Magic Mirror on the Wall, Do I Look Healthy in This Selfie?

By Madora Pennington

What if gazing into your smartphone’s camera did more than make content for your Instagram? What if it could assess your health?

By analyzing the blood flow in your face, an app claims to do just that.

Your facial blood flow says a lot about you --- whether you are at rest, concentrating, happy or sad. And thanks to advances in artificial intelligence, it can also assess the state of your health.

The Anura MagicMirror uses transdermal optical imaging technology to gage cardiac and blood flow activity. It then processes this information to assess your overall health, as well as your risk of developing chronic conditions like diabetes, hypertension, and cardiovascular disease.

The app, which can be downloaded on a smartphone, records the face for thirty seconds. The facial blood flow — imperceptible to the human eye — is then compared to AI models from tens of thousands of individuals. From this data, it churns out individual health feedback. While not as accurate as having a blood pressure cuff or blood test, Anura makes an educated guess about your health indicators.

How accurate is Anura?

“All measurements have been validated using medical grade devices and following established scientific research protocols.  We have ten peer reviewed papers published in scientific journals detailing the methods and procedures used and the corresponding results,” says Marzio Pozzuoli, CEO of NuraLogix, which developed the Anura MagicMirror.

I downloaded a free version of the app – called Anura Lite -- and tried it for myself.

I have Ehlers-Danlos Syndrome, a connective tissue disorder, so I have “invisible” health challenges that don’t easily fall under the gaze of this app.

Anura focuses on the main issues that affect everyone: heart health, metabolic health, and mental health — which are leading indicators for chronic conditions that can end in death: cardiovascular disease, hypertension, diabetes and stroke. 

The app collects data on 30 different health parameters, including your breathing, blood pressure, heartbeat, vascular capacity, body mass index, facial skin age, waist-to-height ratio, body shape index, and mental stress index.

With this data, it then estimates the risk of cardiovascular disease, diabetes, fatty liver disease, and stroke over the next ten years.

The app also asked about my gender, age, weight and height, so I’m assuming it used this self-reported information to answer some of its questions about my health. Here are some of the scores the app gave my health and general wellness:

True, I don’t have a high BMI and am not overweight, so I’m not at high risk for metabolic disease. I already knew that.

I do have heart issues, but they are monitored and managed by my cardiologist -- successfully, it seems, if we believe Anura.

I felt relaxed when I used the app, and the MagicMirror reassuringly agreed.

One thing it got wrong was my skin age. It’s been a while since I was 31. I confess that to get my age lower, I put on makeup and laid on my back for the facial scan. I hope this didn’t affect the overall results. I am always risking my mental health when I focus the painfully high-definition iPhone camera on myself.

For metric junkies, Anura might be as fun as popping on the scale every morning or using a Fitbit.

The app doesn’t have a pain score, but for a patient with chronic pain or illness, it might be insightful to do a scan in times of physical or mental stress to see what, if anything, could be learned and addressed.

Currently, NeuroLogix is finding customers for its technology in the life insurance industry. Instead of accepting the assertions of an applicant at face value or requesting medical records and lab tests, an app like Anura could provide a health assessment more quickly – and cheaply — to the insurer.

It is easy to imagine a place for technology like this in telehealth, where a doctor has no opportunity to put a blood pressure cuff or pulse oximeter on a patient. Clinicians could then gather health data through a remote scan, improving the quality of remote telehealth appointments.

Telehealth is of enormous benefit to disabled people and the elderly, especially in rural areas without easy access to medical care or specialists. That is, if the technology proves reliable. For now, NeuroLogix admits its health assessments are “only estimates and are not a substitute for the judgment of the healthcare professional.”

But in the future, with more research, it might be possible to measure pain by using technology like this instead of relying on flawed methods like the pain scale. Pain is a subjective experience that currently has no objective and reliable way to measure, because it varies from person to person. MagicMirror may someday give us an alternative.

Health Insurance Premiums Rising Faster Than Inflation

By Phillip Reese, KFF Health News

Kirk Vartan pays more than $2,000 a month for a high-deductible health insurance plan from Blue Shield on Covered California, the state’s Affordable Care Act marketplace. He could have selected a cheaper plan from a different provider, but he wanted one that includes his wife’s doctor.

“It’s for the two of us, and we’re not sick,” said Vartan, general manager at A Slice of New York pizza shops in the Bay Area cities of San Jose and Sunnyvale. “It’s ridiculous.”

Vartan, who is in his late 50s, is one of millions of Californians struggling to keep up with health insurance premiums ballooning faster than inflation.

Average monthly premiums for families with employer-provided health coverage in California’s private sector nearly doubled over the last 15 years, from just over $1,000 in 2008 to almost $2,000 in 2023, a KFF Health News analysis of federal data shows. That’s more than twice the rate of inflation. Also, employees have had to absorb a growing share of the cost.

The spike is not confined to California. Average premiums for families with employer-provided health coverage grew as fast nationwide as they did in California from 2008 through 2023, federal data shows. Premiums continued to grow rapidly in 2024, according to KFF.

Small-business groups warn that, for workers whose employers don’t provide coverage, the problem could get worse if Congress does not extend enhanced federal subsidies that make health insurance more affordable on individual markets such as Covered California, the public marketplace that insures more than 1.9 million Californians.

Premiums on Covered California have grown about 25% since 2022, roughly double the pace of inflation. But the exchange helps nearly 90% of enrollees mitigate high costs by offering state and federal subsidies based on income, with many families paying little or nothing.

Rising premiums also have hit government workers — and taxpayers. Premiums at CalPERS, which provides insurance to more than 1.5 million of California’s active and retired public employees and family members, have risen about 31% since 2022. Public employers pay part of the cost of premiums as negotiated with labor unions; workers pay the rest.

“Insurance premiums have been going up faster than wages over the last 20 years,” said Miranda Dietz, a researcher at the University of California-Berkeley Labor Center who focuses on health insurance. “Especially in the last couple of years, those premium increases have been pretty dramatic.”

Dietz said rising hospital prices are largely to blame. Consumer costs for hospitals and nursing homes rose about 88% from 2009 through 2024, roughly double the overall inflation rate, according to data from the Department of Labor. The rising cost of administering America’s massive health care system has also pushed premiums higher, she said.

Insurance companies remain highly profitable, but their gross margins — the amount by which premium income exceeds claims costs — were fairly steady during the last few years, KFF research shows. Under federal rules, insurers must spend a minimum percentage of premiums on medical care.

Rising insurance costs are cutting deeper into family incomes and squeezing small businesses.

The average annual cost of family health insurance offered by private sector companies was about $24,000, or roughly $2,000 a month, in California during 2023, according to the U.S. Department of Health and Human Services. Employers paid, on average, about two-thirds of the bill, with workers paying the remaining third, about $650 a month. Workers’ share of premiums has grown faster in California than in the rest of the nation.

Many small-business workers whose employers don’t offer health care turn to Covered California. During the last three decades, the percentage of businesses nationwide with 10 to 24 workers offering health insurance fell from 65% to 52%, according to the Employee Benefit Research Institute. Coverage fell from 34% to 23% among businesses with fewer than 10 employees.

“When an employee of a small business isn't able to access health insurance with their employer, they're more likely to leave that employer,” said Bianca Blomquist, California director for Small Business Majority, an advocacy group representing more than 85,000 small businesses across America.

Kirk Vartan said his pizza shop employs about 25 people and operates as a worker cooperative — a business owned by its workers. The small business lacks negotiating power to demand discounts from insurance companies to cover its workers. The best the shop could do, he said, were expensive plans that would make it hard for the cooperative to operate. And those plans would not offer as much coverage as workers could find for themselves through Covered California.

“It was a lose-lose all the way around,” he said.

Mark Seelig, a spokesperson for Blue Shield of California, said rising costs for hospital stays, doctor visits, and prescription drugs put upward pressure on premiums. Blue Shield has created a new initiative that he said is designed to lower drug prices and pass on savings to consumers.

Even at California companies offering insurance, the percentage of employees enrolled in plans with a deductible has roughly doubled in 20 years, rising to 77%, federal data shows. Deductibles are the amount a worker must pay for most types of care before their insurance company starts paying part of the bill. The average annual deductible for an employer-provided family health insurance plan was about $3,200 in 2023.

During the last two decades, the cost of health insurance premiums and deductibles in California rose from about 4% of median household income to about 12%, according to the UC Berkeley Labor Center, which conducts research on labor and employment issues.

As a result, the center found, many Californians are choosing to delay or forgo health care, including some preventive care.

California is trying to lower health care costs by setting statewide spending growth caps, which state officials hope will curb premium increases. The state recently established the Office of Health Care Affordability, which set a five-year target for annual spending growth at 3.5%, dropping to 3% by 2029. Failure to hit targets could result in hefty fines for health care organizations, though that likely wouldn’t happen until 2030 or later.

Other states that imposed similar caps saw health care costs rise more slowly than states that did not, Dietz said.

“Does that mean that health care becomes affordable for people?” she asked. “No. It means it doesn’t get worse as quickly.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Most Treatments for Low Back Pain Don’t Work

By Crystal Lindell

While I’ve struggled with relatively mild lower back pain for years now, a few months ago I threw my back out for the first time. I literally could not get out of bed on my own, and I spent almost a week on the couch recovering while my lower back spasmed. 

It was horrible, and even my usual pain relief methods and doses of pain meds did not help much. In the end, for me, it was mostly just time and rest that seemed to help the most. 

Now a new study confirms just how difficult it is to treat low back pain. 

In fact, only about 10 percent of treatments for low back pain actually work, according to new research published this week in the journal BMJ Evidence-Based Medicine. 

The study by an international team of researchers looked at 301 placebo-controlled clinical trials for 56 different treatments for low back pain. The team found that most non-surgical and non-interventional treatments did not work. Those that did work provided only small analgesic effects better than a placebo.

Specifically, they found that NSAIDs were the only treatment that worked for acute low back pain, while five treatments for chronic low back pain provided relief: exercise, spinal manipulative therapy (chiropractic), taping, antidepressants, and transient receptor potential vanilloid 1 agonists, which are topical patches like Qutenza (capsaicin).  

As for the treatments that did not work, the researchers found that three treatments for acute low back pain – exercise, glucocorticoid injections, and paracetamol (acetaminophen) – and two treatments for chronic low back pain (antibiotics and anaesthetic drugs) were ineffective. 

They didn’t have enough good quality evidence for the remaining treatments to determine if they worked or not. 

For acute low back pain, 10 non-pharmacological treatments had “low to very low certainty evidence” that they actually worked, including: acupuncture, behavioral health education, extracorporeal shockwave, heat, laser and light therapy, massage, mobilization, osteopathic, spinal manipulative therapy, and transcutaneous electrical nerve stimulation (TENS). 

They also found that 10 pharmacological treatments had inconclusive evidence about their effectiveness for acute low back pain, including: cannabinoids, colchicine, immunoglobulin, muscle relaxants, muscle relaxants + NSAIDs, nucleoside, opioids, ozone injections, pyrazolone derivatives, and topical rubefacients.

For chronic low back pain, over three dozen treatments had inconclusive evidence to support their efficacy, which included everything from bee venom and TENS to dry cupping and muscle relaxants.

The bottom line is that there’s not much evidence to support the use of many treatments that are commonly prescribed and promoted for lower back pain — even the ones recommended in medical guidelines.

“Our review did not find reliable evidence of large effects for any of the included treatments,” researchers concluded. “There are also common treatments for which no placebo-controlled trials have been conducted despite being commonly recommended in clinical practice guidelines.”

The study ends as many often do, with a plea for more high-quality evidence to give patients and doctors real choices and effective options for treating back pain. 

“While we would like to provide more certain recommendations for where to invest and disinvest in treatments, it is not possible at this time,” researchers said.

Why Are Doctors Reluctant to Recommend Mobility Aids?

By Crystal Lindell 

There’s a common thought process among doctors when it comes to opioid pain medications. 

They usually don’t prescribe them unless you specifically ask for them, because they don’t want to “encourage” you to use them. But also, if you do ask for opioids, then they label you as a drug seeker and assume you’re looking for “the easy way out” or to get high.

In short, most doctors try very hard to avoid giving patients opioids, unless they want to treat addiction with Suboxone – which ironically contains the opioid buprenorphine.

While I strongly disagree with every part of that thought process, in that situation doctors at least have the excuse that they have to worry about the DEA and losing their medical licenses. 

I’ve also noticed that many doctors have the same thought process when it comes to prescribing and/or recommending mobility aids like walking canes, crutches and wheelchairs. 

They don’t like to suggest them to patients because they don’t want to “encourage” their use. However, on the other end, if a patient does ask for them, doctors also bristle at that. They seem to think that mobility aids are, like opioids, “the easy way out.” 

Of course, there’s nothing easy about either opioids or mobility aids. If a patient has gotten to a point where they feel the need to use either one, chances are they are needed. 

I noticed these anti-mobility aid attitudes among doctors myself, when I had pain from a bone spur on my heel. My doctors never suggested crutches, and I had to figure out for myself that not using my foot was the only thing that seemed to help relieve the pain. I had some crutches at home from a previous injury, and using them allowed me to still function while also not putting weight on my foot. They also allowed my body to heal. 

Years ago, when my fiancé had a severe hip injury, he had to go out and buy his own cane because his doctors had not even suggested one, much less prescribed one – despite the very clear need. 

Online you’ll find multiple Reddit threads of patients expressing frustration at how doctors approach mobility aids. About a year ago in the “Mobility Aids” section of Subreddit, a poster asked, “Why are doctors so hesitant to let patients use mobility aids?”

“I use forearm crutches because I struggle to walk sometimes because of how much my pain hurts and my doctor thinks I have [an] autoimmune disorder that causes this pain which I'm getting more testing for but he goes ‘you're 19 you don't need mobility aids.’ But I have literally fallen over before. Laid in bed in agony barely able to move. Cried from how much it hurts and so much more yet they want to deny me what helps me get around?”

The post then has multiple responses from readers lamenting that they have had the same experience with doctors.

“I’ve had the same issues with doctors and just got mobility aids on my own, not through a doctor. I don't understand why doctors avoid it though because there’s been days at a time where I couldn’t leave my bed and it was hard to go anywhere or do anything on bad days [and] even on good days I still have troubles,” one poster wrote.

There is research that seems to confirm those fears.

A recent study in The Lancet found demographic, socioeconomic and social barriers impacted how much access people had to "mobility assistive products" or MAPs. They surveyed 12,080 people over age 50 in England and found that 42% had an unmet need for a mobility aid. 

Researchers found that women were more likely to have difficulty accessing mobility aids when they have a need for them. They also found that older patients who were unemployed or had a low education level had more trouble accessing MAPs.

Interestingly, having a romantic partner also increased the chances of having an unmet need for a mobility aid, whereas being single actually made patients more likely to have them. My guess is that single people are more likely to advocate for access to mobility aids, because they don’t have a partner at home to help them with daily tasks.  

Other studies have shown a prejudice toward patients with mobility aids among doctors. 

For example, a 2023 study published in the National Library of Medicine looked at physicians' attitudes about caring for disabled patients. They interviewed doctors in focus groups and found many had medical offices that presented “physical barriers to providing health care for people with disabilities, including inaccessible buildings and equipment.”

Some doctors openly admitted the lack of accessibility in their clinics. For example, one rural primary care physician said, “I know for a fact our building is not accessible.” 

If a doctor doesn’t even offer an accessible building to patients, odds are that they don’t prioritize mobility aids for the patients either. 

It seems that doctors assume that if patients start using a mobility aid, they’ll end up using it for the rest of their lives. But in my case and my fiance’s case, that’s not what happened. We both used them short term, and stopped as soon as we were healthy enough to do so. 

Regardless, who cares if people use mobility aids for the rest of their lives? Would that be such a bad thing? Being alive and independent with mobility aids is preferable to being confined at home and/or losing your independence. 

Perhaps some doctors see patients with mobility aids as a failure on their part. After all, if a patient needs them, then the doctor must not be doing enough to treat them. 

Mobility aids are exactly what the name implies – an aid that gives people more mobility, and by extension, more independence and freedom. They can greatly improve someone’s quality of life, whether they are used long or short-term. 

There’s no reason for doctors to gate-keep mobility aids, other than their own ablest bias. If they actually want to help patients, they should be suggesting them a lot more often. 

The Fine Art of ‘Knowing’ Your Body

By Cynthia Toussaint  

Three times in my life I knew something big, tragic and seemingly illogical was going to happen to me. All were trauma and health related, though I didn’t know that when my gut spoke to me with complete assuredness. 

Against all naysayers and doubters, my first two premonitions were eerily on target and heartbreakingly so. Trouble is, my third intuition is knocking at the door, and if I can’t change fate, I won’t survive to see my next birthday.

Can I turn my future around to save myself?

I don’t think there’s anything supernatural about my success at prognostication. The only special power I possess is an ability to tune into my inner wisdom and to trust it. As I learned more about the connection between mind and body – the bodymind, if you will – I’ve come to believe that my body unconsciously speaks to my mind and the premonitions are the conscious expression of that communication.       

My first hunch started when I was 17. With great interest, I read a magazine article about anorexia, as I’d almost died from this eating disorder five years prior. At the end of the piece, when the writer incorrectly stated that some anorexics can’t have children after being cured, my gut knew, unequivocally, that would be me.

I became obsessed, speaking endlessly about this knowing to friends and family, always landing on deaf ears because I appeared perfectly healthy. I then shared this fear with my gynecologist and even sought out a psychologist. After both assured me I’d have as many children as I wanted when the time was right, I knew they were wrong. My reasoning for not being able to have a child would morph from anorexia to a future, unknown health problem, one that would rear its head years later.

Meanwhile, at age 20, I regained my footing and was living a seemingly perfect life. I was in college, studying my great passions (singing, dancing and acting), got an agent and was auditioning for TV and film roles. Then out of the blue, another obsessive, dreadful foreknowledge came to me: my show business career would end when I was 21.

Again, my certainty landed on incredulous ears. “You’re making no sense, Cynthia” and “You’ve got your whole career ahead of you” and other reassurances came from all directions. But, again, I knew they were wrong.      

To meet the deadline that was amplifying in my head, I hustled to get my headshots and resumes done. I even recall yelling over the phone at my photographer for taking too much time. He couldn’t fathom my rush, especially when I paid to have someone drive my precious pics from his Bay Area studio to my LA dorm overnight.          

Like a cosmic special delivery, three months before my 22nd birthday, a ballet injury triggered Complex Regional Pain Syndrome (CRPS). Though it would be 13 years before my diagnosis, piece by piece, CRPS dismantled my performing career.

I managed to dance some in a Las Vegas illusion act, posed for Playboy and tried like hell to get hired as a TV host in LA. As a last-ditch effort, I sent hundreds of letters to industry folk and got an agent to represent me for sitting jobs as a “special booking,” all to no avail. No one would hire me due to my significant disability and limitations.           

Back on the baby front, my first premonition was still bubbling away. Just before my partner John and I planned to get pregnant, my gynecologist advised I needed a LEEP procedure to remove dysplasia. Tragically, that procedure spread CRPS into my cervix and vagina, lighting the area on neuropathic fire. As a result, I was unable to have intercourse through the rest of my child-bearing years.

No career, no child. My premonitions were two for two, batting a thousand. 

You can imagine my concern when in my early 40’s a new premonition took hold. I started sharing with John that I knew I would die before reaching age 65. This time around, there were no doubters.

My foretelling seemed to be playing out right on schedule, when at 59 I developed the most aggressive form of breast cancer – and then again two years later when I experienced a recurrence, followed by a year of painful, life-threatening complications caused by my overactive immune system.

But this time, unlike my previous two knowings, I’m pushing back.

I’m certain I’m still alive because I now understand that trauma drives illness, and since my first cancer diagnosis, I continue to do a ton of trauma release work while devoting myself to self-care.

If my next PET/CT scan is clean, I’ll reach the three year disease-free mark, which is considered by most oncologists to be a cure for Triple Negative breast cancer. Free and clear, as they say.

Still, I’m praying that nine months down the road, on New Year’s Eve, I’ll be blowing out candles on my 65th birthday cake. If I do, I’ll know that trauma release, self-care, and giving myself the agency and action to plot my course, allowed me to change my fate.

As those candles go out, my wish for all of us seemingly fated to suffer with chronic pain and other illness, will be that we will listen intimately to our whispering intuitions.  And maybe, just maybe, their words will light our way.  

Cynthia Toussaint is the founder and spokesperson at For Grace, a non-profit dedicated to bettering the lives of women in pain. She has lived with CRPS and multiple co-morbidities for over four decades. Cynthia is the author of “Battle for Grace: A Memoir of Pain, Redemption and Impossible Love.” 

Experimental Cannabis Extract Has ‘Potential to Replace Opiates’

By Pat Anson

A German biotech company says it is seeking regulatory approval in Europe and the United States for an experimental cannabis extract that could be an alternative to opioid pain medication.

Vertanical recently completed two Phase 3 studies of its new drug – called VER-01 – on over 1,000 patients with chronic low back pain who didn’t get sufficient relief from non-opioid analgesics.

One study compared VER-01 to a placebo, while the second trial compared the drug’s safety and tolerability to patients treated with opioids. The company told The Times it was awaiting publication of the studies’ findings in The Lancet before making them public.

“VER-01 reduces pain without creating dependency or having an abuse potential,” said Clemens Fischer, MD, Vertanical’s CEO. “It has the full potential to replace opiates as it’s more effective. It’s a real alternative for chronic patients — the first one.

“Pain patients around the world are trapped in a vicious cycle of pain, insomnia, limited mobility, and depression. VER-01 has the potential to successfully break this cycle.”

VER-01 is a “full-spectrum” extract derived from cannabis sativa leaves and flowers. Although it contains THC, the main psychoactive substance in cannabis, Fischer says patients enrolled in the studies didn’t become high or intoxicated. About 25 percent did “feel a bit dizzy” for two weeks after they started taking it.

Participants also didn’t get “the munchies” or gain weight, a well-known side effect of cannabis.

“We were looking very carefully, because that’s what we hear from cannabis smokers — that the appetite increases as well their weight. But we haven’t seen any increase in weight,” Fischer told The Times.

Vertanical is seeking regulatory approval of VER-01 in Europe and with the UK’s Medicines and Healthcare Products Regulatory Agency. If granted, VER-01 would be the first cannabis-based medicine approved for chronic pain. It would be sold under the brand name Exilby and be taken orally in drops.

The timeline for approval in Europe may be as soon as this summer, but it’s likely to take longer in the U.S.

“We are seeking regulatory approval in the US and are in talks with the FDA. For approval in the US, a further phase 3 study with US patients in the indication of chronic low back pain will start in Q2 2025,” Merit Renner, Senior Manager of Business Development at Vertanical, told PNN in an email. “This, together with the phase 3 study successfully conducted in Europe, will form the basis for approval in the US.”

Vertanical also plans further studies of VER-01 on patients with osteoarthritis and peripheral neuropathy.

Research into the pain-relieving properties of cannabis has been slow in the U.S., in large part because of marijuana’s status as a Schedule 1 Controlled Substance, the same classification as LSD and heroin. The DEA recently allowed more marijuana to be used for research purposes, but has dragged its feet about reclassifying marijuana as a Schedule 3 substance that could be used for medical purposes. Until marijuana is rescheduled, VER-01 is unlikely to get FDA approval.

Some recent studies have shown that certain cannabinoids found in marijuana -- cannabidiol (CBD), cannabigerol (CBG), and cannabinol (CBN) – block pain signals in the peripheral nervous system, not the brain, and don’t have a psychoactive effect that could lead to abuse.

“These findings open new avenues for the development of cannabinoid-based therapies,” said Mohammad-Reza Ghovanloo, PhD, lead author of a study published in PNAS and a research scientist at Yale School of Medicine. “Our results show that CBG in particular has the strongest potential to provide effective pain relief without the risks associated with traditional treatments.”

The cannabinoids in the Yale study interact with a protein in cell membranes called Nav1.8, which blocks peripheral nerves from transmitting pain signals. Inhibiting Nav1.8 is the same method used by Journavx (suzetrigine), a non-opioid analgesic recently approved by the FDA for relieving moderate to severe acute pain in adults.

States Wrestle with Kratom Regulation

By Mara Silvers, KFF Health News

Montana lawmakers are grappling with how — if at all — the state should rein in kratom, an unregulated plant-derived substance with addictive properties sold mainly as a mood and energy booster at gas stations, vape shops, and elsewhere.

Kratom, which originates from the leaves of a tree native to Southeast Asia, is also touted for helping relieve pain and opioid withdrawal symptoms. But it can have wide-ranging mental and bodily effects, according to the federal Drug Enforcement Administration, addiction medicine experts, and kratom researchers. Reports of deadly kratom overdoses have surfaced in recent years, though often in combination with other substances.

But the drug is in a gray federal regulatory area: It’s designated by the DEA as a “drug and chemical of concern,” but it is not considered a controlled substance. Legislation introduced in Congress in 2023 to study kratom has not advanced.

The lack of federal regulation and congressional action has left it to states to step into the complex debate over how to clean up supply chains and protect users.

The kratom industry itself wants to help address this regulatory void. A bill drafted by the American Kratom Association, a national industry lobbying group, is pending in the Montana Legislature. In its current form, the industry-dubbed “Kratom Consumer Protection Act” would ban sales to people under 18 and restrict which products can be labeled as “kratom” based on the amount and potency of two chemical components, mitragynine, and 7-hydroxymitragynine.

Similar industry-backed bills have passed in 14 states, including Oregon, Texas, Kentucky, and Maryland, according to the American Kratom Association website. Other states, including Wisconsin and Arkansas, have enacted kratom bans by listing it as a Schedule I controlled substance.

Oliver Grundmann, a University of Florida researcher who has studied kratom since 2016, said industry-written bills often hinge on producers accurately representing what’s in their products. Lawmakers and the public in Montana may not be convinced that the proposed legislation will put public health considerations above commercial interests.

“Naturally, a company is driven by profits and making sure that they can retain their profits,” Grundmann said. “I’m skeptical of self-regulation.”

Whether the Montana bill will be effective hinges on the state’s having enough resources to regulate the industry, as well as industry retailers honestly testing and marketing their products, he said.

The bill’s sponsor, Republican Rep. Nelly Nicol, said she’s trying to bring her fellow lawmakers up to speed on a substance that few people understand. Nicol said she delayed House Bill 407’s first committee hearing to give herself more time to speak with legislators and to hear from groups that support and disagree with the industry’s suggested approach. She indicated she’s open to amending the bill, though it has not yet been rescheduled for a committee hearing.

“We’re going to be changing our minds and learning things and molding this as we’re going,” Nicol said in a February interview.

Potentially Addictive

Researchers and addiction medicine experts have struggled in recent years to pin down kratom’s health effects and patterns of use. A federal survey from 2021 estimated that 1.7 million Americans age 12 and older used the substance in some way the year before the study.

Medical providers and addiction researchers in Montana say patients often don’t disclose their kratom use to health care providers. Some consider it an herbal supplement, a perception driven by its accessibility in gas stations and vape shops, rather than a mind-altering and potentially addictive drug.

Megan Zawacki, a physician assistant and addiction medicine specialist in Helena, said many of her patients seek help for misuse of other substances and aren’t easily convinced of kratom’s negative side effects.

“The majority of my patients that are using it can’t even quantify to me how much they’re using,” Zawacki said.

But if their use spirals into addiction, she said, the consequences of the substance become clearer. At her clinic in Helena, Zawacki said, more of her patients are currently being treated for kratom addiction than for opioid use disorder.

“I’ve had two patients specifically in the last calendar year tell me, ‘We need to bring legislation against kratom,’” she said. “Because it is so readily available and so misunderstood that it just is wreaking havoc on their lives.”

Depending on how it’s manufactured and how much users consume, kratom can function as a stimulant or a sedative.

Though not an opioid, its key chemical components can target opioid receptors in the brain, leading some advocates to cite its potential for helping opioid users manage withdrawal.

Zawacki and other Montana providers say they have prescribed buprenorphine to help patients stop using kratom — the same treatment often used to manage opioid addiction.

“What we have seen in recent years is even stronger extracts that focus specifically on mitragynine and 7-hydroxymitragynine. These should not be seen as ‘kratom’ any longer.”

— Dr. Oliver Grundmann, University of Florida

Some Montana advocacy groups that work to prevent substance misuse have also flagged concerns about kratom use among minors. Beth Price Morrison, with the Alliance for Youth in Great Falls, said her organization has pressured gas stations in the area to stop carrying kratom products or at least keep them behind the counter.

“Our youth are really struggling with mental health right now, and they turn to substances to cope. And this stuff is easily accessible,” Price Morrison said.

Price Morrison and Nicol expressed support for raising the age limit on kratom sales to users 21 and older, rather than 18, which is in the current draft of the American Kratom Association bill.

The legislation would allow state regulators to screen kratom products coming on the market in Montana and create a registry of permitted distributors. Vendors would be banned from selling or promoting kratom products whose concentration of 7-hydroxymitragynine exceeds 2% of the total alkaloid content.

The American Kratom Association and other supporters say that such a restriction would help weed out natural forms of kratom from synthetic, higher-potency concoctions. Some kratom researchers have endorsed this type of market regulation, citing the chaotic array of products currently allowed to sport kratom labels.

Grundmann, the University of Florida researcher, said there has been an “evolution” in the United States of products being labeled and sold as kratom.

“The kratom that was on the market then was basically ground-up leaf powder that was not further concentrated,” Grundmann said. “What we have seen in recent years is even stronger extracts that focus specifically on mitragynine and 7-hydroxymitragynine. These should not be seen as ‘kratom’ any longer.”

Grundmann, who supported a similar version of legislation in Arizona in 2019, said Montana’s bill is a starting point for regulation. He said other states, including Colorado, began with a common framework and put more guardrails in place in recent years.

Price Morrison, the youth prevention advocate, said she has broader misgivings about any bill that normalizes the sale of kratom in Montana. In an ideal world, she said, she would like to see the product banned completely.

“We know that availability drives use. And when a product is marketed as regulated, it gains legitimacy,” Price Morrison said. “And more people, including those who are vulnerable, end up using it.”

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

Virtual Nature Scenes May Help Relieve Minor Pain

By Crystal Lindell

Nature scenes may help relieve minor acute pain – even if you only “see” the nature scene in a virtual reality program. That’s according to new research published this week in, appropriately, the journal Nature Communications. 

Researchers administered mild electric shocks to cause a pain response in 49 healthy volunteers, and then showed them a virtual reality scene that was either a nature scene of a lake, an urban cityscape, or an indoor office setting.  

The researchers then used both brain scans and self-reported pain reactions to analyze whether any of the scenes reduced pain. 

NATURE COMMUNICATIONS

They found that areas of the brain that handle physical pain signals were less active when people saw the virtual nature scene. Self-reported pain also was lower in the nature vs. urban and indoor settings. 

I will admit that, at first, I didn’t want to believe that “virtual nature scenes” could have the same mental effect as actual, living nature. But then I quickly realized that I did enjoy virtual nature scenes, fake or not. 

Every morning, after watching the news, I open the YouTube app on my Roku and select a calming nature scene to play on the TV throughout the day. In the winter, it’s a roaring fire; in the spring, a calming rainy scene; in the summer, ocean waves; and in the fall, autumn leaves rustling. 

While I’m not sure if any of the YouTube nature scenes help my physical pain, I do think they help calm my anxiety – in the same way that watching the news usually increases my anxiety. 

Of course, the mostly Austrian research team couldn’t resist slipping in a little anti-opioid messaging, writing: 

“Besides advancing our basic knowledge, such research may have considerable importance for efforts to complement pharmaceutical treatment approaches, with their well-documented negative side effects and addictive properties.”

While I’m glad they used the word “complement” instead of “replace,” it’s their mention of “negative side effects and addictive properties” that makes it clear that they do want this research to eventually lead to non-opioid pain treatments. 

But when you actually look at the study, you’ll see that it very specifically looks only at minor, acute pain. So this research should not be used to reduce pain medications for people with chronic pain. 

I’m not accusing the authors of wanting that, since they clearly think more studies are necessary. But in our current opioid-phobia environment, I do have concerns about doctors seeing the study headline and giving patients “go look at a lake” advice to reduce medication-based pain treatments.

Ideally, research like this would be used responsibly, inspiring healthcare providers to add more natural elements to places like doctor’s offices and even nursing homes – whether those nature elements are virtual, digital or physical paintings. 

Previous research has found that patients recovering from surgery used fewer analgesics and recovered faster if their hospital window gave them a view of trees, rather than a brick wall.

However, I remain extremely doubtful that this type of research will ever result in finding a way to use nature elements as an effective pain treatment in any way that even reduces the need for pain medication.

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.

CBD Is a Scam. Will New Cannabinoid Products Be Any Different?

By Crystal Lindell

CBD didn’t do anything for me. I tried different brands, different formats, and different price points because I really wanted it to work. 

I like to describe my experience like this: Wine and grape juice are both made from grapes – but that doesn’t mean a glass of Welch's has the same effect as a glass of wine.

From the beginning, CBD always sounded a little too good to be true. Touted as the “cannabis that doesn’t get you high, but treats chronic pain,” it was supposed to be the new holy grail of pain medicine. After all, doctors are looking for something to give patients that doesn’t give them any pleasurable mental effects, but does actually treat their pain. 

Unfortunately, CBD was too good to be true because the marketing and hype are fake. 

For a while, CBD seemed to be sold in every gas station, supermarket and convenience store. Filling shelves with everything from candies to liquid elixirs. 

But I’ve noticed over the last couple years that a lot of those CBD display cases have either shrunk or disappeared completely. 

It’s not just in my head. A 2023 article from SupplySide Supplement Journal was among the first to report on the downward trend in the sector. 

Headlined: "Major CBD brands report steep annual sales declines,” it focused on the fact that two major brands, CV Sciences and Charlotte’s Web, reported depressed earnings and “significant downsizing initiatives.”  

Almost a year later, The New York Times published a similar article, with the headline “Companies Were Big on CBD. Not Anymore.” 

The article blamed the sales decline on a “lack of federal regulation and a mishmash of state laws [that] made selling products featuring the cannabis-derived ingredient not worth the trouble.” 

I think that’s just generous industry framing. Sales declined because CBD products were not good and inordinately expensive. CBD did not do much of anything for most people, and the price points were astronomical. 

A 2024 study at Bath University in the U.K. makes the point directly. The subhead on a press release reads: "There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, new research finds." 

“CBD presents consumers with a big problem,” said Professor Chris Eccleston, who led the research at the Centre for Pain Research at Bath. “It’s touted as a cure for all pain but there’s a complete lack of quality evidence that it has any positive effects. It’s almost as if chronic pain patients don’t matter, and that we’re happy for people to trade on hope and despair.”

Eccleston is definitely right there. The views of chronic pain patients are often dismissed. That’s why many doctors are happy to push placebos and snake oils on us, as long as it means they can avoid prescribing any opioids. 

The decline in CBD’s popularity hasn’t stopped the medical industry from trying to find other ways to use cannabinoids to treat pain without causing the mental high. 

Last week, researchers at Stanford University and Washington University School of Medicine in St. Louis announced that they designed a new compound to potentially treat chronic pain by targeting type 1 cannabinoid (CB1) receptors in the peripheral nervous system.

In a paper published in Nature, the researchers said the compound “could effectively treat multiple types of pain in mouse models without causing the psychoactive side effects typically associated with the CB1 receptor or causing the mice to build up a tolerance to it.”

So it’s still being studied in mice, which means it’s a long way off from being offered to humans, if it ever is. 

While this is a synthetic version of a cannabinoid – as opposed to the natural version – I’m skeptical of anything that claims to treat physical pain without psychoactive side effects.  

It’s also frustrating to see researchers still trying to push for this at all. 

In a news release about the study, co-author Alexander Powers,  who conducted the work while earning his PhD in chemistry at Stanford, said: “This molecule shows that we can get a separation between the side effects and the analgesic effects – we can target the CB1 receptor and get the good effects without the bad.”

The most telling part of that quote is at the very end: “without the bad.”

The implication is that psychoactive effects are inherently bad. I disagree. When you’re in extreme pain, it impacts you emotionally and mentally. So it only makes sense that medications that treat pain also improve your mood. That’s a good side effect. 

Maybe research like that coming out of Stanford will lead to new breakthroughs. Maybe they will finally discover the holy grail of pain medication that they desperately seek. But I remain skeptical of any research from people who frame positive effects of pain medication as “bad.” 

A Pharmacist’s Oath: ‘The Relief of Suffering’

By Carol Levy

The words “First do no harm” are actually not in the Hippocratic Oath, at least not directly:

"I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous."

But the meaning is clear: Do no harm to patients.

I expect that from doctors, although many of us have been disappointed by their adherence to the Hippocratic Oath. What never occurred to me was that pharmacists also have an oath, which includes these pledges:

“I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow: I will consider the welfare of humanity and relief of suffering my primary concerns.

“I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for all patients. I will respect and protect all personal and health information entrusted to me.”  

The DEA has given pharmacists the freedom to ignore their oath, and has coerced some pharmacy chains into handing over our personal health information without a warrant.

Every time a pharmacist refuses to fill a prescription, questions why you need a medication, or asks personal questions, they are not using the “Oath of a Pharmacist.” They are instead exercising a “corresponding responsibility” under DEA regulations, which requires them to make sure a prescription for opioids and other controlled substances is valid and needed.

As far as the DEA is concerned, pharmacists have the same legal obligation as a physician to ensure that a medication has a “legitimate medical purpose.”   

The DEA essentially allows pharmacists to substitute their opinion for that of the doctor, even if it runs counter to their pledge about “the relief of suffering.” Refusing to dispense opioid medication to a pain patient who is dependent on them basically ensures suffering.

I can see some pharmacists saying, “Well, I think that opioids are dangerous. Not filling the prescription is absolutely for the welfare of the patient.”

That argument sounds legitimate. But is it?

The pharmacist has not examined the patient. He/she does not know their medical history or the effect on them when their pain goes untreated. They haven't seen the patient’s x-rays, imaging, and other tests that confirm an injury or disorder that’s causing their pain.

Pharmacists may see us as their “patient" but we are really their customers. They have a product that we want. We come to them with the legally required paperwork to make a purchase. If they have the medication, there should be no issue. They should hand it over and we should pay for it.

If you know little or nothing about a customer, where do you get the right to decide what medication they can get? That decision should be left to our doctors, not to pharmacists or the DEA. 

Those of us in chronic pain have a desperate need for doctors we can trust.  The next step is pharmacists we can trust. Pharmacists who honor their oath to relieve suffering. Not pharmacists who are so fearful of the DEA that they think their best option is to ensure our suffering.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here. 

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.

The Pain Scale is a Pain, but Doctors Ignore Alternatives

By Crystal Lindell

When I first started having debilitating rib pain more than 10 years ago, doctors would constantly ask me to rate my pain on a scale of 1-10. 

It was the worst pain I had ever experienced, but I didn’t want to sound too dramatic, so I would almost always tell them an 8 or a 9. 

However, I started to notice a troubling pattern: No matter what number I said, the doctors still treated me with the same mostly dismissive attitude. 

So, regardless of whether I said my pain was a 7, a 3, or even an 11, the doctors I was dealing with did not seem to believe me. They seemed to think I was being dramatic no matter what. 

At the time, I blamed myself. Surely I must not be communicating the severity of my pain well, if these doctors are still ignoring me, I thought. 

So I started scrounging around online for alternatives. I assumed that if I just explained myself better, then they would react with the urgency that I felt the situation called for.  

I also thought that perhaps I was picking the wrong number, which was causing doctors to dismiss me as someone who couldn’t accurately assess my own body. 

The first thing I found was a pain scale written out, where each number was explained, like this one from “My Health Alberta.” 

It includes a written description with each number, starting with:

0 = No pain.

1 = Pain is very mild, barely noticeable. Most of the time you don't think about it.

2 = Minor pain. It's annoying. You may have sharp pain now and then.

3 = Noticeable pain. It may distract you, but you can get used to it.

And so on. 

Looking at that chart, I decided that my new rib pain – which was eventually diagnosed as intercostal neuralgia that was caused by Ehlers-Danlos Syndrome – was a: “8 = Very strong pain. It's hard to do anything at all.”

The fact that I would often just lay on the exam table silently crying while I prayed that whatever doctor I was in front of would actually help me, made me feel pretty confident in my assessment of an “8.”. 

It was, indeed, very strong pain that made hard to do anything at all. 

I was also naive enough to believe that if I personally added the descriptor when I gave my number, that it would serve as some sort of magic spell that would finally unlock access to the treatment I needed. 

Alas, that did not work. Doctors just nodded and typed “8” into their little online chart and then moved on through the appointment the same way that they always had: With their trademark unsympathetic arrogance and suggestions about taking more gabapentin.  

After that, I went a step further: I tried to find a pain scale that felt more relevant. Eventually, I discovered the Quality of Life Scale, (QOLS). It’s designed for chronic pain patients to show how their pain is impacting their daily life.  

It's a reverse of the traditional pain scale, in that 0 is the worst pain, while 10 means you're doing pretty well. 

It features descriptions like: 

0: Stay in bed all day. Feel hopeless and helpless about life. 

1: Stay in bed at least half the day. Have no contact with the outside world. 

All the way up to:

10: Go to work/volunteer each day. Normal daily activities each day. Have a social life outside of work. Take an active part in family life. 

At the time, I was about a 4: Do simple chores around the house, minimal activities outside the home two days a week. 

Although those "activities" were just doctor's appointments, I was technically leaving my house every few days.

Looking back, I truly believed that using the QOLS scale with my doctors would be the breakthrough moment for my relationship with them. I remember printing it off and putting it in my healthcare binder full of hope that they would finally understand how bad things were for me. 

Alas, I was mistaken. 

Before I started having chronic pain, I was working a full-time job and a part-time one, and living independently. But my pain had gone untreated for so long that I had cut back on everything possible in my life. I shifted my full-time job to a work-from-home position, quit my part-time job, gave up my apartment, and moved in with family, who lived 2 hours away. 

I still remember thinking that when I told the two doctors I was seeing regularly about how I needed to quit my job and move in with my mom, that they would FINALLY see how severe my pain had been. Afterall, these were the real-life implications of where I was on the QOLS pain scale! 

Wrong again. Instead, both doctors just expressed quiet relief that I was moving out of the area, and thus I’d no longer be their problem! 

Thankfully, when I moved, I did find a new doctor who did take my pain seriously. And although it took some time to get the pain treatment situation under control, it’s been relatively well managed for years now. 

What I have come to realize about the pain scale is that most of the time, it’s not so much an assessment tool as it is a way for patients to feel a false sense of agency over their medical situation.

It’s like a little breadcrumb that doctors give patients to make them feel included in their own healthcare. 

Because in practice, doctors don’t give much weight to whatever number you say your pain is at. Instead, they rely on their own visual and sometimes physical assessment to determine how much pain they think you are in. 

This can be especially problematic for patients from oppressed or marginalized groups, because doctors are less likely to take their pain seriously in general. 

It’s also a huge problem for patients with chronic pain. That’s because when you live with pain every single day, you don’t react to a 10 on the pain scale the same way someone with acute pain would. It’s just not possible to live everyday screaming at the top of your lungs, or performing whatever stereotypical action doctors assume that someone with “real” pain would exhibit. 

For example, one of the things I learned quickly is that I needed to keep myself as calm as possible during a pain flare, because the more stressed and anxious I got, the more it elevated my pain. 

However, a 10 on the pain scale is still just as horrific, even if you’ve been at a 10 for months at a time. And it should elicit the same sense of urgency that would be customary for someone in acute pain saying that their pain was at a 10. 

In fact, I’d go so far as to argue that a 10 for a chronic pain patient can be even more harmful, because if you’re dealing with that level of pain for a long time, it will likely destroy your life. 

Unfortunately, most doctors can’t grasp any of this. So if you show up to an emergency room with an eerie sense of calm while trying to tell them that your pain is a 10/10, they are likely to be very skeptical. 

I wish I could end this column with some sort of solution for patients, but sadly, I don’t think I have one. If your doctor isn’t taking your pain seriously, they probably won’t change their approach just because you show them a different version of a pain scale. 

No, the solution to the frustrating experience of the pain scale will have to come from the other side: from doctors. 

My suggestion is that they start by just believing all patients and then responding accordingly. Unfortunately, under our current healthcare system, I don’t see that happening any time soon.

So all I’ve got for now, is all I’ve ever got: My hope for you that you’re not in too much pain today. 

Physical Activity Helpful for Women with Chronic Pelvic Pain

By Pat Anson

About 1 in 7 women worldwide suffer from a gynecological or chronic pelvic pain disorder (CPPD) such as endometriosis or uterine fibroids – conditions that often don’t respond well to medical treatment.

With their pain and other symptoms poorly treated or even misdiagnosed, it’s not surprising then that many women with CPPDs suffer from depression, anxiety and a poor quality of life.

A new study at the Icahn School of Medicine at Mount Sinai suggests that moderate physical activity like brisk walking or aerobic exercise can improve the mental health of women who have a CPPD.

"Chronic pelvic pain disorders are incredibly complex and burdensome for those affected, yet we still have very few effective treatment strategies," says lead author Ipek Ensari, PhD, an Assistant Professor of Artificial Intelligence and Human Health at the Icahn School. "Our research suggests that physical activity could be an important tool for improving mental health in these patients, offering them a proactive way to enhance their well-being."

Ensari and her colleagues followed 76 women with CPPDs over 14 weeks using mobile health technology, collecting over 4,200 days’ worth of data. The mean average age of the women was 35. Nearly half (43%) said their mental health was only fair or poor, and 28% had previously been diagnosed with anxiety or a mood disorder.

Participants self-reported their mental health, physical functioning, and pain levels weekly on an app (ehive), while Fitbit devices measured their daily physical activity.

The study findings, recently published in the Journal of Pain Research, show a strong association between physical activity and good mental health. Women who did not reach recommended levels of physical activity had higher pain levels and poorer mental health, while those who were physically active had better mental health and physical functioning.  

One key finding was that the benefits of physical activity appear to accumulate over time, rather than provide immediate relief.

"We were particularly intrigued to find that the positive effects of exercise seem to lag by a few days, meaning the mental health benefits may build up gradually," said Ensari. "This insight is vital for both patients and health care providers, as it underscores the importance of consistency in physical activity."

The study is believed to be the first to use data collected in real time on the positive effects of physical activity on the mental health of women with CPPDs. It also demonstrates the potential of artificial intelligence and mobile health technology in chronic disease management.

“By using innovative data modeling techniques, we can better understand how lifestyle factors like physical activity interact with health conditions and pave the way for more personalized treatment approaches," says Girish Nadkarni, MD, Chair of the Windreich Department of Artificial Intelligence and Human Health at the Icahn School.

Endometriosis can have a profound impact on a person’s life. A recent study found that over two-thirds of women with endometriosis missed school or work due to pain from the condition. Women with endometriosis may struggle to keep up with their classes, friends, homework or extracurricular activities. It can also cause pain during sex, putting a strain on romantic relationships.  

What Do Tariffs and the War On Pain Patients Have in Common? Fentanyl-Phobia

By Crystal Lindell

Did you know that there’s a drug that kills 480,000 people in the United States annually? Based on years of headlines, you might assume that the drug in question is fentanyl, but you’d be wrong. It’s actually tobacco.

There’s another drug that kills 178,000 people in the United States annually. It's called alcohol. 

Meanwhile, illicit fentanyl, the street drug everyone loves to be scared of, was involved in the deaths of 73,654 people in 2022.

Any death is too many, but those statistics highlight how disproportionately we focus on fentanyl as the deadly drug we should fear most. 

For years now, overdoses involving fentanyl have been used to justify denying pain patients access to much safer prescription opioids, such as hydrocodone. Now it’s also being used as an excuse for new tariffs against Canada, Mexico and China, which went into effect this week. 

During his speech Tuesday night, President Donald Trump justified the tariffs by saying: “They’ve allowed fentanyl to come into our country at levels never seen before, killing hundreds of thousands of our citizens and many very young, beautiful people, destroying families. Nobody has ever seen anything like it.”

The situation shows how many aspects of our daily lives are impacted by the War on Drugs, whether it’s a doctor’s visit or economic policy. It also highlights just how much the war is used to justify whatever economic, healthcare, and law enforcement policies our government wants at any given time. 

Because, of course, if any of this was actually about saving lives, then we would be focusing on the drugs that kill more people than fentanyl: alcohol and tobacco. Those are both still sold over the counter though. 

Instead, our leaders lean on whipping up a moral panic about fentanyl. The end result is the same, whether that moral panic is used against patients or neighboring countries: it causes unnecessary pain and suffering. 

The headline on an NBC News article calls out the fact that the tariffs probably won’t reduce fentanyl deaths: “Trump says tariffs were enacted to curb fentanyl, but U.S. overdose deaths are already declining.”

The article also points out that nearly all confiscated fentanyl is seized at the US-Mexican border. In the current fiscal year, just 10 pounds of fentanyl have been recovered at the Canadian border, compared to 5,400 pounds at the Mexican border.

Canadian Prime Minister Justin Trudeau is under no illusion that fentanyl deaths are the real reason for the tariffs. MarketWatch reported that Trudeau called Trump’s rationale for using tariffs to stop the miniscule amount of fentanyl coming from Canada "completely bogus." 

"We have to fall back on the one thing he has said repeatedly – that what he wants is to see a total collapse of the Canadian economy, because that will make it easier to annex us," Trudeau said. "We are, of course, open to starting negotiations, (but) let us not fool ourselves about what he seems to be wanting."

Stepping back a bit, it’s important to note that the fentanyl bogeyman is just the latest facet of the War on Drugs, which the United States has been fighting and losing since 1971. The tariffs highlight how little the so-called war has ever been based on actually helping anyone. 

It would be wise to be skeptical anytime the War on Drugs is used as a justification for government policy. Just because a government claims something is the reason for a law or policy, that does not mean that that is the actual reason. That applies to tariffs, as well as limiting opioid pain medication. 

Skepticism should be applied to all drug-related policy in the United States.