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.

Cancer Patients Were Supposed to Be Exempt From CDC Opioid Guideline. They’re Not.

By Crystal Lindell

Cancer patients needing pain treatment were always meant to be exempt from the recommendations of the 2016 CDC opioid guideline, including the updated guideline released in 2022:

“This clinical practice guideline does not apply to patients undergoing cancer-related pain treatment, palliative care, or end-of-life care because… for many persons at the end of life, serious potential long-term opioid-related harms such as opioid use disorder might not be relevant.” 

A new study reveals that many older cancer patients were deprived of opioids anyway, even though they often require opioids as a first-line pain treatment.

The study looked at nearly 12,000 older adults on Medicare who were being treated for cancer from 2010 to 2020, including about 1,300 with advanced cancer or cancer pain.

Researchers found a significant 24% decline in opioid prescribing to cancer patients after the 2016 guideline was released. What did they get instead for pain relief?

There was a 7.5% increase in tramadol prescribing for cancer pain, while gabapentinoid prescribing for cancer patients rose by 25%. Even patients with advanced cancer were switched to tramadol or gabapentinoids, a class of nerve medication originally developed to treat seizures, not pain. 

“These findings suggest the 2016 guideline may have led to pain management shifts from first-line opioids to less-safe tramadol and less-effective gabapentinoids for older adults with cancer,” wrote lead author Rebecca Rodin, MD, Assistant Professor of Geriatrics and Palliative Medicine at the Icahn Mount School of Medicine at Mount Sinai.

It’s great to see the study authors call out tramadol and gabapentinoids as being “less safe” and “less effective.” Pain patients have long known that to be true, but the medical community still seems resistant to this information. 

While tramadol is technically an opioid, the DEA classifies it as a weaker Schedule IV drug, unlike oxycodone, hydrocodone and other opioids classified as Schedule II. The differentiation means doctors face less restrictions for prescribing it and less risk of going to prison. 

Gapabentin (Neurontin), pregabalin (Lyrica) and other gabapentinoids are prescribed off-label for cancer pain and chemotherapy-induced neuropathy —  even though they are medical conditions the drugs are not approved for. Gabapentinoids are not only ineffective analgesics for cancer pain, they can cause sedation and confusion, particularly in older adults.

Opioids, on the other hand, are very effective for moderate-to-severe cancer pain, with a response rate of 75% and a 50% average reduction in pain intensity.

Studies like this validate what the pain community has been trying to warn about for almost a decade: opioid-phobia has gone too far. It has reached a point where even cancer patients can’t get the pain relief they need.

Part of why this persists is that most people don’t think opioid restrictions are a problem until they or a loved one needs them. But if you wait until you’re dying from cancer to oppose opioid restrictions, it will be far, far too late. 

Of course, the other problem is, cancer is not the only thing that can cause debilitating pain. And people with other types of pain also deserve effective relief.

Another recent study by Dr. Rodin found that seriously ill patients in palliative and hospice care also have trouble getting opioids, due to inadequate supplies in pharmacies and insurance obstacles.

“The reality is that hundreds of thousands of seriously ill patients in the U.S. rely on opioids as a first-line treatment for pain. For people with advanced cancer, chronic organ failure, or other life-limiting conditions, opioids are often the only medications that can effectively control pain and allow them to function, Rodin wrote in a recent op/ed in STAT .  

Opioids have been used for centuries to treat pain for a reason: They work very well, and the risks of opioid addiction and.overdose are far less than what the public has been led to believe. 

Now we just need to convince doctors and the CDC of that. 

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.

I Hate That I Need Opioid Pain Medication

By Crystal Lindell

I genuinely hate that I need opioid pain medication. 

I hate that I need it to function. I hate how expensive it is. I hate how I have to endure background checks like drug tests and interrogations to get it — like I was a criminal. 

I hate how tired it makes me. 

I hate that I can’t just buy it over-the-counter. I hate that I have to deal with judgmental doctors and pharmacists every single month to get it. I hate how vulnerable it makes me feel. I  hate how much stigma there still is around it. 

I hate that I hate it as much as I do, and yet people still think that I only take it because I’m a lazy loser who loves to get high. 

I hate that when I take it — it actually works — because that just shows how much I need it. 

Chronic pain sucks. But needing daily pain meds for a chronic condition also sucks. 

I have gone to great lengths to try to get off opioids — to try to live without them. 

I’ve done painful nerve block procedures, weekly lidocaine infusions at a hospital over an hour from my house, and gone to every specialist in that hospital. I’ve tried THC, kratom, nicotine gum, wine, and capsaicin cream. I’ve tried yoga, chiropractors, and acupuncture. I’ve tried gluten-free diets, losing weight, daily walking, and prayer.

I’ve also tried to just live with the pain. 

But I can’t. I still need opioid medication. 

I need it to shower. I need it to work. I need it to relieve the pain that makes me suicidal if left untreated.

Without opioid pain meds, I’d either be too disabled to function, or in too much pain to live. 

And I hate that so much. 

I wish that was not the case. I wish I could just exist in this stupid world without needing opioids to be alive, to actually live. 

I wish there was some other way to manage my chronic pain or even better, that I didn’t have chronic pain to begin with.

But alas, that is not the case. I literally need opioid pain medication to survive. 

So I keep taking it. 

I keep submitting to all the stupid hurdles put in place by doctors, pharmacists, and the DEA. I keep coming up with money to pay for my appointments and prescriptions. And I keep enduring the stigma that comes with it.

But I still have hope that one day people who need opioid pain medication won’t have to hate that they need it. That they’ll have access to it, and that they won’t have to submit to dehumanizing treatment to get it. 

I hope that one day needing opioid pain medication won’t be a burden to patients that must be endured on top of whatever ailments they already have. I’d rather they just bring the relief they were intended for.

The healthcare system doesn’t have to be like this. We can change it. Opioid pain medication could be accessible, inexpensive, and stigma-free. We just have to make it so.

Lupus Unknown to Most Americans, Despite Widespread Prevalence

By Pat Anson

About 1.5 million Americans suffer from lupus, a disabling autoimmune condition that causes extreme fatigue, cognitive issues and damage to tissues and joints. Although lupus is a leading cause of death for young women, many of them Black or Hispanic, most Americans know little about the disease.

A new survey commissioned by the Lupus Foundation of America found that over half of American adults (53%) know very little about the disease or nothing at all --- even though 42% say they personally know someone living with lupus. The survey findings are being released to coincide with Lupus Awareness Month in May.

"The survey is a sobering reminder that lupus remains a misunderstood and underestimated chronic condition," Louise Vetter, President & CEO of the Lupus Foundation of America, said in a press release. "Lupus Awareness Month is a call to action because we know that awareness is the first step toward deeper understanding, stronger doctor-patient engagement, and healthier lives."

One of the reasons lupus is so poorly understood is that it is difficult to diagnose. The symptoms vary from person-to-person, can come and go or change over time, and are often misdiagnosed. On average, it takes nearly six years for people to be diagnosed after they first notice lupus symptoms.

About 43% of survey respondents said they did not know lupus is an autoimmune disease, 44% did not know lupus can impact any organ in the body, and more than a third (38%) were not aware that lupus can be fatal.

While lupus primarily impacts younger women aged 15-44, nearly half of Americans (40%) said they did not know that children can also develop the disease. Up to 20% of people with lupus are diagnosed as children, and pediatric onset of the disease tends to be more severe and aggressive than in adults.

There are no known causes or cure for lupus, and the FDA has approved only three medications that were specifically developed to treat lupus. Several non-lupus medications, originally developed to treat malaria or cancer, are being repurposed to treat lupus. On average, people with lupus take an average of nearly eight prescription medications to manage their symptoms.

The Lupus Foundation says there has been significant progress in developing new lupus treatments in the last five years, but concern is growing that cuts in federal health research will stifle further progress.

A continuing resolution passed by Congress in March would eliminate funding for the Lupus Research Program at the Department of Defense. The Department of Health and Human Services would also lose about a third of its funding under a proposed 2026 budget. That would coincide with a major reorganization of the CDC and the HHS Office of Minority Health, which threatens to eliminate two additional lupus programs.

“The Lupus Foundation of America is profoundly concerned by the reorganization and significant staff reductions taking place at the U.S. Department of Health and Human Services (HHS) in addition to cuts that already have been made to the Lupus Research Program at the Department of Defense (DoD). These changes threaten to disrupt and delay vital lupus programs and negatively impact lupus research, drug development, and public health initiatives,” the foundation said in a statement.

The foundation will hold its annual National Lupus Advocacy Summit on May 4-6 in Washington DC, which you can watch via livestream.

World Lupus Day is on May 10, with a call to action for patients and advocates to wear purple and light significant landmarks with the color purple.

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. 

Forced Tapering: Only Chronic Pain Patients Are Treated This Way

By Neen Monty

Imagine this: A patient, let’s call her Sue, has severe depression. Her GP prescribes an anti-depressant and refers her to a psychologist. Sue is advised to come back in four weeks. Which she does.

She’s not doing better, so the dose is increased. Sue is reviewed two more times over the next eight weeks, and each time her dose is increased.

Sue starts feeling better. The medication is working. The darkness has lifted, the black dog has been banished. She is grateful to her GP.

The GP is also happy. It has taken many weeks, but the GP raised the dose to find the minimum effective dose that controls Sue’s depression.

Sue comes back in another four weeks. She is happy, back at work, and socialising again. Life is good!

That’s when the GP tells her that it’s time to taper the anti-depressants.

Wait, what?

Or how about this: Sue has high blood pressure. She is at her GP for her yearly physical and the hypertension is discovered. The doctor prescribes a blood pressure medication and advises Sue to return in two weeks. At this review, her blood pressure is still too high, so the dose is increased.

Sue has two more dose increases, and her blood pressure falls into the normal range. She is experiencing no side effects and is very happy with the treatment.

When Sue sees her GP again with perfect blood pressure, he is pleased. Then he tells her it’s time to taper off the medication.

What if Sue had high cholesterol? Or high blood sugar? Or asthma? Epilepsy maybe?

I think you see where I am going with this.

The tapering would never happen, because it’s ludicrous and makes no sense, medically or otherwise. In these situations, people like Sue are often advised that they need to be on a medication for rest of their lives.

Where in medicine do doctors increase the dose of a medication until the symptoms are well managed and the patient is doing better -- and then gets tapered?

Only when the patient has chronic pain and is on opioid therapy. Doctors will prescribe a trial of opioids, which prove to be effective. The patient reports well-controlled pain, no significant side effects, and they are back at work, socialising, and living life again.

And then the doctor starts tapering the opioids. Against the patient’s wishes.

Utter insanity.

That’s not “evidence-based medicine.” There is no evidence to support this practice. I know what the theory is, and what doctors have been taught. But it’s not realistic. Yet many doctors don’t question it.

The theory is that once a patient gets pain relief, they will learn how to manage it without opioids. They’ll start to exercise and meditate, see a psychologist, work on their sleep hygiene, and get proper nutrition.

Except these other modalities will do nothing for severe, disabling pain.

Please point me to one study that shows that improving sleep will reduce the pain of multiple sclerosis, chronic inflammatory demyelinating polyneuropathy, or Parkinson’s disease. Or one study that shows cognitive behavioral therapy or mindfulness will reduce the pain of rheumatoid arthritis and lupus.

Those treatments may be helpful in very small ways. But their effect has been vastly overstated for chronic secondary pain -- pain that is caused by an injury, tissue damage, or disease.

Lifestyle modification can have an impact on a person who has mild to moderate primary pain -- chronic pain that does not have a known pathological cause. That pain is sometimes driven by emotional or psychological causes, so psychological treatments might be effective.

But they are ineffective for chronic secondary pain.

People will feel better on opioids, but its not “euphoria.” It’s because they can start exercising again, restart their hobbies, and return to work. They’ll feel happy again. Those positive things happen because their pain is now being treated.

Take away the pain medication, and the pain will return. The career grinds to a halt, the social life disappears, depression returns. Exercise is impossible while in severe pain. Everything returns to terrible.

There is no magic trick that can replace opioids. There is nothing else that will touch severe pain, be it acute or chronic.

And so, for doctors to provide a trial of opioids for secondary pain with the goal of eventually tapering patients is insanity. The only reason opioids should be tapered is if there are intolerable side effects, if they are not effective for the pain, or the patient wants to taper.

No one should be forcibly tapered. Ever. Forced tapering leads to a pain crisis, suicidal ideation, overdose and death. That’s what the science says.

Opioids are safe and effective when taken long term by a select minority of people – those who live with severe, disabling pain due to an incurable disease or injury.

Think about how cruel it is to provide them with a solution to their pain, to give them their life back, and then take it away.

Its abhorrent.

Its barbaric.

It’s not medicine. It’s not science. It’s not human.

Neen Monty is a writer and patient advocate in Australia who is dedicated to challenging misinformation about pain management. Drawing on lived experience and scientific research, Neen has created a website for Pain Patient Advocacy Australia that is full of evidence that opioids can be safe and effective, even when taken long term. You can also subscribe to her free newsletter on Substack, “Arthritic Chick on Chronic Pain.”

Does Not Taking Pain Medication Make You a Hero?

By Crystal Lindell

There’s a deeply ingrained belief in American culture that suffering is both cleansing and healing. It’s likely connected to the widespread mythology about the American Dream: With hard work, you can achieve anything – emphasis on the “hard.”

If it’s easy – or even just easier – something must be wrong, and maybe even immoral. In other words, if you’re not in pain, you’re not gaining. 

This belief, sadly, has even permeated healthcare in a number ways. Many doctors act as though suffering is the point when it comes to certain ailments that we’ve moralized, like weight loss, substance use, mental health, and of course, pain.  

This thought process has also seeped into the general population, like a virus. I’ll often hear people brag that they didn’t need any of their prescribed pain medication after a surgery – as though that’s some sort of achievement. 

I’ve also heard patients with chronic ailments imply their own superiority by making it clear that they almost never take pain medication – as if that makes them better than the patients who need it. 

But suffering, in and of itself, does not make you a hero. Denying yourself medication that helps you is not some sort of gold-star achievement. You don’t get a medal because you endured more pain than everyone else. You just get, well, more pain. 

If you truly don’t need your pain medication, then obviously you don’t need to take it – but it’s not something to brag about. 

Especially because one day, as you grow older and your body deteriorates, you may find that you actually do need the very medication you thought you were a hero for avoiding. Then you’ll have the added battle of unpacking all the shame you’ve internalized about using it.

The last thing anyone with pain needs is another battle. 

Pain medications aren’t just for comfort either, and avoiding them out of some moral obligation can quite literally be dangerous to your health. In acute care situations, like post-surgery or after a bone break, you need them so that your body can focus its energy on healing. They also allow you to move more so that you can avoid post-op complications like pneumonia. 

Pain medications are also vital for chronic pain conditions. They help patients maintain their physical health, stay independent, and even do things like work and household chores. Pain meds also make it possible for us to love, laugh and socialize, just like healthy people do.  

Beyond that though, your body was not designed to endure pain every single day. If you don’t treat pain, it will start to impact your brain, and more urgently, your sleep. Without good sleep, your health will deteriorate. 

Ultimately, there is no reward for “pushing through it.” Pain and suffering will not make you a better person. In fact, they are incredibly dangerous. So if you need opioid medication or some other pain reliever, you should take it. 

And if you don’t need it, there’s no reason to brag about it. Pain won’t make you a hero. Only compassion can do that. 

Top 3 Ways I Make Money While Living With Chronic Pain 

By Crystal Lindell 

Living with chronic pain can make it difficult to navigate traditional employment, due to the physical challenges and the unpredictability of our symptoms   

Unfortunately, we still need money to exist in our society, so I cobble together a living every month with various side jobs that I try to make into a whole job. Below is a look at some of those jobs, and the pros and cons of doing them if you have chronic pain or any sort of chronic illness.  

One large disclaimer is that none of these jobs offer health insurance. For me, for now, that just means that I don’t have insurance and I pay for medical care with cash. But I know a lot of others in a similar situation who either qualify for government insurance or they are able to purchase insurance on the government marketplace. 

Another disclaimer is that having a bunch of side jobs will make doing your taxes much more difficult, so try to put money away for that throughout the year in preparation for it. 

DoorDash

Pros: Flexible schedule, options for same-day pay, low barrier to entry. 

Cons: Success varies greatly based on where you live; the work can be physically exhausting; customers can be unpredictable and difficult; and there’s wear and tear on your car.

I started doing DoorDash in March after my cat Princess D was diagnosed with feline diabetes, and I needed to come up with some extra money for her treatment fast. 

I had a friend who told me she made $400 in four days doing DoorDash, and that was enough incentive to get me to sign up for the Dasher app. 

I live in a rural area where there are few DoorDash customers, so I drive about 20 minutes to a mid-sized city, where there are more customers and I can easily make $100 in about 4-6 hours of work. I’ve noticed that about 10 percent of my earnings go to gas, so I usually do one extra order each night to cover that. 

While there is the possibility of very low-paying orders of just $2, as long as customers tip, each order is usually at least $5 or as much as $15 in my area. 

There’s also an option to do “shop and deliver” orders, where you basically do someone’s grocery shopping. You don’t get offered those jobs at first, but as you get more experience in the app, they will start to give them to you. I had one that paid $60 for a little over an hour of shopping, because I was shopping three grocery orders simultaneously. That’s a great way to increase your earnings. 

I really, really like how flexible DoorDash is and that they offer a couple different ways to get paid the day you work. So if you need some quick cash for something like a utility bill or even just a fun outing, it’s possible to make the money fast and get paid fast. 

In the beginning, I worked mostly dinner hours and focused on Thursday through Sunday, because that’s when the app is the busiest. But after you earn various status levels, they give you more options for working whatever hours you want. Now I’m able to go out during the day, if that works for me. 

Best of all, if I’m having a bad pain day, I don’t do Doordash or can I work a very short shift. That’s flexibility that most traditional jobs don’t offer. 

Plus, if you need to stay below certain income thresholds to qualify for government benefits, it allows you to work exactly as much as you want/need to. 

If you decide to try it, I highly recommend joining some online DoorDash support groups on places like Facebook and Reddit. They are full of tips for drivers and can help you navigate the app and the job as a whole. 

Obviously, doing gig work like DoorDash will put a lot of wear and tear on your car, so you’ll need to keep up with vehicle maintenance. 

But if you’re looking for quick cash that you can make working your own schedule, then DoorDash and other similar gig work like UberEats can be a great way to do that. 

Freelance Writing

Pros: Some flexibility, can pay well, and can often be done at home

Cons: High barrier to entry; basically have to have connections to get work; and the work can be very unsteady.

I have a lot of professional experience as a writer and editor, so after I got laid off from my full-time journalism job in 2022, I had a few people reach out to me with freelance opportunities. 

This has been one of the better paying ways I make money, with some jobs paying as much as $50/hour or more. 

Even if you don’t have experience, that doesn’t mean you can’t freelance. If you have a special skill of any sort, whether it’s painting, photography or house cleaning, you can usually just post on your social media that you’re looking for work and you may be surprised by how many people reach out. 

My main advice would be to charge by the project rather than by the hour, so that you don’t have to track your hours as you go, and you don’t have to worry about any awkwardness between you and the client regarding how fast you’re working. 

If you’re setting your own rates, you have to factor in taxes and healthcare, so you should aim to make about as much per hour as you’d want to make yearly if you multiplied it by 1,000. So if you want to make $60,000 a year, you’ll want to charge a rate that works out to about $60/hour.

The biggest con to freelancing is that the work can be unsteady, which means you can’t really count on the income from month to month. For me, it’s usually based on what the publication or company I’m writing for needs at any given time. If they don’t need me, there’s no work, and thus, no money. 

Also, in the last few years, Generative AI, like ChapGPT, has dried up some of the writing and marketing work that used to be more plentiful for me. I suspect that trend will continue for my industry and others. 

However, I love writing, and freelancing allows me to be choosy about which writing jobs I want to take, so that I can focus on the things l’m passionate about, like writing for Pain News Network. Plus, making any money at all from my writing always feels like a victory to me. 

Selling Used Lego Online 

Pros: Fully done at home, can lead to a decent daily income stream, immediate pay, and it’s fun.

Cons: Relatively high barrier to entry because you have to invest in Legos and set up your own virtual store. It takes many hours of work to get things off the ground.

My fiance and I also run a virtual store where we sell used Lego. We buy bulk Lego from private sellers, wash them, sort them, inventory what we have, and then sell them by the piece. 

I’m not entirely sure I would really recommend this unless it’s something you’re passionate about, as it has been a LOT of work to run the store. And we have to use multiple rooms in our house to store Lego. 

We’ve also had some generous help from relatives, who have helped front the cost of the bulk Lego purchases we get, which helps a lot. 

But we’ve been running the store for a few years now, and it brings in a very steady stream of daily proceeds. And the more we expand the store, the more we tend to make. 

It’s also great to be able to work on the store at home and on our own schedule. 

There are other ways to make money selling used items online, and I know a lot of people make a living selling things on sites like eBay. But again, I really don’t recommend it unless it’s a product you’re really passionate about. 

For example, if you already love thrifting clothes, you may be able to find some cheap but valuable items that you can resell online. But you’ll quickly grow bored and frustrated with how much work is involved if you don’t love the process of sourcing in the first place. 

I will confess that even with all of these jobs, we are often tight on money. But we are very rich in other ways. We choose our own schedules, we are happy, we are able to rest when our bodies need it, and we get to spend a lot of time with our beloved cats. 

Maybe some day I’ll be healthy enough, both mentally and physically, to work full-time again, but for now, I’m just enjoying this chapter in our lives and all the flexibility it gives us. 

Safer Opioid Supply Helps Reduce Overdoses

By Pat Anson

Should people at high risk of an overdose be prescribed opioids like hydromorphone or should they get methadone to help them cope with opioid addiction?

It’s a controversial question in Canada, where harm reduction programs are being used to give high-risk drug users a “safer supply” of legal pain medications as an alternative to increasingly more toxic and deadly street drugs. Critics say safer opioid supply (SOS) programs don’t reduce overdoses and are a risky alternative to more traditional addiction treatment drugs like methadone.

A new study, however, found that SOS programs are just as effective as methadone and may even be safer in the long run. Researchers in Ontario followed the health outcomes of over 900 people newly enrolled in SOS programs, comparing them with a similar number of drug users who started methadone treatment.  

Their findings, published in The Lancet Public Health, show that people in both the SOS and methadone groups had significant declines in overdoses, emergency department (ED) visits, hospitalizations, severe infections, and health care costs in the year after they started treatment. In both groups, deaths related to opioids or any other cause were uncommon.

ED Visits Fell After High-Risk Drug Users Enrolled in SOS or Methadone Programs

THE LANCET PUBLIC HEALTH

"This is the first population-based study to compare SOS programs with opioid agonist treatment, and to explore how people's outcomes change in the year after initiation," said lead author Tara Gomes, PhD, an epidemiologist and Principal Investigator at the Ontario Drug Policy Research Network (ODPRN).

Gomes and her colleagues found that people on methadone had a slightly lower risk of an overdose or being admitted to hospital, but they were also more likely to discontinue treatment and be at risk of a relapse. The higher dropout rate outweighed most of the benefits of methadone over SOS.

"Neither methadone nor safer supply programs are a one-size-fits-all solution, but our findings show that both are effective at reducing overdose and improving health outcomes," said Gomes. "They are complementary to each other, and for many people who haven't found success with traditional treatments like methadone, safer supply programs offer a lifeline. Our findings show that when safer supply programs are implemented, we see fewer hospital visits, fewer infections, and fewer overdoses."

SOS programs were launched in Ontario and British Columbia to combat a rising tide of overdoses linked to illicit fentanyl. A decade ago, Vancouver was the first major North American city to be hit by a wave of fentanyl overdoses, which led Vancouver to become a laboratory for harm reduction and safe injection sites that provided heroin or prescription opioids to drug users.  

The results have been somewhat mixed. An investigation by the National Post found that hydromorphone pills given to drug users in Vancouver were being sold on the black market, with the sellers then using the money to buy street drugs. Complaints about people selling their safe supply drugs led to British Columbia’s Health Minister recently changing the rules so that the SOS drugs are consumed while under the supervision of a pharmacists or healthcare provider.

A 2024 study in JAMA Internal Medicine found that opioid-related hospitalizations rose sharply in British Columbia after harm reduction programs were launched there, although there was no significant change in overdose deaths. The spike in hospitalizations may have been due to more toxic street drugs and counterfeit pills on the black market.

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.

The Silent Opioid Crisis: Seriously Ill Patients Face Frequent Delays in Pain Treatment

By Pat Anson

Shortages of opioid pain medication and insurance obstacles are causing frequent delays and suboptimal treatment for seriously ill patients, according to a new study by researchers at the Icahn School of Medicine at Mount Sinai.

In a survey of 52 palliative care clinicians in Mount Sinai’s New York-based medical system, nearly nine out of ten (88%) reported frequent obstacles in getting opioids for their patients. On average, clinicians spent over an hour each day on the phone with insurance companies and pharmacies trying to gain access to limited opioid supplies. Nearly a third (31%) said this resulted in suboptimal care for their patients.

The survey findings were recently published in NEJM Catalyst Innovations In Care Delivery.

“Prescriptions are written, but patient is not able to get the correct dose or quantity at their pharmacy,” one clinician reported.

“I once had to send an oxycodone prescription to eight pharmacies,” said another.

“I spent the better part of 2 days... trying to figure out a pharmacy that would [fill] the oxycodone. Sometimes I spend more time handling access issues than actually talking to and thinking about the patient,” another palliative care clinician reported.

Patients in palliative or hospice care often have severe pain from cancer, major surgery, or a sudden emergency like a sickle cell crisis. Although they are usually exempt from opioid guidelines that limit the dose or amount, seriously ill or dying patients face many of the same obstacles getting opioids as patients with more moderate pain. Researchers say this “silent opioid crisis” has largely been ignored.

“Taken together, these findings raise alarms about a new crisis in opioid access for people with serious illness, for whom opioids are often essential pain relief medicines,” wrote lead author Rebecca Rodin, MD, Assistant Professor of Geriatrics and Palliative Medicine, Icahn Mount School of Medicine at Mount Sinai.

“Our clinicians reported that the numerous challenges in opioid access led to significant adverse effects on patient outcomes, such as uncontrolled pain, rehospitalization, and opioid withdrawal, and on clinician administrative burden. That burden included time spent contacting pharmacies and insurance companies rather than on direct patient care, which adversely affected clinician job satisfaction.”

In some cases, Rodin said clinicians changed their prescriptions to “less-than-ideal” opioid formulations and doses, a change based on the drugs’ availability rather than what is appropriate for their patients.

To improve patient access, Mount Sinai clinicians started collaborating more closely with pharmacies, finding out which opioids were in stock and improving their documentation to show why a prescription is medically necessary. Outpatient pharmacies also started delivering opioids to oncology patients before they were discharged, which helps ensure there is no disruption in pain care when they go home.  

Knowing which pharmacies have opioids in stock proved to be a critical time-saver for doctors and helped Mount Sinai develop a list of preferred pharmacies that is updated in real time.  

“Our strategies have been effective within the Mount Sinai ecosystem, but they do not address root causes of barriers which can include a number of factors, such as much broader supply chain shortages at the regional and national level, public and private coverage policies, and pharmacy stocking and dispensing practices. We need to do more to address these barriers,” said Rodin.