, and reducing joint pain.

“Dietary factors and interventions have a marked impact in controlling the progression of RA. Lifestyle modifications involving dietary changes such as higher fibre intake and reduced consumption of red meat should be recommended for patients diagnosed with RA,” said Pawlik, who says further studies are needed to examine the influence of probiotics and other diets on the inflammatory process.

Prevotella copri is a gut bacterium that has long been associated with rheumatoid arthritis. There are many others -- and some we’re just learning about.

A 2022 study identified a harmful gut bacteria known as Subdoligranulum didolesgii in about 20% of people diagnosed with RA. The bacterium has not been detected in the intestines of healthy people.

About 1.3 million people in the U.S. and 1 in every 100 people worldwide have RA, a a chronic autoimmune disease in which the body’s own defenses attack joint tissues, causing swelling, inflammation and bone erosion.   

Teen in Chronic Pain Had Surgery, but Insurer Won’t Cover It

By Lauren Sausser, KFF Health News

When Preston Nafz was 12, he asked his dad for permission to play lacrosse.

“First practice, he came back, he said, ‘Dad, I love it,’” recalled his father, Lothar Nafz, of Hoover, Alabama. “He lives for lacrosse.”

But years of youth sports took a toll on Preston’s body. By the time the teenager limped off the field during a lacrosse tournament last year, the pain in his left hip had become so intense that he had trouble with simple activities, such as getting out of a car or turning over in bed.

Months of physical therapy and anti-inflammatory drugs didn’t help. Not only did he have to give up sports, but “I could barely do anything,” said Preston, now 17.

No Medical Billing Code

A doctor recommended Preston undergo a procedure called a sports hernia repair to mend damaged tissue in his pelvis, believed to be causing his pain.

PRESTON NAFZ

The sports medicine clinic treating Preston told Lothar that the procedure had no medical billing code — an identifier that providers use to charge insurers and other payers. It likely would be a struggle to persuade their insurer to cover it, Lothar was told, which is why he needed to pay upfront.

With his son suffering, Lothar said, the surgery “needed to be done.” He paid more than $7,000 to the clinic and the surgery center with a personal credit card and a medical credit card with a zero-interest rate.

Preston underwent surgery in November, and his father filed a claim with their insurer, hoping for a full reimbursement. It didn’t come.

But the final bill did: $7,105, which broke down to $480 for anesthesia, a $625 facility fee, and $6,000 for the surgery.

‘Trying to Wiggle Out’

Before the surgery, Lothar said, he called Blue Cross and Blue Shield of Alabama and was encouraged to learn that his policy typically covers most medical, non-cosmetic procedures.

But during follow-up phone calls, he said, insurance representatives were “deflecting, trying to wiggle out.” He said he called several times, getting a denial just before the surgery.

Lothar said he trusted his son’s doctor, who showed him research indicating the surgery works. The clinic, Andrews Sports Medicine and Orthopaedic Center, has a good reputation in Alabama, he said.

Other medical providers not involved in the case called the surgery a legitimate treatment.

A sports hernia — also known as an “athletic pubalgia” — is a catchall phrase to describe pain that athletes may experience in the lower groin or upper thigh area, said David Geier, an orthopedic surgeon and sports medicine specialist in Mount Pleasant, South Carolina.

“There’s a number of underlying things that can cause it,” Geier said. Because of that, there isn’t “one accepted surgery for that problem. That’s why I suspect there’s not a uniform CPT.”

CPT stands for “Current Procedural Terminology” and refers to the numerical or alphanumeric codes for procedures and services performed in a clinical or outpatient setting. There’s a CPT code for a rapid strep test, for example, and different codes for various X-rays.

The lack of a CPT code can cause reimbursement headaches, since insurers determine how much to pay based on the CPT codes providers use on claims forms.

More than 10,000 CPT codes exist. Several hundred are added each year by a special committee of the American Medical Association, explained Leonta Williams, director of education at AAPC, previously known as the American Academy of Professional Coders.

Codes are more likely to be proposed if the procedure in question is highly utilized, she said.

Not many orthopedic surgeons in the U.S. perform sports hernia repairs, Geier said. He said some insurers consider the surgery experimental.

Preston said his pain improved since his surgery, though recovery was much longer and more painful than he expected.

By the end of April, Lothar said, he’d finished paying off the surgery.

Partial Payment

A billing statement from the surgery center shows that the CPT code assigned to Preston’s sports hernia repair was “27299,” which stands for “a pelvis or hip joint procedure that does not have a specific code.”

After submitting more documentation to appeal the insurance denial, Lothar received a check from the insurer for $620.26. Blue Cross and Blue Shield didn’t say how it came up with that number or which costs it was reimbursing.

Lothar said he has continued to receive confusing messages from the insurer about his claim.

Both the insurer and the sports medicine clinic declined to comment.

The Takeaway

Before you undergo a medical procedure, try to check whether your insurer will cover the cost and confirm it has a billing code.

Williams of the AAPC suggests asking your insurer: “Do you reimburse this code? What types of services fall under this code? What is the likelihood of this being reimbursed?”

Persuading an insurer to pay for care that doesn’t have its own billing code is difficult but not impossible, Williams said. Your doctor can bill insurance using an “unlisted code” along with documentation explaining what procedure was performed.

“Anytime you’re dealing with an unlisted code, there’s additional work needed to explain what service was rendered and why it was needed,” she said.

Some patients undergoing procedures without CPT codes may be asked to pay upfront. You can also offer a partial upfront payment, which may motivate your provider to team up to get insurance to pay.

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

Dogs Can Help Us Feel Less Pain

By Pat Anson

If you’re a dog lover like me, you know how beneficial a pet dog can be. Dogs give us unconditional love and companionship, and help us reduce stress, stay active and be socially connected.

What you may not know is that our four-legged friends can also help us feel less pain. In fact, according to a new study, they’re better at it than humans.

A team of European researchers conducted an unusual experiment to see if people experience less pain when their dog was nearby or when they were with a close friend.

They recruited 124 healthy female pet owners to immerse their hands in cold water (about 36°F) for up to five minutes to induce pain. The so-called “cold pressor task” is a common way for researchers to induce acute pain in clinical studies.

For this study, the cold water test was performed in a laboratory while the participants had either their pet dog or a same-sex friend nearby. Some of the women took the test while alone and served as a control group. The interaction of the participants, dogs, and their friends was monitored by video camera.   

The study findings, recently published in the journal Acta Psychologica, suggest that dogs can help people cope with painful situations better than humans can.

“Participants reported and showed less pain and they felt less helpless in the dog condition compared to the alone condition,” wrote lead researcher Heidi Mauersberger, a Research Assistant in the Department of Psychology at Humboldt University in Berlin.

“Participants accompanied by their dog reported less pain and showed lower physiological pain reactions, greater pain tolerance, and less intense facial displays of pain as well as felt less helpless than participants…accompanied by their friends.”

Being with a friend was better than being alone, but Mauersberger says the presence of another human being -- even a close friend -- made the women feel like they were being judged or evaluated.

“In contrast to the presence of pet dogs, the mere presence of close friends may have triggered social demands and social-evaluative threat in the painful situation. In fact, the increased eye contact frequency between participants and friends compared to participants and dogs may be a reason for the heightened threat perceptions in the friend compared to the dog condition.”

To test their theory further, researchers conducted a second test, this time immersing the participants’ hands in cold water while they were with a complete stranger or a dog they were unfamiliar with.

The results were largely the same. The pet owners felt more comfortable and coped better with pain around dogs they had not bonded with. Individuals with positive attitudes about dogs experienced the most pain relief.

“Participants demonstrated better adaptation to pain, exhibited less pain behavior, reported reduced helplessness and higher self-efficacy as well as experienced more positive affect when suffering pain in the presence of unfamiliar dogs compared to the presence of unfamiliar human companions,” said Mauersberger.

To be clear, this experiment wasn’t designed to come up with another wacky treatment for chronic pain. People with chronic pain or taking prescription medication were excluded from the study.

The research was conducted to help demonstrate the value of therapy dogs, which have long been known to provide psychological benefits to people suffering from stress, anxiety or loneliness.

A 2020 study helped explain how that happens. People being treated for fibromyalgia who interacted with a therapy dog had a significant increase in levels of oxytocin – a hormone released by the pituitary gland that’s known as the “cuddle hormone” or “love hormone.” They were also more relaxed, their heart rates slowed, and they had more positive thoughts and feelings.  

Do you have a dog, cat or pet of any kind that helps you feel better? 

Brain Imaging Shows How Mindfulness Reduces Pain

By Pat Anson

Chronic pain patients have long been skeptical of mindfulness meditation, a form of cognitive behavioral therapy that is often touted as an alternative treatment for pain. Here are a few of the comments we’ve gotten about mindfulness over the years:

“Mindfulness is helpful. But it is only helpful when the pain is under control enough to implement it. If you are rocking back and forth from excruciating pain, any alternative therapies are useless.”

“Mindfulness may distract from pain while you are doing it. But it doesn't have any long-lasting effects.”

“Mindfulness is lazy hippie horseshit. It’s not medicine. It’s not science. It’s not therapy.”

But a new study published in Biological Psychiatry found some of the first physical evidence that mindfulness activates neural processes in the brain that help reduce pain levels. Researchers at the University of California San Diego School of Medicine used advanced fMRI brain imaging to compare the pain reducing effects of mindfulness with placebo treatments.

The study involved 115 healthy volunteers who were randomly assigned to four groups. One group participated in a guided mindfulness meditation, while the others received “sham” mindfulness that only consisted of deep breathing or a placebo cream that participants were told reduced pain. The fourth group listened to an audio book and served as a control.

The researchers then applied a painful but harmless heat stimulus (120°F) to the back of the leg and scanned the participants’ brains both before and after the interventions.

Compared to the other three groups, researchers found that mindfulness meditation produced significant reductions in pain intensity and pain unpleasantness ratings, while also reducing brain activity patterns associated with pain and negative emotions. Although the placebo cream and sham-mindfulness also lowered pain, mindfulness meditation was significantly more effective.

“The mind is extremely powerful, and we’re still working to understand how it can be harnessed for pain management,” said lead author Fadel Zeidan, PhD, a professor of anesthesiology at UC San Diego Sanford Institute for Empathy and Compassion. “By separating pain from the self and relinquishing evaluative judgment, mindfulness meditation is able to directly modify how we experience pain in a way that uses no drugs, costs nothing and can be practiced anywhere.”

Zeidan and his colleagues found that mindfulness reduced the synchronization between brain areas involved in introspection, self-awareness and emotional regulation. Those parts of the brain comprise the neural pain signal (NPS), a pattern of brain activity thought to be common to pain across different individuals and different types of pain.

In contrast, the placebo cream and sham-mindfulness did not show a significant change in the NPS when compared to controls. Instead, those interventions engaged entirely separate brain mechanisms with little overlap or synchronization.

“It has long been assumed that the placebo effect overlaps with brain mechanisms triggered by active treatments, but these results suggest that when it comes to pain, this may not be the case,” said Zeidan. “Instead, these two brain responses are completely distinct, which supports the use of mindfulness meditation as a direct intervention for chronic pain rather than as a way to engage the placebo effect.”

Researchers hope that by understanding changes in the brain associated with mindfulness, they can design more effective treatments to harness the power of mindfulness to reduce pain.

In a 2018 study of mindfulness that also induced pain through heat, Zeidan found that a part of the brain that processes thoughts, feelings and emotions – the posterior cingulate cortex -- was more active in people who reported higher pain levels. Participants with lower pain levels had less activity in that critical part of the brain.

“Millions of people are living with chronic pain every day, and there may be more these people can do to reduce their pain and improve their quality of life than we previously understood.” said Zeidan.

FDA Clears New Prescription-Only TENS Device

By Pat Anson

Transcutaneous electrical nerve stimulation – more commonly known as TENS – uses mild electric currents to temporarily relieve pain in sore muscles and tissues. Some TENS units are elaborate wearable devices that cost hundreds of dollars, while others are simple gadgets that can be purchased online or over-the-counter for about $30.

Due to lingering questions about their effectiveness, many health insurers don’t cover TENS devices, while others make patients jump through hoops to get reimbursed for them.

Medical device maker Zynex Medical is hoping to bridge the gap in insurance coverage with a new TENS device called TensWave, which is only available by prescription. The company says the FDA has “cleared” TensWave for marketing, allowing sales to begin immediately.

"The introduction of TensWave aligns perfectly with our commitment to providing comprehensive pain management solutions," Thomas Sandgaard, CEO of Zynex, said in a press release.

"We recognized a gap in the market for a high-quality TENS device that meets the specific criteria for insurance reimbursement, and TensWave is our answer to that demand. It complements our flagship multi-modality device, the NexWave, where Interferential current is the main modality and driver of obtaining prescriptions. This device broadens our product portfolio and enhances our support to patients."

ZYNEX IMAGE

Unlike NexWave, which has three different electrical stimulation modalities, TensWave only uses TENS technology, which Zynex believes will make it easier to get insurance coverage. The company currently has no estimate of TensWave’s cost if a patient has to buy it out-of-pocket.   

In its press release, Zynex said TensWave “has been clinically proven to reduce chronic and acute pain,” which is a bit of an exaggeration, because the device did not go through the FDA’s lengthy review and approval process. However, because TensWave has “substantial equivalence” to other TENS units already on the market, it was cleared for sale without ever undergoing a clinical trial to prove its safety and efficacy. This is a common practice allowed by the FDA when new medical devices are introduced.

The World Health Organization takes a dim view of TENS, saying the evidence of its effectiveness in relieving chronic lower back pain is “very low” due to a limited number of clinical trials. In some trials, TENS worked no better than a placebo.

The UK’s National Health Service (NHS) has a similar view of TENS, saying there is not enough good-quality evidence to recommend its use as a reliable method of pain relief.

“Healthcare professionals have reported that it seems to help some people, although how well it works depends on the individual and the condition being treated,” the NHS states. “TENS is not a cure for pain and often only provides short-term relief while the TENS machine is being used.”

Can Psychedelics Be a New Option for Pain Management?

By Kevin Lenaburg

Science, healthcare providers and patients are increasingly finding that psychedelics can be uniquely effective treatments for a wide range of mental health conditions. What is less well-known, but also well-established, is that psychedelics can also be powerful treatments for chronic pain.

Classic psychedelics include psilocybin/psilocin (magic mushrooms), LSD, mescaline and dimethyltryptamine (DMT), a compound found in plants and animals that can be used as a mind-altering drug. Atypical psychedelics include MDMA (molly or ecstasy) and the anesthetic ketamine.

More than 60 scientific studies have shown the ability of psychedelics to reduce the sensation of acute pain and to lower or resolve chronic pain conditions such as fibromyalgia, cluster headache and complex regional pain syndrome (CRPS).

The complexity of pain is well matched by the multiple ways that psychedelic substances impact human physiology and perception. Psychedelics have a number of biological effects that can reduce or prevent pain through anti-nociceptive and anti-inflammatory effects. Psychedelics can also create neuroplasticity that alters and improves reflexive responses and perceptions of pain, and helps make pain seem less important. 

New mechanisms of action for how psychedelics improve pain are continually being discovered and proposed. Mounting evidence seems to show that a confluence of biological, psychological and social factors contribute to the potential of psychedelics to treat complex chronic pain. 

It is premature to state that there is one key or overarching mechanism at work. Research continues to explore different ways that psychedelics, combined with or without adjunctive therapies, can impact a wide range of pain conditions.

The National Institutes of Health recently posted a major funding opportunity to study psychedelics for chronic pain in older adults. And for the first time, PAINWeek, one of the largest conferences focused on pain management, has an entire track dedicated to Psychedelics for Pain at its annual meeting next month in Las Vegas. 

Clearly, pain management leaders are welcoming psychedelics as a vitally needed, novel treatment modality, and it is time for healthcare providers and patients to begin learning about this burgeoning field.

It is important to note that all classic psychedelics are currently illegal Schedule I controlled substances in the US. The FDA has granted Breakthrough Therapy Designation to multiple psychedelics, potentially accelerating access, but the road to approval at the federal level is long. 

However, at the state level, the landscape is changing rapidly. Similar to how states led the way in expanding legal access to cannabis, we are now seeing the same pattern with psychedelics. 

In 2020, Oregon voters approved an initiative that makes facilitated psilocybin sessions available to adults who can afford the treatment. 

Voters in Colorado approved a similar measure in 2022, with services becoming available in 2025. To become a certified facilitator in Colorado, individuals must pass a rigorous training program that includes required instruction on the use of natural psychedelics to treat chronic pain. 

This coming November, voters in Massachusetts will also decide on creating legal access to psychedelics. 

Over the next decade, we will likely see multiple pathways to access, such as continued expansion of state-licensed psychedelic therapies; FDA-approved psychedelic medicines; and the latest proposed model of responsible access, Personal Psychedelic Permits. The last option would allow for the independent use of select psychedelics after completing a medical screening and education course focused on benefits and harm reduction. Overall, we need policies that lead to safe supply, safe use and safe support.

As psychedelics have become more socially accepted and available, rates of use are increasing. This includes everything from large “heroic” doses, where people experience major shifts in perception and profound insights, to “microdoses” that are sub-perceptual and easily integrated into everyday life. 

In the area of chronic pain, a lot of the focus is on finding low-doses that are strong enough to reduce pain, but have no or minor visual effects. This amount seems sufficient for many people to activate the necessary receptors to reduce chronic pain.

While doctors are years away from being able to prescribe psychedelics, increasing public usage indicates that now is the time for the medical community to become more knowledgeable about psychedelic-pharmaceutical interactions and psychedelic best practices to serve the safety and healing of their patients.

We also need healthcare providers and pain patients to join the advocacy fight for increased research and expanded access to psychedelics. Providers have the medical training and knowledge to treat pain, while patients often have compelling personal stories of suffering and their own form of expertise based on lived experience. 

One of the most effective lobbying tandems is a patient who can share a powerful personal story of healing, hope and medical need, combined with the expertise and authority of a doctor. Together, we can create a world with responsible, legal access to psychedelic substances that lead to significant reductions in pain and suffering.

Kevin Lenaburg is the Executive Director of the Psychedelics & Pain Association (PPA) and the Policy Director for Clusterbusters, a nonprofit organization that serves people with cluster headache, one of the most painful conditions known to medicine. 

On September 28th and 29th, PPA is hosting its annual online Psychedelics & Pain Symposium, which features presentations from experts and patients in the field of psychedelics for chronic pain and other medical conditions. The first day is free and the second day is offered on a sliding scale, starting at $25.

Can Ketamine Treat Fibromyalgia Pain?

By Pat Anson

At a time when the medical and recreational use of ketamine is coming under more scrutiny from law enforcement, a new study highlights its potential value as a treatment for fibromyalgia pain.

Ketamine is an anesthetic drug that is only FDA-approved for depression and anesthesia. But in recent years ketamine infusions are increasingly being used “off-label” for severe chronic pain conditions such as Complex Regional Pain Syndrome (CRPS).

In a small systematic review (a study of studies), researchers in Brazil found that ketamine infusions were safe and effective in relieving fibromyalgia pain. The review was small – just 6 clinical trials involving 115 patients – because ketamine has rarely been considered as a treatment for fibromyalgia due to its potency. Ketamine infusions require constant medical supervision because they put patients into a temporary dream-like state that can lead to hallucinations and out-of-body experiences.

But the Brazilian researchers found the side effects from infusions were mild and short-term, with some fibromyalgia patients experiencing pain relief that lasted for days or weeks.

Fibromyalgia is a poorly understood condition that causes widespread body pain, fatigue, insomnia, brain fog and mood disorders. The FDA has approved only three medications for fibromyalgia, two antidepressants (Cymbalta and Savella) and a nerve drug (Lyrica), but many patients consider the drugs ineffective.

Could ketamine be another option?

“Ketamine infusions might be a reasonable therapeutic approach for short-term relief of symptoms but unsatisfactory at inducing long-term analgesia in FM (fibromyalgia) patients,” the Brazilian research team reported in Advances in Rheumatology. “Future studies that evaluate the safety and effectiveness of ketamine in FM are desired for long-term follow-up. In patients refractory to conventional therapy, ketamine infusions might be a reasonable therapeutic approach.”

A recent case study suggests ketamine does have potential as a long-term treatment. A 68-year-old woman with fibromyalgia experienced “significant, widespread pain relief” after receiving several ketamine infusions over a two-week period. She continued getting infusions twice a week for the next year.    

“Pain relief has persisted under this regimen, along with a demonstrable improvement in quality of life, a reduced use of morphine, and the cessation of anti-depressant medication. This case indicates that long-term ketamine infusions show promise for chronic pain management and that more longitudinal studies on this treatment are warranted,” researchers reported.

‘Targeting and Investigating Doctors’

The positive news about ketamine is being overshadowed by the investigation into the death of actor Matthew Perry, who drowned in a hot tub last year after getting three ketamine injections in one day – none of them while under medical supervision.  Five people, two of them doctors, were recently arrested in connection with Perry’s death, including an alleged drug dealer known as the “Ketamine Queen.”

Perry had long struggled with substance abuse issues, but federal prosecutors say the defendants “were more interested in profiting off Mr. Perry than caring about his well-being.”  The two doctors charged in the case both surrendered their DEA licenses and can no longer prescribe controlled substances.      

In a recent appearance on CBS’ Face the Nation, DEA Administrator Anne Milgram likened Perry’s death to the opioid crisis, claiming that his doctors were ultimately responsible.  

“It started with two unscrupulous doctors who were violating their oath, which is to take care of their patients, and instead supplying Matthew Perry with enormous quantities of ketamine in exchange for huge amounts of money. And then it switched to the street where Matthew Perry was buying the ketamine from two drug traffickers,” Milgram said.

“Every single day, (we) are targeting and investigating doctors, nurse practitioners, others who are violating this duty of trust to their patients by over prescribing medicine or prescribing medicine that isn't necessary.”

Milgram also claimed that ketamine “has a high potential” for addiction. While experts agree the drug can be abused, ketamine is not an opioid and does not suppress respiration, the leading cause of an overdose.  

Kamala Harris’ Stepdaughter Draws Backlash for Advocating Pain Treatments

By Crystal Lindell

Ella Emhoff, the 25-year old stepdaughter of Vice President Kamala Harris, recently revealed that she has chronic back pain and shared a list of ways that she tries to address it. 

It’s a move that could give a boost to patient advocacy, especially if her stepmother moves into the White House.

Emhoff’s social media posts about pain and her lengthy list of potential treatments have gotten some pushback in the media, in part because one of the things Emhoff advocates for is ketamine infusions for chronic pain. The anesthetic has been a hot topic recently for its role in the drowning death of actor Matthew Perry. Last week prosecutors brought charges against five people who helped supply Perry with ketamine. 

Emhoff shared her chronic pain story via Instagram, where she has nearly 400,000 followers, writing that she was born with a tethered spine, which caused her back to not properly lengthen when she was growing up. That, in turn, caused kyphosis, an abnormally formed spine also known as a “hunchback.”

Emhoff said she was in and out of doctors’ offices for physical therapy for most of her adolescence, and then eventually got lower back surgery, which led to her growing taller. But she still has chronic back pain. 

After receiving a lot of responses to sharing her story, she then followed-up by sharing a link to a Google Doc list of pain management options, which she calls “The Big Pain Management List.” 

“Alright the responses have been COMING IN HOT. It's actually very comforting seeing how many people can relate to chronic pain and also very sad," Emhoff wrote, sharing a disclaimer about her list.

"These are all just recommendations made to me. These should not be taken as medical advice. I am just a girl tryna feel less pain."

INSTAGRAM

Emhoff’s list is broken down into six categories: devices, topicals, exercises, lifestyle changes and books. Most of the recommendations are probably common knowledge to anyone who's been dealing with chronic pain. But the list still offers a good, well-organized resource for anyone looking for new or old ideas to relieve pain. 

Under devices, she includes a firm mattress and red light therapy pad. For topicals, she suggests lidocaine patches and salt baths. Under exercises, Emhoff includes things like weighted squats and pilates. For lifestyle, she recommends things like shorter work days, “weed” and an anti-inflammatory diet. 

The therapies column is where she lists ketamine infusions, as well as somatic therapy and EDMR therapy. Under books, she recommends “The Pain Management Workbook" and “The Way Out.”

Personally, I find it a little disappointing that Emhoff never mentions one of the most effective pain treatments we have: opioid-based pain medication. It’s not as though she was worried about being controversial, given her inclusion of ketamine therapy. Perhaps opioids aren’t helpful for her, but they are helpful for millions of others dealing with chronic pain. 

Regardless, I’m always glad to see anyone with influence drawing awareness to the suffering those of us with chronic pain endure. My hope is that she will be able to push her powerful stepmom to advocate for broader access to some of her recommendations, such as ketamine and cannabis. 

Of course, because of Emhoff’s visibility and political connections, some publications covered her pain management suggestions as though they were controversial.  

The Daily Mail headline read: “Kamala Harris' woke step daughter pushes ketamine and shorter working days in excruciating Gen Z rant.”

The New York Post headline read: "VP Kamala Harris’ stepdaughter Ella Emhoff pushes ketamine, ‘shorter work days’ in ‘pain management’ rant."

It’s a little disappointing to see those types of headlines around the topic of chronic pain. My guess is that many of Emhoff’s followers suffer from chronic pain, and many of them may even benefit from her recommendations. But headlines like that can scare people away from trying treatments like ketamine, which is normally used for depression but some people find very useful treating some types of chronic pain. 

Thankfully, Emhoff has the ability to reach out to pain patients directly through her social media. So even if other media entities try to frame her suggestions in a poor light, she’s still able to get her message out to those who need it.

A New Therapy Can Help Relieve Painful Emotional Trauma

By Laurel Niep

If you’ve been to a therapist’s office in the past few years, there’s a good chance you’ve heard of eye movement desensitization and reprocessing, or EMDR, therapy.

Most commonly used for treating long-standing and acute traumas, EMDR is also being shown to help with some kinds of chronic pain.

A growing body of studies shows that EMDR can be used to effectively treat a variety of conditions, such as substance abuse, specific phobias and anxiety that occurs alongside symptoms stemming from a trauma. More studies are needed, but results so far are encouraging.

I’m a trauma therapist who was trained in EMDR in 2018. Since then, I have consistently used this approach with dozens of clients to work through trauma and deeply held negative core beliefs.

EMDR and Traditional Therapy

Eye movement desensitization and reprocessing was developed in 1987 by Dr. Francine Shapiro after she discovered that moving her eyes from her left foot to her right as she walked – in other words, tracking her feet with each step – resulted in lower levels of negative emotions connected with difficult memories, both from the more recent frustrations of the day and deeper events from her past.

Conventional treatments, such as cognitive behavioral therapy or dialectical behavioral therapy, rely on extensive verbal processing to address a client’s symptoms and struggles. Such therapy may take months or even years.

Depending on the trauma, EMDR can take months or years too – but generally, it resolves issues much more quickly and effectively. It is effective for both adults and children, and can be done remotely.

EMDR is an evidence-based therapy that can help people process trauma in ways that other forms of treatment cannot.

EMDR has the capacity to work faster by targeting negative thoughts and emotions in combination with what is called bilateral stimulation – that is, the use of eye movements, tapping, audio or tactile sensations to process the emotions.

The most common form of bilateral stimulation is when the patient holds their head steady and uses their eyes to follow the therapists’ finger movements back and forth. Patients may also wear headphones that alternate music from ear to ear, or a tone that goes back and forth. Another common technique is having the patient hold a small buzzer in each hand that alternates vibration back and forth. Sometimes, therapists alternate tapping on each of the client’s hands or knees.

Some practitioners equate it to adding conscious thought to what the brain is trying to do during rapid eye movement, or REM, sleep. During this stage of sleep, the eyes go back and forth under your closed eyelids as you’re dreaming.

How EMDR Works

Researchers are still working out exactly how and why EMDR is effective at helping patients heal from trauma.

Trauma is a physiological and psychological response to an event where one perceives a threat to their safety – or to someone close to them – that is so severe, it overwhelms their capacity to cope.

The traumatic event can give rise to various symptoms that affect daily life, such as anxiety, depression, mood swings, intrusive thoughts, hypervigilance, difficulty sleeping or changes in appetite or weight. Sometimes, the person has thoughts of self-harm or suicide.

The trauma can also leave one with various triggers – sights, smells, sounds, locations, phrases – that bring up memories of the event. This causes the person to relive the emotions or reactions they had when the trauma initially occurred, as if it’s happening again.

For example, on a stroll through a crowded mall, someone who had been assaulted months earlier might catch a whiff of the same cologne the perpetrator was wearing. As the smell of the cologne triggers them, they suddenly feel like they’re experiencing the assault again, including physical sensations and seeing images of the event.

Dislodging Trauma

Memories of traumatic events often become stuck in the brain’s limbic system, where the fight, flight and freeze response resides. This is not the place where memories are intended to be stored. Here, the memory is triggered by various experiences in daily life – a similar sound, smell, sight or sensation – that can make the client feel as if the trauma is happening again in that moment.

Targeting the traumatic memory while engaging in bilateral stimulation during EMDR allows the brain to highlight and move the memory from the limbic system – where it cannot effectively connect to other critical information or memory networks – to the prefrontal cortex and other cortical brain regions where the memory is better able to be processed and supported.

Certain places, disturbing noises or large crowds can trigger traumatic memories.

EMDR therapy is a multistep process. Together the patient and therapist first identify targets, meaning the specific traumatic memories to be addressed during the reprocessing phase.

Next, the patient is asked to associate the event with a negative thought about themselves linked to the trauma. For example, I might say, “And when you think about the worst part of that event, what is a negative thought you have about yourself?” Often something comes up along the lines of “I’m unlovable,” “I’m worthless” or “I’m not worth protecting.” The patient is also asked to identify and locate any physical sensations they might be having in the body.

Then the therapist will ask the client to focus on all three of those things – the specific trauma memory, the negative thought about themselves and where they feel it in their body – while applying some form of bilateral stimulation.

EMDR in Practice

Although trauma therapy is a very individualized experience, research shows that 80% to 90% of clients can process – meaning resolve – a singular traumatic event with only three sessions of this therapy. In one initial study study from 1998, past experiences such as post-traumatic stress disorder from combat were resolved in 77% of participants after 12 sessions. Other research suggests that for patients who have suffered chronic trauma or abuse, more treatment time is likely needed to resolve the symptoms stemming from the trauma they survived.

In this context, resolve means that the target thought or memory has been cleared and the impact should be greatly reduced – not that the person will no longer have any negative thoughts or emotions about it.

If a patient has multiple traumas, I’ll ask them to identify the memories that stand out the most. The therapist will start with the earliest of those memories and work toward present day. One memory at a time is focused on, and once it has been completely processed – there’s no more disturbance in the body when thinking of the memory – then the therapist and patient move on to the next one.

One of my patients had struggled with devastating childhood memories of verbal, emotional and physical abuse by their parents. This consistently affected their relationships with family and peers into adulthood. After working with EMDR, the patient was able to process the haunting memories, gain insight on setting boundaries with others, and provide comfort and guidance to the young child they once were.

Another patient was a high school student, afraid to leave the house after enduring an assault on the way home from school. Concrete, visible changes began after the second session. School attendance became more consistent; grades improved. “I don’t understand what’s happening,” said the patient. “It’s like magic. I’m not so scared anymore.”

But EMDR is not magic. It is a unique strategy that allows the client to approach the trauma in a different way. The client is able to think about the events they are affected by and engage with the support of the therapist without having to verbalize each detail of their trauma.

Finding EMDR Specialists

If you’re considering trying out eye movement desensitization and reprocessing therapy, find a therapist who is trained or certified for this treatment. The EMDR International Association website has a list of them, though there are many other qualified therapists not affiliated with that organization, and you could ask about a clinician’s credentials before beginning treatment with them.

If you’re struggling daily with past trauma or deeply held negative beliefs about yourself, are willing to delve into those difficult emotions and would like to try a different type of therapy backed by research, I would strongly recommend giving EMDR a chance.

Laurel Niep, LCSW, is a Trauma Therapist and Senior Instructor with the Stress, Trauma, Adversity Research, and Treatment (START) clinic in the Department of Psychiatry at the University of Colorado School of Medicine.

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

The Best Advice for Someone New To Chronic Pain: Sleep

By Crystal Lindell

If you’re new to chronic pain, try your best to get some sleep. 

Whether you use a pill, a sick day, a babysitter, or some combination of all three — your first priority is to get a really good, restful night of sleep. 

Nothing can be dealt with before that happens, but everything will feel more manageable when you wake up. 

As someone who writes about chronic illness, people often reach out to me when they or someone they love suddenly finds themselves dealing with a new health issue. And my first piece of advice is always the same: YOU NEED TO SLEEP. 

Chronic illness – especially chronic pain – has a way of eating away at your sleep like a party full of toddlers grabbing chunks of birthday cake. Even if you lay in bed all night long, true sleep can easily evade you. 

Lack of sleep will make you crazy so much faster than you think it will. It will make every problem you face impossible. And it will make every interaction you have with humans or pets infuriating. 

When I first started having chronic pain at age 29, I did not understand any of this. At the time, I was working two jobs, with one requiring a daily hour-long commute each way. I was secretly proud to be living on as little sleep as possible, long before I started having serious health issues.

I thought I was the type of person who could easily live on little-to-no sleep. But there’s a big difference between getting five hours of sleep, going to work, then coming home to crash for 10 hours versus getting less than two hours of sleep a night for multiple nights in a row.

I didn’t realize how much sleep my new pain was stealing from me. And I didn’t realize just how quickly it would start destroying my will to live.

During one early pain flare, before I had any of the tools I have now to manage such things, I was awake for like five days straight. I say “like” because that week is kind of a traumatic blur. It was only a few days, but it felt like a month. 

After one of the first rough nights, I showed up at my primary care doctor’s office before it even opened, begging for help. Another day, I went to an urgent care clinic. By the end of the week, I was laying on my living room floor planning ways to kill myself. 

It doesn’t take long to reach really dark places when you aren’t getting enough sleep. And lack of sleep will make almost any physical pain worse too. Combine those two things, and it’s easy to mistakenly start convincing yourself that being alive is the wrong choice. 

Eventually, a pain doctor gave me a strong antidepressant and sleeping aid called amitriptyline, and I finally got some real rest. Of course, like any strong sleep aid, it came with a lot of side effects. It made me very tired in the morning, sometimes making it impossible to get up for work. It made me gain unwanted weight. And it left me groggy throughout the day. 

But after going days without sleep, those were all side effects I was happy to accept. 

Bodies need the power reset that sleep is supposed to provide, both mentally and physically. When you don’t get that, things get scary glitchy fast.

So if you’re new to chronic pain, do whatever you need to do to get some sleep. And if you aren’t able to get the sleep you need with the tools you have at home, do not hesitate to go to the doctor or even the emergency room. Sleep is that important. 

After a few nights of real rest, then you can start to tackle the rest of the ways your newfound health issues are affecting you. Because trust me, there'll be plenty of time for all that in the morning. 

There’s Little Evidence That Massage Therapy Helps With Pain

By Crystal Lindell

It’s often touted as an alternative pain treatment, but it turns out there’s not much evidence showing that massage therapy actually helps with either chronic or acute pain. 

That’s according to new research published in JAMA Network Open that analyzed hundreds of clinical studies of massage therapy for pain. In a systematic review of those studies, the authors found little evidence that massage therapy actually helps relieve pain. In fact, most of the studies concluded that the certainty of evidence was low or very low. 

Notably, the researchers looked at studies involving many different types of pain, including cancer-related pain, chronic and acute back pain, chronic neck pain, fibromyalgia, labor pain, myofascial pain, plantar fasciitis, postpartum pain, postoperative pain, and pain experienced during palliative care. 

“There is a large literature of original randomized clinical trials and systematic reviews of randomized clinical trials of massage therapy as a treatment for pain,” wrote lead author Selene Mak, PhD, a researcher and program manager at the VA’s Greater Los Angeles Healthcare System. 

“Our systematic review found that despite this literature, there were only a few conditions for which authors of systematic reviews concluded that there was at least moderate-certainty evidence regarding health outcomes associated with massage therapy and pain. Most reviews reported low- or very low–certainty evidence.”

The results are especially concerning because massage therapy is often recommended as an nonopioid alternative for treating pain. In fact, in its revised 2022 opioid guideline, the CDC specifically mentions “massage” multiple times as a nonpharmacologic alternative. 

“Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient,” the guideline says.

Researchers involved in the current study found that “massage therapy” was a poorly defined category of treatment, which made it more difficult to analyze. For example, in some studies, acupressure was considered massage therapy, but at other times it was classified as acupuncture. 

“Massage therapy is a broad term that is inclusive of many styles and techniques,” Mak wrote. “This highlights a fundamental issue with examining the evidence base of massage therapy for pain when there is ambiguity in defining what is considered massage therapy.”

Researchers also found that it was difficult to do placebo-controlled massage studies because it’s difficult to compare massage with a sham or placebo treatment. 

“Unlike a pharmaceutical placebo, sham massage therapy may not be truly inactive,” they wrote. “It is conceivable that even the light touch or touch with no clear criterion used in sham massage therapy may be associated with some positive outcomes.… Limitations of sham comparators raise the question of whether sham or placebo treatment is an appropriate comparison group in massage therapy trials.”

The researchers said it might be better to compare massage therapy with other treatments rather than a placebo. They also called for more high-quality research to look into exactly how helpful massage therapy is for pain. 

All of this doesn’t mean that massage therapy offers zero benefits, and patients who get something out of it should continue to use it.  However, medical professionals (and guideline authors) should be more cautious about recommending massage as a substitute for proven pain treatments, such as opioids. Because the last thing people in pain need is to be given ineffective treatments while being denied effective ones..

Can a Smartphone App Relieve Fibromyalgia Symptoms?

By Pat Anson

It was a little over a year ago that the FDA authorized the marketing of the first smartphone app designed specifically to treat fibromyalgia. The Stanza app uses a form of cognitive behavioral therapy (CBT) to help patients improve their quality of life by lessening the pain, anxiety, fatigue and depression that often come with fibromyalgia.

New findings from a placebo-controlled Phase 3 study, recently published in the The Lancet, helped demonstrate Stanza’s potential benefits.  

“This novel, non-drug therapy, available using a smartphone, makes management of fibromyalgia more accessible and convenient. This offers new hope for people with fibromyalgia, who have continued to experience unmet treatment needs,” says lead investigator Lesley Arnold, MD, an Associate Professor of Psychiatry at the University of Cincinnati College of Medicine.

Arnold and her colleagues enrolled 275 fibromyalgia patients in a 12-week trial, with half randomly assigned to receive Stanza treatment and the other half serving as a control group. Participants were allowed to continue taking medications and any other therapies they were using before the study.

Fibromyalgia is a difficult condition to diagnose and treat, because it comes with a wide array of symptoms such as widespread body pain, headaches, fatigue, insomnia, brain fog and mood disorders. The FDA has approved only three medications for fibromyalgia -- duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica) – but many patients consider the drugs ineffective or have too many side effects.

Stanza uses a form of CBT called Acceptance and Commitment Therapy (ACT) to teach patients psychological skills to help lessen the impact of fibromyalgia on their lives. A daily 15–20-minute session includes ACT lessons on deep breathing, mindfulness and other self-management skills.   

The effectiveness of Stanza was measured by the patients themselves, through a self-assessment test known as Patient Global Impression in Change (PGIC), in which participants described changes in their overall well-being.  

After 12 weeks, over 70% of participants in the Stanza group had improvements in their PGIC score, compared to 22% in the control group. Stanza participants also had more significant improvement in their pain intensity, physical function, fatigue, sleep and depression. No adverse events were observed either group.

It’s important to note the research was funded by Swing Therapeutics, the maker of Stanza, which calls it largest study ever conducted of a medical device for fibromyalgia.

“Fibromyalgia options are typically limited to a handful of pharmacological interventions that have limited efficacy and that can come with difficult-to-manage side effects,” says Mike Rosenbluth, CEO of Swing. “This publication validates Stanza as a guideline-directed non-drug approach that many patients previously couldn’t access due to few available trained clinicians, geographic limitations and cost.

Stanza is intended for use five to seven days per week, for a standard treatment period of 12 weeks. After that, Stanza can be used as needed. Previous studies have found that improvements in fibromyalgia symptoms can last up to 12 months after Stanza therapy.

Although it’s a self-guided app, Stanza requires a prescription and the supervision of a medical professional trained in its use.  Currently, Stanza clinicians are only available in the states of Illinois, Michigan, Missouri, Nevada, Ohio, Pennsylvania, Tennessee and Texas.  Medicare Part B and some private insurers cover Stanza treatment.  

Making a Monkey Out of Western Medicine

By Pat Anson

When it comes to using plants to self-medicate, chimpanzees and other primates may be a whole lot smarter than their human counterparts.

The latest evidence comes in a new study published in PLOS ONE, which found that wild chimpanzees consume plants and trees with medicinal properties that relieve pain, reduce inflammation and fight infection. The chimp study follows right on the heels of another recent observational study, about an orangutan that used a plant to help heal a facial wound.  

An international team of researchers spent 8 months following two groups of chimpanzees in Uganda’s Budongo Forest, recording what plants and trees the chimps ate, and whether they were sick or injured. They also analyzed the animals’ feces and urine to check for parasites and elevated levels of immune cells.

The researchers identified 13 plant species with little nutritional value that the chimps seem to instinctively know would help them feel better and recover from illness. The animals would either swallow the leaves whole or chew on bitter bark and tree sap.  

One adult chimp with a severe hand injury was observed moving away from his group to spend a few minutes alone eating a fern called Christella parasitica. When researchers later tested the fern, they found it had “highly anti-inflammatory properties” that may have reduced pain and swelling in the chimp’s hand.

Other chimps with gastrointestinal problems were seen chewing on the bark of the Alstonia boonei tree, which has long been used by indigenous natives to treat snake bites, asthma and wounds.

Notably, both Christella parasitica and Alstonia boonei are cyclooxygenase-2 (COX-2) inhibitors, the same enzyme that is targeted by aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and relieve pain and fever.

Rather than banning or restricting plant-based medicines -- as we have seen with cannabis, kratom and opium -- researchers say we should be looking at “forest pharmacies” for ways to benefit our own healthcare.

“Our findings of strong antibacterial growth inhibition across numerous plant species growing in Budongo have promising implications for our ability to discover novel compounds in existing forest habitats,” researchers said.

“As we learn more about the pharmacological properties of plants ingested by chimpanzees in the wild, we can expand our understanding of their health maintenance strategies. Our results provide pharmacological evidence, from in vitro assays of plant parts consumed by wild chimpanzees collected in situ, for the presence of potent bioactive secondary plant metabolites in Budongo chimpanzee diets for a variety of potential illnesses.”

Whether medicinal plants are consumed intentionally or unwittingly by chimps and other animals remains an open question. But the field of “zoopharmacognosy” – the study of animals using plant-based medicine – could be the answer to many chronic illnesses that Western medicine can’t cure or treat effectively.

“For this to happen, however, it is imperative that we urgently prioritize the preservation of our wild forest pharmacies as well as our primate cousins who inhabit them,” researchers concluded.

The Best Remedy for Low Back Pain? Go for a Walk

By Pat Anson, PNN Editor

Almost everyone experiences low back pain at some point in their lives. Repeated episodes of acute low back pain are also very common, with 70% of people who recover from one episode having another one within a year.

Is there any reliable way to end the cycle before low back pain turns chronic?

A new Australian study suggests the best and most cost-effective way to keep low back pain from returning is simple: Go for a walk.

Researchers at Macquarie University’s Spinal Pain Research Group enrolled 701 adults who recently recovered from low back pain in a clinical trial. Half were randomly assigned to an individualized walking and education program led by a physiotherapist for six months; while the other half served as a control group, receiving no treatment at all.

Participants in the walking group were encouraged to walk five times a week for at least 30 minutes, but were free to do more or less. Most gradually increased their walking, with the average amount of walking time doubling in the first 3 months.

Both groups were then followed for at least one year, with researchers tracking any recurrences of low back pain lasting at least 24 hours that were severe enough to limit daily activities.

The study findings, recently published in The Lancet, show that participants in the control group had a recurrence of low back pain after 112 days on average, while those in the walking group were pain free nearly twice as long, a median of 208 days. The overall risk of having a new episode of low back pain fell by 28% for the walkers.

“We don’t know exactly why walking is so good for preventing back pain, but it is likely to include the combination of the gentle oscillatory movements, loading and strengthening the spinal structures and muscles, relaxation and stress relief, and release of ‘feel-good’ endorphins,” said senior author Mark Hancock, PhD, a Professor of Physiotherapy at Macquarie University.

"And of course, we also know that walking comes with many other health benefits, including cardiovascular health, bone density, healthy weight, and improved mental health.”

Another benefit is cost. A significantly higher percentages of participants in the control group sought treatment from massage therapists, chiropractors, physiotherapists and other healthcare providers.

While it’s hard to assign a dollar number to quality of life, researchers estimate the total cost-effectiveness of walking vs. no treatment at AU$7,802. In U.S. dollars, that’s $5,190.    

“It not only improved people’s quality of life, but it reduced their need both to seek healthcare support and the amount of time taken off work by approximately half,” said lead author Natasha Pocovi, PhD, a Postdoctoral Fellow at Macquarie University.

In 2023, the World Health Organization (WHO) released its first guideline for managing low back pain, recommending treatments such as exercise, physical therapy, and patient education. Pocovi and her colleagues say a regular program of walking would be a cheaper alternative to joining a gym or hiring a trainer.

“The exercise-based interventions to prevent back pain that have been explored previously are typically group-based and need close clinical supervision and expensive equipment, so they are much less accessible to the majority of patients,” Pocovi said. “Our study has shown that this effective and accessible means of exercise has the potential to be successfully implemented at a much larger scale than other forms of exercise.”

Low back pain is the leading cause of disability worldwide. According to a 2022 Harris Poll, nearly 3 out of 10 U.S. adults live with chronic low back pain. On average, the typical back pain sufferer seeks relief from at least three healthcare providers, with many treatments proving ineffective.