Pelvic Pain Patients Often Face Medical Gaslighting

By Crystal Lindell

Doctors are telling women with pelvic pain disorders to drink alcohol, learn how to relax, or get psychiatric care to treat their symptoms, according to a new study in JAMA Network Open. 

Researchers at The Centers for Vulvovaginal Disorders surveyed 447 patients pelvic pain, and found that medical gaslighting is common among doctors treating women with vulvodynia, endometriosis, interstitial cystitis and other pelvic conditions. 

The gaslighting was so disheartening that over half of the patients (52.8%) considered ceasing care because their concerns were not being addressed. Nearly 40% of the women said they were made to feel crazy, and one in five were referred to psychiatry without any medical treatment. 

Additionally, 16.8% of the patients surveyed felt unsafe during a medical exam. About a quarter of the doctors were belittling (26.6%) or did not believe the patient (20.5%). Many of the patients said their doctors lacked clinical knowledge about pelvic pain and were dismissive. 

The research also included quotes from patients who were surveyed, including one from a woman about a doctor who neglected her: 

"[I’ve been] told that they don't see anything or there is nothing there, despite that I was in severe pain and crying and had been in that provider's office almost every day for a week for these burning symptoms.”

As a pain patient myself, I have had the same experience. It’s difficult to explain to people who have never dealt with a long-term, complex health issue because most people still buy into the myth that doctors will do everything possible to help you. Unfortunately, that’s often not the case when it’s an ailment that’s difficult to treat or involves awkward topics like sex. 

One doctor dismissed the concerns of a patient about having sex, telling her that “intercourse is overrated anyway.”

I have to confess I was shocked to read that a doctor would ever say anything as ignorant as “intercourse is overrated.” It just proves that some doctors lack empathy, because there is no way a doctor would accept that response if an ailment was impacting their own sex life.

The same patient also complained about a doctor saying her discomfort was a normal part of growing older. 

“Providers that say 'it's just part of aging' don't address why it's not part of aging for my peers and even friends who are significantly older,” she said.

Which brings us to a common excuse that doctors use to dismiss patients of every age: You’re either “too young” to have a serious problem, or so old that whatever you’re experiencing must be “a normal part of aging.” 

This is evidenced by another respondent, who wrote: "I have had providers simply refuse to do tests on me because they said that I'm too young to worry about reproductive issues or that my pain is 'normal for young women' or that my pain is 'probably just stress.'"

One of the best ways to combat medical gaslighting and dismissive doctors is to spread awareness about it happening in the first place.

Those abusive tactics work because patients are often made to feel like they are crazy and stay silent. However, once they see that a doctor is talking to other patients the same way, it becomes clear that the patient is not the problem – the doctor is.

Researchers said their findings show “an urgent need for education supporting a biopsychosocial, trauma-informed approach to vulvovaginal pain and continued development of validated instruments to quantify patient experiences.”

In other words, the doctors need better training. And I couldn’t agree more. 

Patients don’t have the power to fix this problem on their own. It’s going to have to be the medical community that addresses it. And they can start by believing patients and showing some basic empathy.

Can Gut Bacteria Help Diagnose CRPS?

By Pat Anson

In what’s being called a breakthrough discovery, an international team of researchers has identified patterns in gut bacteria that appear to be associated with Chronic Regional Pain Syndrome (CRPS), a disabling nerve disease that causes severe pain. The discovery could lead to easier diagnosis of CRPS and potential new treatments.

Researchers at McGill University in Canada, working with colleagues in Israel and Ireland, used artificial intelligence (AI) to identify significant differences in the gut bacteria of CRPS patients and those of pain-free individuals. The findings were based on an analysis of stool and plasma samples from 53 CRPS patients and 52 healthy volunteers, which confirmed differences in fecal and plasma short-chain fatty acid levels.

The study, published in the journal Anesthesiology, adds to a growing body of evidence that gut microbiome — the population of microorganisms that live in the gastrointestinal tract —.plays a role in some chronic pain conditions.

“What’s remarkable about this study is that we trained our machine learning algorithms on high quality microbiome data from patients in Israel and successfully predicted CRPS in Canadian patients with over 90-per-cent accuracy,” said lead author Emmanuel Gonzalez, PhD, from the McGill Centre for Microbiome Research and Canadian Centre for Computational Genomics.

“This is extraordinary because factors like geography, climate, diet and natural variation between people typically create large microbiome differences. Yet, our AI approach seems to have identified a common ‘microbiome signature’ of CRPS, suggesting microbiome-based diagnostics could work across populations in different countries.”

CRPS is a nerve disorder that often starts with an injury to an arm or leg, with the skin in the affected area becoming warm, red and painful to touch. Most cases are mild and people recover, but in rare cases it gets worse, resulting in chronic nerve pain that spreads throughout the body.  

Also known as Reflex Sympathetic Dystrophy (RSD), CRPS affects between 400,000 and 2.1 million people worldwide. The disease is poorly understood, making it difficult to diagnose and treat.

“CRPS remains challenging to treat, with patients often experiencing prolonged suffering before receiving appropriate care,” said senior author Amir Minerbi, MD, Director of the Institute for Pain Medicine at Rambam Health Campus in Haifa, Israel.

With no known cure and few ways to manage symptoms, some CRPS patients become so desperate they resort to amputation. Researchers found that three male patients whose symptoms disappeared after limb amputation still had the same gut bacteria pattern that was linked to CRPS.   

“This persistent signature suggests the gut microbiome might make some people more prone to developing CRPS, with an injury or other event triggering the condition,” said Yoram Shir, MD, a Professor of Anesthesia and Director at McGill’s Alan Edwards Pain Management Unit.

“The identification of a gut microbiome signature for CRPS, paired with AI’s remarkable diagnostic accuracy, brings hope for earlier detection and tailored treatments,” says Barby Ingle, the founder and past president of the International Pain Foundation (iPain), who has lived with CRPS much of her adult life.

“This study affirms the intricate connection between our gut and chronic pain, a link I’ve personally explored through microbiome testing, stomach biopsies, and whole genome sequencing. While the exact correlation remains unclear to me, it’s great to see McGill’s scientists uncovering similar patterns, paving the way for innovative, patient-centered care that could truly transform lives.”

Previous studies have linked gut bacteria to rheumatoid arthritis and irritable bowel syndrome (IBS). A healthy balance of bacteria helps the body fight disease and regulate inflammatory reactions. Changes in the microbiome can disrupt the immune system and lead to inflammaging, when low levels of inflammation become chronic and spread throughout the body.

Online Emotional Support Therapy Modestly Reduces Chronic Pain

By Pat Anson

An online support program designed to “retrain the emotional brain” modestly reduces chronic pain and helps patients keep their negative emotions in check, according to a small pilot study in Australia.

Many people with chronic pain also develop anxiety and depression, but are unable to get psychological treatment because they live in rural areas or have mobility issues, and don’t have easy access to a therapist.

“We’ve known now for some time that chronic pain is more than just ‘Ouch, it hurts.’ It’s more than a sensory experience, it’s incredibly emotional,” says lead author Nell Norman-Nott, PhD, a research fellow at the University of New South Wales and clinical trial manager at the NeuroRecovery Research Hub.

Norman-Nott and her colleagues enrolled 89 people with chronic pain in the “Pain and Emotion Therapy” program. Half of the patients participated in 8 weekly group sessions over Zoom, in which a therapist teaches them emotional skills such as distraction, breathing exercises, and relaxation and self-soothing techniques.

The other participants received the treatment they were already getting, such as medication or physical therapy, and served as a control group.

The study findings, published in JAMA Network Open, show that after 9 weeks there were moderate improvements in depression, anxiety and sleep in those that received online therapy. But there was no change in pain intensity compared to those in the control group.

However, after a 6-month follow-up period, participants reported a 10% reduction in their pain levels, as well as continued improvement in their emotions and sense of well-being.

One of them is Janelle Blight, who lives with chronic back pain, arthritis and neuropathic pain. For the first time in 30 years, she was able to reduce her morphine dose after getting online therapy.

“I’ve been on a lot of opioids and things like that, but I’ve had nothing or found no course that’s been able to help take away the pain or help control the pain at home,” said Blight. “By doing the course, I’ve been able to learn how to reduce my emotional side of my pain, which has helped my chronic pain in the end.”

During a briefing with reporters, researchers called the study a “major step forward in pain care.” But in the actual study, they said the 10% reduction in pain intensity after six months was not well understood and “should be treated with caution.” The improvement was dependent on participants continuing to use the emotional skills they developed during online therapy.

Researchers hope to build on what they’ve learned with a larger study involving 300 participants in 2026. Registrations are open (for Australians only) on the NeuroRecovery Research Hub website.

Women’s Health Initiative Improved Healthcare, but Has Uncertain Future

By Jean Wactawski-Wende

Women make up more than 50% of the population, yet before the 1990s they were largely excluded from health and medical research studies.

To try to help correct this imbalance, in 1991 the National Institutes of Health launched a massive, long-term study called the Women’s Health Initiative, which is still running today. It is the largest, longest and most comprehensive study on women’s health ever conducted in the U.S. It also is one of the most productive studies in history, with more than 2,400 published scientific papers in leading medical journals.

On April 20, 2025, the Department of Health and Human Services told the study’s lead investigators it plans to terminate much of the program’s funding and discontinue its regional center contracts. On April 24, after pushback from the medical community, HHS officials said the funding had been reinstated. But the reversal was never officially confirmed, so the study’s lead investigators – including me – remain concerned about its future.

I am a public health researcher who has studied chronic disease prevention in women for nearly 40 years. I have been centrally involved with the Women’s Health Initiative since its inception and currently co-direct one of its four regional centers at the University at Buffalo.

The project’s findings have shaped clinical practice, prevention strategies and public health policies across the U.S. and the world, particularly for older women. In my view, its loss would be a devastating blow to women’s health.

Little Medical Research of Women’s Health

The Women’s Health Initiative was established in response to a growing realization that very little medical research existed to inform health care that was specifically relevant to women. In the U.S. in the 1970s, for example, almost 40% of postmenopausal women were taking estrogen, but no large clinical trials had studied the risks and benefits. In 1985 an NIH task force outlined the need for long-term research on women’s health.

Launched by Bernadine Healy, the first woman to serve as director of the NIH, the Women’s Health Initiative aimed to study ways to prevent heart disease, cancer and osteoporosis.

Between 1993 and 1998, the project enrolled 161,808 postmenopausal women ages 50 to 79 to participate in four randomized clinical trials. Two of them investigated how menopausal hormone therapy affects the risk of heart disease, breast cancer, hip fractures and cognition. Another examined the effects of a low-fat, high-fiber diet on breast and colorectal cancers as well as heart disease. The fourth looked at whether taking calcium plus vitamin D supplements helps prevent hip fractures and colorectal cancer.

Women could participate in just one or in multiple trials. More than 90,000 also took part in a long-term observational study that used medical records and surveys to probe the link between risk factors and disease outcomes over time.

Menopausal Hormone Therapy

Some of the most important findings from the Women’s Health Initiative addressed the effects of menopausal hormone therapy.

The hormone therapy trial testing a combination of estrogen and progesterone was set to run until 2005. However, it was terminated early, in 2002, when results showed an increased risk in heart disease, stroke, blood clotting disorders and breast cancer, as well as cognitive decline and dementia. The trial of estrogen alone also raised safety concerns, though both types of therapy reduced the risk of bone fractures.

After these findings were reported, menopausal hormone therapy prescriptions dropped sharply in the U.S. and worldwide. One study estimated that the decreased use of estrogen and progesterone therapy between 2002 and 2012 prevented as many as 126,000 breast cancer cases and 76,000 cardiovascular disease cases – and saved the U.S. an estimated US$35 billion in direct medical costs.

Reanalyses of data from these studies over the past decade have provided a more nuanced clinical picture for safely using menopausal hormone therapy. They showed that the timing of treatment matters, and that when taken before age 60 or within 10 years of menopause, hormones have more limited risk.

Advances in Women’s Health

Although the Women’s Health Initiative’s four original clinical trials ended by 2005, researchers have continued to follow participants, collect new data and launch spinoff studies that shape health recommendations for women over 65.

Almost a decade ago, for example, research at my institution and others found in a study of 6,500 women ages 63 to 99 that just 30 minutes of low to moderate physical activity was enough to significantly boost their health. The study led to changes in national public health guidelines. Subsequent studies are continuing to explore how physical activity affects aging and whether being less sedentary can protect women against heart disease.

Bone health and preventing fractures have also been a major focus of the Women’s Health Initiative, with research helping to establish guidelines for osteoporosis screening and investigating the link between dietary protein intake and bone health.

One of the Women’s Health Initiative’s biggest yields is its vast repository of health data collected annually from tens of thousands of women over more than 30 years. The data consists of survey responses on topics such as diet, physical activity and family history; information on major health outcomes such as heart disease, diabetes, cancer and cause of death, verified using medical records; and a trove of biological samples, including 5 million blood vials and genetic information from 50,000 participants.

The Women’s Health Initiative set out to prevent heart disease, cancer and osteoporosis in menopausal women.

Any researcher can access this repository to explore associations between blood biomarkers, disease outcomes, genes, lifestyle factors and other health features. More than 300 such studies are investigating health outcomes related to stroke, cancer, diabetes, eye diseases, mental health, physical frailty and more. Thirty are currently running.

In addition to data amassed by the Women’s Health Initiative until now, about 42,000 participants from all 50 states, now ages 78 to 108, are still actively contributing to the study. This cohort is a rare treasure: Very few studies have collected such detailed, long-term information on a broad group of women of this age. Meanwhile, the demographic of older women is growing quickly.

Continuing to shed light on aging, disease risk and prevention in this population is vital. The questions guiding the project’s ongoing and planned research directly address the chronic diseases that Health Secretary Robert F. Kennedy Jr. has announced as national priorities.

So I hope that the Women’s Health Initiative can continue to generate discoveries that support women’s health well into the future.

Jean Wactawski-Wende, PhD, is a Professor of Public Health at the University at Buffalo and is the principal investigator of UB's Women's Health Initiative (WHI) Northeast Regional Center. She has served in various leadership roles in WHI, including publications chair and the WHI executive committee, and has served as the national Chair of the WHI Steering Committee.

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

How Workplace Conditions Contribute to Chronic Pain and Mental Health Issues

By Pat Anson

If you are of a certain age – like me – you’ll remember when computers started entering the workplace in the 1980’s. There was a huge learning curve, but eventually work became faster and more efficient.

There was also a tradeoff: employees reported back and neck pain from sitting at keyboards all day, and carpal tunnel syndrome became a thing. Companies learned about the hazards of repetitive motion, and how chair height, limited desk space and poorly shaped computer mouses affected worker health, absenteeism and productivity. A new industry was born: ergonomics.

Flash forward 40 years and companies are now being urged to think about “emotional ergonomics” – how workplace stress contributes to anxiety, depression, burnout, and chronic pain.

“Physical pain is often a symptom of deeper, underlying stressors—from job pressures to mental health challenges. Addressing industrial ergonomics without considering emotional well-being is an incomplete strategy. The most forward-thinking companies recognize that true injury prevention must integrate both,” says Kevin Lombardo, CEO of the DORN Companies.

DORN has partnered with organizations that specialize in ergonomics, business psychology, and suicide prevention on a new white paper called “Emotional Ergonomics: How the Intersection of Industrial Ergonomics, Pain, and Mental Health Shapes Worker Wellbeing.”

The paper’s main findings are that workplace conditions deeply affect the physical and mental health of workers, and that organizations must address them together to have a healthy, high-performing workforce. Workplace stress affects 40% of employees in the United States and contributes to about $190 billion in added healthcare costs.

Unlike the 1980’s, when most jobs entailed a 40-hour work week and were performed outside the home, today’s knowledge-driven economy blurs the lines between professional and personal lives. Employees may get work-related emails or texts at all hours of the day and night, and a growing number work from home. This increases exposure to stress, cognitive demands, poor sleep habits, and the psychosocial risks that come with juggling work, family and personal time.

A recent study found that stress and anxiety have become the most common work-related injuries, accounting for over half (52%) of new cases. That trend is mirrored in Google searches for “burnout,” which have risen dramatically in the last 10 years.

“This research signals a necessary shift in how we approach workplace well-being. Emotional Ergonomics bridges the gap between physical safety and mental resilience, ensuring that employee health is not just a compliance checkbox but a business imperative. Organizations that fail to recognize this connection risk long-term workforce instability and financial strain,” says Dr. Sally Spencer-Thomas, President of United Suicide Survivors International.

Common psychosocial hazards in the workplace include:

• Excessive workload and time pressures

• Toxic relationships between coworkers and supervisors

• Hazing, bullying, harassment and discrimination

• Exposure to workplace accidents and trauma

• Low autonomy and limited decision-making

• Job insecurity

• Work-Life disruption

To address these issues, companies can adjust workloads and allow for more flexible scheduling; adopt health and wellness programs; train supervisors in empathetic communication skills; and allow for “quiet time” and space where workers can decompress from job strain.

The goal is to view workers not as cogs in a machine, but as individuals with different physical, emotional, and psychological needs. An “I’ve got your back” mentality in the workplace builds trust and helps employees feel valued.  

To learn more about the study findings and ways to build emotional ergonomics, you can sign up to watch a live webinar on Wednesday, May 21.

The Nocebo Effect: How Negative Expectations Can Make Pain Worse

By Pat Anson

You’ve probably heard of the placebo effect – the phenomenon where a patient’s symptoms improve after receiving a sham or fake medical treatment. Although not fully understood, experts think the placebo effect occurs when someone believes a treatment will work, which tricks the brain into releasing endorphins and other hormones that relieve pain and help us feel better.

Less well known is the nocebo effect, which works the opposite way. When patients think a treatment won’t work or may even cause harm, their pain and other symptoms will get worse, not better.

German researchers wondered whether the placebo or nocebo effect was stronger, and enrolled 104 healthy volunteers in a study to find out.

“While many studies have explored placebo and nocebo effects individually, few have directly compared the two in the same people over time,” says co-lead author Katharina Schmidt, PhD, a researcher in the Department of Neurology at University Duisburg-Essen, Germany. “We set out to determine whether negative expectations towards treatment have a stronger or longer-lasting effect on pain perception than positive ones.”

The volunteers were given two sham treatments one week apart. On the first day, participants were exposed to short bursts of heat pain after being led to believe that they would feel either pain relief (placebo), increased pain (nocebo), or no change (control).

The expectations were created using a combination of verbal suggestions from researchers and a fake pain relief treatment – a sham nerve stimulator that appeared real but delivered no actual relief. Participants were then asked to rate the intensity of their pain on a scale between 0 (not painful) and 100 (unbearably painful). Unbeknownst to the participants, researchers adjusted the heat stimulus to reinforce their expectations – making it less painful in the placebo condition and more painful in the nocebo condition.

In the second session, the heat stimulus was kept identical for the placebo, nocebo and control groups, allowing researchers to test whether expectations formed on the first day continued to shape the participants’ pain perception.

The results, published in a reviewed preprint in eLife, show that both placebo and nocebo suggestions significantly influenced pain perception – but the nocebo effect was stronger.

On the first day, participants in the nocebo group rated their pain an average of 11.3 points higher than the control group; while the placebo group rated their pain only 4.2 points lower than the control group.

When participants returned one week later for the second session, the patterns persisted. The nocebo effect remained stronger than the placebo effect, with participants in the nocebo group rating their pain 8.9 points higher than the control group. The findings in the placebo group were more modest, with average pain ratings just 4.6 points lower than the control group.

“This suggests that people are more likely to expect and feel worse outcomes than better ones,” says Schmidt. “It reflects a ‘better-safe-than-sorry’ strategy – humans may have evolved to be more attuned to potential threats, making negative expectations carry more weight.”

Schmidt and her colleagues found that participants who experienced a strong placebo or nocebo effect on the first day were more likely to show the same response a week later. Psychological factors were also involved. Participants who rated the researcher in the sham sessions as highly competent were more susceptible to nocebo effects – possibly because they found the negative suggestions more believable.

“Our findings highlight the enduring nature of both placebo and nocebo effects in pain, with nocebo responses showing consistently greater strength over time,” said senior author Ulrike Bingel, MD, Director of the Interdisciplinary Center for Pain Medicine and Translational Pain Research at the University Duisburg-Essen. “While we often focus on boosting positive expectations in patients, we show that it may be just as important – if not more so – to avoid unintentionally creating negative ones, which appear to be more easily triggered.”

Bingel said the study demonstrates the need for better communication between patients and practitioners in real-life clinical settings. Negative or positive outcomes for patients can be triggered by how doctors and nurses communicate with them. In other words, a good bedside manner can improve patient outcomes.

“Positive framing, avoiding unnecessary emphasis on side effects, and building a trusting relationship can all reduce the risk of triggering nocebo responses. In a time when cost-effectiveness in healthcare is essential, preventing nocebo effects should be a key strategy for improving treatment outcomes,” said Bingel.

A recent study found that about a third of patients with irritable bowel syndrome (IBS) falsely believe that gluten or wheat trigger their symptoms. This may be a nocebo effect, where patients experience IBS symptoms after eating what they consider unhealthy food, even when there is no evidence that they are sensitive to wheat or gluten. 

Drugs Targeting ‘Zombie Cells’ May Reduce Low Back Pain

By Pat Anson

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

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

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

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

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

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

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

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

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

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

Researchers Replicate Human Pain in Lab Dish

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

Poor Oral Health Linked to Fibromyalgia and Migraines

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

How Chronic Pain Impacts Romantic Relationships

By Crystal Lindell

The more you love someone with chronic pain, the more likely it is that their pain will cause you emotional distress. 

That’s according to new research published in the Journal of Health Psychology, which looks at the ways middle-aged romantic partnerships are impacted when one person has chronic pain. 

The researchers collected twice-daily surveys over the span of 30 days from 147 couples who were at least 50 years of age and had one partner who suffered from chronic back pain. 

Using the couples' answers to questions about distress and relationship closeness, as well as reports of pain severity from the pain-affected partner, they examined how emotional, behavioral and cognitive closeness affected the quality of couples’ daily interactions.

On the positive side, researchers found that emotional closeness between couples dealing with chronic pain led to more marital satisfaction on days when the couple felt close. 

However, on the other side of things, the closer the couple felt emotionally on any given day, the more likely it was that the non-pain partner experienced more distress. The non-pain partner apparently feels empathy for the pained partner, which results in them feeling stressed. 

As anyone who’s ever been in love knows, empathy is the required price. When your partner is sad, you will also tend to be sad on their behalf. 

This is not inherently a bad thing. Feeling empathy for your partner when they are dealing with pain makes it more likely that you’ll work harder to ease their pain, by doing things like advocating for them in healthcare settings and allowing them to rest while you do the household chores. 

The researchers framed this as something to avoid though, which I guess makes sense if it’s happening excessively.

“Couples have to find a balance that is ideal for them in managing closeness versus independence — this is true for all couples, not just those dealing with the impacts of chronic pain. But for those dealing with chronic pain, we can help them learn how to balance the benefits of closeness with minimizing shared distress stemming from a chronic condition,” lead researcher Lynn Martire, PhD, a professor of human development and family studies at Penn State’s Center for Healthy Aging, said in a press release.: 

The findings suggest that methods could be developed to help couples find the right balance in closeness, which would protect them from causing more pain and distress for each other. Martire and her colleagues plan further studies on the roles of behavioral and cognitive closeness.

“I’m excited to dive deeper into the other research questions we can examine from this data set,” Martire said. “We gathered data using different measures of relationship closeness, how they differ between patients and partners and how relationship closeness changes over time. We are poised to learn a great deal about the impact of pain on couples.”

Prior studies show that closeness is associated with many positive and beneficial relationships, including higher levels of commitment and satisfaction, and a lower risk of the relationship ending. 

However, researchers also say their findings suggest that too much closeness may transfer negative emotions and physical symptoms between partners.

“These findings illustrate a complex interplay between closeness and personal well-being in couples managing chronic illness and suggest the need for interventions that target both the benefits and potential costs of closeness,” they concluded. 

Yes, indeed, there are “benefits and potential costs” in any close relationship. It’s a contradiction that countless poets have spent centuries trying to navigate. 

Love comes at a price, but most of the time, the price is worth it. 

Pain Makes Young Adults More Likely to Mix Cannabis with Alcohol

By Crystal Lindell

A new study reveals that being in pain as a young adult makes you more likely to mix cannabis and alcohol. 

The research, published in the journal Alcohol, looked at 18 to 24 year olds. They found that those with moderate to severe pain were 1.4 times more likely to engage in the co-use of alcohol and cannabis over the next four years, compared to those with no pain. 

The Binghamton University researchers say this is the first study to examine pain as a predictor for co-using alcohol and cannabis. 

Previous research has shown that young adults who mix alcohol and cannabis are more likely to engage in impaired driving, risky sexual behavior, and/or experience mental health problems. 

But that begs the question, which causes which? 

I don’t think we should assume that using cannabis and alcohol together causes mental health issues. Perhaps it is the stress and anxiety of young adulthood – and poorly treated pain – that cause people to seek relief with things like alcohol and cannabis.

Previous studies have shown that about two-thirds (67%) of young adults in the U.S. reported pain in the past six-months, and more than 2 million of them had chronic pain. 

Physical pain in young adulthood can have long-lasting consequences. 

"Pain is of particular concern during emerging adulthood because it directly impacts developmental milestones across multiple domains, and emerging adults with chronic pain report greater isolation from their peers, fewer educational and occupational opportunities, greater anxiety and depression, and a poorer overall quality of life," the authors write. 

All of this really highlights why it’s so important that we fully treat pain in young adults – and really, in everyone who suffers from it. 

Unfortunately, that’s not the framing the authors chose to go with in their paper. Instead, they write that “pain is a unique risk factor for substance use.”

The choice to use “risk factor” in that sentence speaks volumes, although I am glad that they then used “substance use” as opposed to the more judgemental “substance abuse.”

Because that’s the thing, using a substance to treat something is not inherently bad. People use ibuprofen to treat headaches. But we don’t have research papers claiming that “headaches are a risk factor for Advil use.” Or even “having diabetes is a risk factor for insulin use.” 

Like yeah, you think? People use medications that treat their ailment in order to treat their ailment. 

Pain is definitely an aliment – and cannabis and alcohol are substances that do indeed relieve pain. The only reason anyone believes otherwise is because of government framing. 

We have drastically reduced the amount of opioids prescribed, but that doesn’t mean we have drastically reduced the amount of pain that people endure. It’s only natural that people will seek out alternatives. Younger people tend to have a more difficult time convincing doctors to treat their pain, meaning they are more likely to be left to fend for themselves. 

Alcohol and cannabis may not be the best choices for pain relief, but they may be the only ones available.

People in pain — at any age — will always look for ways to alleviate that pain. And the more options people in pain have, the more likely it is that they’ll find what works best for their body and their circumstances, while causing the least amount of negative side effects. 

If their only effective option is alcohol mixed with cannabis, then that’s what they’ll use. If the government and medical community don’t like that, then they should give them more options. 

An ‘All in Your Head’ Diagnosis Can Cause Lasting Harm to Autoimmune Patients

By Melanie Sloan

Feeling disbelieved when knowing that there is something very wrong with your body can have devastating and long-term consequences. One of the most obvious consequences is that you won’t get the correct treatment and support.

A study my colleagues and I conducted of over 3,000 people with autoimmune disease uncovered many extra long-lasting disadvantages when the misdiagnosis involved a mental health or psychosomatic label (often termed an “in your head” misdiagnosis by patients).

These often included feelings of shame, self-doubt and depression. For some, it extended to suicidal thoughts and even suicide attempts.

A further consequence was that people had much lower trust in doctors. This distrust led to some people avoiding seeking further medical help, often for fear of being disbelieved again.

A concerning finding from our study was that these negative emotions and distrust often remained just as strong many years after feeling that a doctor had not believed their symptoms.

Psychological scars were deep and usually unhealed. Over 70% of people reporting a psychosomatic or mental misdiagnosis said that it still upset them. And over 80% said that it had damaged their self-worth.

One of our study participants, who had several autoimmune diseases, told her story that spoke for many: “One doctor told me I was making myself feel pain – I still can’t forget those words. Telling me I’m doing it to myself has made me very anxious and depressed.”

These findings were not just anecdotal. Overall, we found depression levels were significantly higher and well-being levels lower in people who reported receiving mental health or psychosomatic misdiagnoses.

‘It Has Affected My Mental Health’

We chose to use this woman’s testimony in the title of our study: “I still can’t forget those words.” Not only did it accurately reflect our findings, but it symbolises our research team’s ethos to give these often unheard patients a voice.

The hurt of misdiagnosis was compounded by having “nowhere to voice my anger” or distress. Some of the most moving stories were from people whose early symptoms of autoimmune disease, when they were still children, had been disbelieved by doctors.

Even in middle or older age, those words and feelings had remained with them for decades, often felt as strongly as the day that they were heard. As one of the patient partners in our research team described it, they lived the rest of their lives with “seared souls”.

A woman with lupus told the interviewer that her doctor had told her at age 16 that she had “too many symptoms for it not to be hypochondria”. She spoke very emotively and articulately about the damage caused to a developing sense of self.

“It has affected my mental health very negatively and I do think it’s affected me in my like sense of self. It’s not good for anyone at any age but as a teenage girl being told you don’t know your own feelings is absolutely no way to shape a human being.”

It is natural when hearing all these very difficult stories, and seeing the damage caused, to blame doctors, but is that fair? Doctors very rarely set out to cause harm. Rather, in some cases, it is impossible to diagnose autoimmune diseases quickly.

However, our study highlights that some doctors do reach too quickly for a psychosomatic or mental health explanation for autoimmune disease symptoms.

Some research that may have influenced doctors in giving psychosomatic misdiagnoses says that a long list of symptoms is a red flag that the symptoms are not caused by a disease. This generalisation rather dangerously fails to account for the fact that a long list of symptoms is also a red flag for many autoimmune diseases.

Many autoimmune symptoms are also invisible, and there are no clear tests that will show how bad they are to the doctor. Some of the terms that patients find upsetting and dismissive when doctors talk or write about their symptoms include “vague” and “non-specific”.

Doctors often write letters quickly due to health service constraints, sometimes unthinkingly using terms passed down from their seniors; letters that use terms like “patient claims” or “no objective evidence found of” can increase feelings of being disbelieved.

Empathetic Listening

Our research suggests that more doctors need to think about autoimmunity as a diagnosis early on when faced with multiple varied symptoms that often don’t seem to fit together. Above all, many diagnostic clues can be found by listening to and believing the people experiencing the symptoms.

Empathetic listening and support are also required to help misdiagnosed patients heal emotionally – they very rarely can just “move on” as one doctor advised. We should not underestimate the power of doctors saying “I believe you” to patients with multiple invisible symptoms, and “I am sorry for what has happened in the past” if they had a difficult road to diagnosis.

Most of the 50 doctors interviewed for the study reported that misdiagnoses were common in autoimmunity, but few had realised that the repercussions of these misdiagnoses were so severe and long lasting.

Reassuringly, almost all of them were saddened and motivated to improve their patients’ experiences. Several explained that they thought they were being reassuring by telling patients that their symptoms were most likely to be psychological or stress-related and thought this would be preferable to patients worrying about having a disease.

Although many people experience mental health and psychosomatic symptoms, and doctors must consider them as a possible explanation, a clear lesson from our study is that psychosomatic (mis)diagnoses are rarely seen as reassuring to patients with autoimmune disease symptoms. Rather, they are usually deeply damaging with lifelong and life-changing repercussions.

Melanie Sloan, PhD, is a public health researcher at the University of Cambridge. She is also a Senior Research Fellow at the University of East Anglia. 

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

Depression and Anxiety Affect 40% of Chronic Pain Patients

By Pat Anson

About 40% of adults with chronic pain have clinical symptoms of depression or anxiety, according to a large new study that calls for the routine screening of pain patients for mental health issues.

Researchers conducted a systematic review and meta-analysis of 376 studies involving nearly 350,000 people with chronic pain around the world. Their findings, published in JAMA Network Open, show that pain patients with fibromyalgia had the highest rates of depression and anxiety, along with those who are younger and female.

“To address this significant public health concern, it is essential to routinely screen for mental health symptoms in clinical settings where people with chronic pain are treated,” wrote lead author Rachel Aaron, PhD, a clinical psychologist at Johns Hopkins University School of Medicine

Aaron and her colleagues found that people with fibromyalgia, complex regional pain syndrome (CPRS) and other types of nociplastic pain -- persistent nerve pain that occurs without tissue damage – were most likely to have depression and anxiety; while those with post-surgical pain, arthritis and other conditions with documented tissue damage were less likely to have mental health issues.

Many patients resent the idea that their pain is “all in their head,” but researchers think emotional stress and trauma may play a causal role in the development of chronic pain.

“The overall pattern of findings aligns with evidence that psychological distress and adverse life experiences increase the risk for chronic nociplastic pain,” researchers said.  “The present findings underscore the need for innovative treatment development to address these prevalent comorbidities, particularly for nociplastic pain.

“For physicians treating individuals with chronic pain in primary care and specialty practice, systematic screening of depression and anxiety is critical, as is having a network of mental health referral sources when a positive screening result is detected. Short-term, cost-effective, and remotely delivered psychological treatments for chronic pain are becoming increasingly available and can be recommended to individuals with chronic pain.”

Previous studies have also found an association between chronic pain, anxiety and depression.

Researchers at McGill University found that people who experienced physical, sexual or emotional abuse as children were 45% more likely to report chronic pain in adulthood. Childhood trauma has also been linked to an increased risk of fibromyalgia, migraine and lupus, as well as mood and sleep problems.

A 2023 study estimates that 12 million adults with chronic pain in the U.S. have anxiety or depression so severe that it limits their ability to work, socialize and complete daily tasks. That study also recommends that pain patients be routinely evaluated for anxiety and depression.

Can Aching Joints Predict the Weather?

By Michelle Spear

For centuries, people have claimed that their aching joints can predict changes in the weather, often reporting increased discomfort before rain or cold fronts. Given the scale and duration, there is a sense of legitimacy to these anecdotes – but this phenomenon remains scientifically contentious.

From shifts in barometric pressure to temperature fluctuations, many theories attempt to explain how environmental factors might influence joint pain. But is there an anatomical basis for this claim, or is it simply an enduring weather-related myth? Are our joints any more reliable than the Met Office?

At the heart of this debate lies barometric pressure, also known as atmospheric pressure – the force exerted by air molecules in the Earth’s atmosphere. While invisible, air has mass, and the “weight” pressing down on us fluctuates with altitude and weather systems.

Higher barometric pressure often signals fair-weather conditions with clear skies and calm winds, whereas lower pressure typically precedes unsettled weather, such as cloudy skies, precipitation and humidity.

Moveable joints are intricate structures cushioned by synovial fluid, the viscous liquid that lubricates joints, and encased in capsules rich in nerve endings. In healthy joints, these components should allow smooth, pain-free movement. However, when joints are compromised by cartilage damage (as in osteoarthritis) or inflammation (as in rheumatoid arthritis), even subtle changes in the environment may be acutely felt.

One leading hypothesis suggests that changes in barometric pressure may directly influence joint discomfort. When atmospheric pressure drops ahead of storms, it can allow inflamed tissues within joints to expand slightly, increasing stress on surrounding nerves and amplifying pain. Conversely, rapid increases in pressure, characteristic of fair-weather systems, may compress already sensitive tissues, leading to discomfort in some people.

Scientific studies offer some support for these claims, though results remain mixed. For instance, a 2007 study published in the American Journal of Medicine found a slight but significant correlation between dropping barometric pressure and increased knee pain in osteoarthritis patients. However, this pattern is not universally observed across all joint conditions.

A 2011 systematic review in Arthritis Research & Therapy examined the relationship between weather and pain in rheumatoid arthritis patients. It revealed highly variable responses: while some people reported increased pain under low-pressure conditions, others noted no change. A few even experienced discomfort during high-pressure fronts.

More recently, a 2019 citizen-science project called Cloudy with a chance of pain used app-based pain tracking to explore this connection. The study found a modest association between falling pressure and heightened joint pain, but it also highlighted substantial individual differences in how people perceive weather-related pain.

These findings suggest that while changes in barometric pressure may influence joint pain for some, responses are far from uniform and depend on a complex interplay of factors, including the individual’s underlying joint condition and overall pain sensitivity.

Why Responses Differ

Barometric pressure rarely acts in isolation. Fluctuations in temperature and humidity often accompany pressure changes, complicating the picture.

Cold weather can have a pronounced effect on joints, particularly in people with existing joint conditions. Low temperatures cause muscles to contract and become stiffer, which can lead to reduced flexibility and a greater risk of strain or discomfort.

Ligaments, which connect bones to one another, and tendons, which anchor muscles to bones, may also lose some of their elasticity in colder conditions. This decreased pliability can make joint movement feel more restricted and exacerbate pain in conditions like arthritis.

Cold weather can also cause blood vessels to narrow — particularly in the extremities, as the body prioritises maintaining core temperature. This reduced blood flow can deprive affected areas of essential oxygen and nutrients, slowing the removal of metabolic waste products like lactic acid, which may accumulate in tissues and exacerbate inflammation and discomfort.

For people with inflammatory conditions, the reduced circulation can aggravate swelling and stiffness, especially in small joints like those in the fingers and toes.

Cold also slows the activity of synovial fluid. In lower temperatures, the fluid becomes less effective at reducing friction, which can heighten joint stiffness and make motion more painful, particularly for people with degenerative conditions such as osteoarthritis.

Sudden temperature changes may also play a role. Rapid shifts can challenge the body’s ability to adapt, which might worsen pain in people with chronic conditions. Similarly, high humidity can intensify sensations of heat or dampness in already inflamed areas, further complicating the experience of pain.

However, isolating a single variable – whether humidity, temperature or pressure –proves difficult because of the interplay of overlapping factors.

Responses to weather also depend on individual factors, including the extent of joint damage, overall pain sensitivity and psychological expectations. This variability makes it difficult to link a single meteorological factor to a biological response.

Still, the evidence suggests that people with joint conditions tend to be more attuned to environmental changes, particularly pressure fluctuations.

While the relationship between weather and joint pain remains an imperfect science, the collective evidence indicates that there may be some truth to the age-old belief. For those with chronic joint conditions, shifts in barometric pressure and accompanying weather changes might indeed serve as nature’s warning system – albeit one that’s far from foolproof.

Michelle Spear, PhD, is a Professor of Anatomy at the University of Bristol in the UK.

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

Where Have All the Pain Doctors Gone?

By Pat Anson

In recent years, it’s become increasingly difficult for a patient in pain to find a new doctor. Many physicians have stopped treating pain, retired early or switched specialties, rather than run the risk of being investigated or even put in prison for prescribing opioids.

In a recent PNN survey, one in five patients said they couldn’t find a doctor to treat their pain. Others said they were abandoned or discharged by a physician (12%) or had a doctor who retired from clinical practice (14%).   

“All the doctors in this area are justifiably terrified to involve themselves at all with opiates,” one patient told us. “It's now going on 6 months that I've been hunting for a doctor who isn't afraid to continue my former opiate regimen, which only made my pain tolerable, allowing me some small quality of life. I don't know what to do next and I am truly at my wits end.”

“This year my doctor retired, then 8 months later the hospital closed the pain clinic. I'm waiting to get into a new pain clinic that is 200 miles away. Every local doctor refuses to prescribe my pain meds, so now I'm forced to travel 4 hours each way to see a new doctor,” another patient said.

“I have to fly to another state for my medical care,” said another person in pain. “Many patients I’ve met over the last ten years have not had the same care. They can’t afford the medical treatment and can’t find doctors to help.”

A new study suggests the problem is only going to get worse, because medical schools are seeing fewer anesthesiology residents applying for fellowships in pain medicine. The number of applications fell 45% from 2019 to 2023.

“While the demand for pain specialists is growing in the U.S., the pipeline of new doctors to fill these roles is drying up,” says lead author Scott Pritzlaff, MD, an associate professor in the UC Davis Department of Anesthesiology and Pain Medicine and director of the school’s Pain Medicine Fellowship program.

Pritzlaff and his colleagues analyzed data from the National Resident Matching Program (NRMP), Electronic Residency Application Service (ERAS) and a special report from the American Association of Medical Colleagues (AAMC) to see trends in medical specialties.

Their findings, recently published in the journal Pain Practice, show significant changes in specialties that are being driven by market forces and professional preferences. While demand and pay scales for general anesthesiologists have increased, the number of anesthesiology trainees applying for pain medicine fellowships is dropping. The trend is most notable among female residents applying for the specialty, which has fallen by 27.5%, compared to a 9.8% decline in male applicants.

“Fewer doctors choosing pain medicine means longer wait times, rushed care and fewer treatment options for patients suffering from chronic pain,” Pritzlaff said. “In a country already grappling with an opioid crisis, this could leave millions without the specialized care they need to manage their pain safely and effectively.”

Co-author Chinar Sanghvi, MD, says the drop in applications is partially driven by opioid lawsuits against drug makers and criminal cases against doctors, which have made medical residents and trainees leery about practicing pain medicine.

“For trainees observing this during their formative years, it may have created a perception of pain medicine as a high-risk specialty — both legally and ethically,” said Sanghvi, an assistant clinical professor in the UC Davis Department of Anesthesiology who mentors first and second year-medical students. “This fear of litigation, coupled with the stigma surrounding opioid prescribing, could discourage aspiring physicians from entering the field.”

The data also revealed some upward trends. Applications from residents for physical medicine and rehabilitation fellowships rose almost 33%, while residents specializing in emergency medicine increased by 190%.

General anesthesiologists have some of the best paying jobs in medicine, with median salaries of nearly $499,000 a year. For an anesthesiologist to specialize in pain medicine requires an additional year of training and pays less. With high demand and higher salaries, many doctors skip the extra training and enter the workforce right after completing their anesthesiology residency.

To help attract new residents, the UC Davis Health Division of Pain Medicine increased its recruiting efforts and became more active on social media. The efforts helped UC Davis fill its fellowship slots in pain medicine despite the national downturn.

“Pain medicine is caught in a strange paradox. On one hand, pain is one of the biggest public health problems in America, costing billions annually. On the other, the field is underappreciated and underfunded,” said senior author David Copenhaver, MD, a professor in the UC Davis Department of Anesthesiology and Pain Medicine and chief of the Division of Pain Medicine. “This decline isn’t just about numbers — it’s a wake-up call for the future of pain care in America.”