Losing My Religion: How Chronic Pain Took My Faith

By Crystal Lindell

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

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

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

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

I read the Bible and prayed every night.

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

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

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

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

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

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

I really did grapple with the loss though.

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

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

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

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

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

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 Carrying the cross, nails through his hands (or wrists depending on your historical reference), and a literal crown of thorns.

Because Jesus died in pain, we got to live.

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

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

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

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

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

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

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

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

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

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

Calls About Kratom to U.S. Poison Control Centers Surge

By Pat Anson

In what could be part of a new federal effort to ban kratom nationwide, the CDC has released a new study pointing to an exponential increase in kratom-related calls to U.S. poison control centers over the past decade.

There was a 1,200% increase in kratom-related reports to the National Poison Data System, from 258 in 2015 to 3,434 in 2025, including a “marked surge” last year. 

There was a similar 1,200% increase in kratom-related reports that resulted in adverse events and hospitalizations, from 43 cases in 2015 to 538 in 2025.

Over that 11-year period, there were a total of 233 kratom-related deaths. Most of the deaths and hospitalizations involved other drugs, such as alcohol, opioids, cannabis, stimulants and benzodiazepines. 

About half of the exposure reports were considered “intentional misuse” or suspected suicide attempts, researchers reported in the CDC’s Morbidity and Mortality Weekly Report (MMWR).

“Kratom-related adverse effects are increasing in number and complexity in the United States. Increasing use, the availability of high-potency kratom, and frequent multiple-substance exposure reports contribute to hospitalizations from physical as well as psychiatric causes,” wrote lead author Christopher Holstege, MD, Professor of Emergency Medicine and Pediatrics at the University of Virginia School of Medicine.

Last summer, the FDA said it would seek to have the potent kratom alkaloid 7-hydroxymitragynine (7-OH) – but not whole leaf kratom – classified as an illegal Schedule One controlled substance. 

7-OH occurs naturally in kratom in trace amounts, but some kratom vendors are selling concentrated versions of 7-OH that boost its potency as a pain reliever and mood enhancer. The surge in poison control cases in 2025 is mainly attributed to the growing use of 7-OH products. 

“As FDA moves to regulate 7-hydroxymitragynine but not whole-leaf kratom products, surveillance should distinguish product types to assess risks. Building this evidence base is essential to promoting safe kratom use, identifying high-risk combinations of substances, and guiding public health action to prevent future health effects in this rapidly evolving drug landscape,” said Holstege. 

Misleading Numbers

It’s important to note that the growing number of kratom-related calls to poison control centers coincide with kratom’s increasing popularity in the United States. 

Kratom comes from the leaves of a tree in Southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. Kratom’s use began growing in the U.S during the 2010’s, as restrictions were placed on opioid analgesics and pain patients sought other ways to get relief. 

According to the MMWR, about 5 million Americans have used kratom, although some estimates are as high as 20 million..

The 14,449 kratom-related calls to poison centers over the 11-year period represents only a tiny fraction (0.28%) of the estimated 5 million kratom users.

Critics say calls to poison control centers are “notoriously unreliable” and an imperfect way to measure the risks associated with a substance, since most calls involve minor symptoms such as upset stomachs or dizziness.

The number of calls can also be misleading. For example, a study of poison control data from 2000 to 2017 found there were more calls about exposure to nutmeg than there were about kratom.  

Nevertheless, the poison control data is often used by federal health officials and law enforcement agencies to seek changes in the legal status of a substance.  In 2016, the DEA and FDA cited another MMRW study to justify their efforts to have 7-OH and the alkaloid mitragynine listed as Schedule One controlled substances, in the same category as heroin. Such a move would have effectively banned kratom.

“Evidence from poison control centers in the United States also shows that there is an increase in the number of individuals abusing kratom, which contains the main active alkaloids mitragynine and 7-hydroxymitragynine. As such, there has been a steady increase in the reporting of kratom exposures by poison control centers,” the DEA said in 2016.

The DEA dropped its proposal to schedule mitragynine and 7-hydroxymitragynine after a public outcry, saying a ban on kratom would have “significant risk of immediate adverse public health consequences.” 

A top federal health official later admitted the FDA and the DEA based their scheduling request on “embarrassingly poor evidence & data.”

The growing controversy over 7-OH has revived efforts to restrict or ban sales of kratom and 7-OH at the state and local level. It may only be a matter of time before the DEA joins that movement, by renewing its effort to schedule 7-OH, mitragynine, and perhaps kratom itself.

How Chronic Pain Makes Childcare Difficult

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Beth Schinoff and Elana Feldman

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

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

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

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

Pushing Through the Pain

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

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

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

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

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

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

Hiding Their Pain

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

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

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

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

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

Breaking the Cycle

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

Why were they able to break free?

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

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

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

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

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

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

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

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

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

Pain Patients Ridicule FDA Plans for Opioid Disposal Systems

By Pat Anson

Should the FDA require pharmacies to provide in-home opioid disposal systems to patients, so they can safely dispose of their unused pain medication?

That’s the question being asked by the FDA in the Federal Register as it seeks public comment on the agency’s latest effort to combat opioid abuse. Although opioid prescriptions have already been reduced significantly – by 50% or more since 2011 – the FDA claims many pain patients still have excess opioids that can easily fall into the wrong hands.

“Having unused opioids laying around at home can be a significant risk to those struggling with opioids and can be a gateway for opioid-naïve family members,” said FDA Commissioner Marty Makary, MD. “We need to develop creative ways to address opioid misuse and abuse.”

Do patients really have opioids “laying around at home” that they don’t need? Given how far opioid prescriptions have fallen and how difficult they are to obtain, some find the idea laughable.

“Ridiculous, waste of money. I'm pretty sure there aren't any leftover pain medications that need disposal because they're not being prescribed to people who truly need them. This is like one of the most ridiculous wastes of money I have ever seen,” wrote April Stetka in her comment on the FDA proposal.

“I live with chronic pain. I am scrambling all the time to get enough medication to alleviate my pain,” said Isaac Arnett Jr. “The idea that people getting prescribed opioids for pain have extras sitting around is laughable.”

“This new proposed regulation is asinine, inhumane, morally corrupt, and continues to push a narrative full of xenophobia and stigma against people who require opioid analgesics. No one in their right mind would throw away life saving medications that are impossible to acquire in proper pain treating doses, if at all,” said Rodney Hipsher

“What are you going to do? Are you going to go into everyone’s house and go through their cabinets, looking for opioids?” asked Catherine Harris. “This is just one more step in treating surgical and chronic pain patients as toddlers, unable to monitor their own use and their own opioids. You have absolutely no right. This whole practice has been barbaric and the federal government and everybody involved should be ashamed at how far these policies have gone.” 

The FDA already requires pharmacies to provide prepaid envelopes to patients to mail back their unwanted opioids. Many pharmacies also have kiosks where unneeded medication can be dropped off, and the DEA regularly has drug “take back” days in local communities. As a last resort, the FDA even recommends flushing some excess opioids down the toilet.

Despite these efforts, the FDA claims that opioid analgesics remain the most common class of prescription drug that is misused, with about 8 million people reporting past-year misuse.

The term “misuse” is misleading, however, because it includes anyone not rigidly following their doctor’s orders. That can include someone taking less medication than what’s prescribed, or someone who stops taking a drug because it doesn’t work, has unwelcome side effects, or simply because they don’t need it anymore. 

Opioids are so difficult to obtain for some patients that they’ve resorted to hoarding excess pills because they’re uncertain if or when they’ll be able to get them in the future. In a PNN survey, nearly a third (32%) of pain patients admitted hoarding opioid medication — patients unlikely to need or want an in-home disposal system.

The odds of any excess opioids falling into the wrong hands are also low. According to the DEA, the estimated diversion rates for hydrocodone (0.53%) and oxycodone (0.69%) are both well under one percent.

Do Disposal Systems Work?

The FDA is vague about how opioid disposal systems should work, only that they be able to “inactivate, sequester, and/or absorb the opioid analgesic” so that it can be safely disposed in household trash.

At least nine commercial drug disposal systems already exist, but because the systems are not regulated and there are no industry standards to follow, there is limited information on their effectiveness or safety. The FDA says there have been reports to poison control centers of children accidentally being exposed to the disposal systems and of patients misunderstanding what the systems are for and ingesting their contents. 

The agency provides no estimate of a possible cost of in-home disposal systems or who should pay for it. But even if they were purchased by opioid manufacturers or pharmacies, you can bet those costs would eventually trickle down to insurers and/or patients. 

An in-home disposal system that is relatively inexpensive is DisposeRx. For $28.99, patients can get a lockable storage kit and packets containing a chemical powder that, when mixed with water, will bind to a medication and make it unusable.

A woman with two teenagers who cares for her elderly sick parents spoke highly of DisposeRx. She worries about her teens having access to her parents’ medications, and tries to get rid of them as soon as possible.

“I would save up my parents’ old meds on the counter until I had time to take them into a kiosk. There have been times where the kiosk is full or out of service and then I have to take everything back home where it goes on the counter again. This actually increases risk,” wrote Lara Popovich. “Now, as soon as I have an Rx my parents no longer need, I use DisposeRx powder and get rid of it immediately.”

People interested in leaving their own comments in the Federal Register have until April 6. You can learn more about the FDA proposal and submit a comment by clicking here.

Why Chronic Pain Often Leads to Depression

By Jianfeng Feng, Trevor Robbins and Xiao Xiao

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Treating Pain and Depression

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

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

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

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

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

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

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

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

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

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

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

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

Doctors Increasingly Mention Kratom in Patient Notes

By Crystal Lindell

Kratom is a hot topic these days, as states and local governments scramble to enact bans on the sale of kratom or put age limits on who can purchase the controversial herbal supplement.

Kratom is also being talked about more in hospital settings, according to a new study published in JAMA Network Open.

The study looked at how often the word “kratom” was mentioned in clinical notes after an emergency department visit or hospitalization at Mass General Brigham (MGB), a large healthcare system based in Massachusetts. 

Researchers looked at patient records between 2017 and 2024, and found a steady increase in kratom being mentioned, both in the ER and in the hospital – about 15% a year in the case of hospitalizations. 

Mentions of “Kratom” in Patient Notes

JAMA NETWORK OPEN

Researchers did not analyze the context under which kratom was mentioned, only that that word “kratom” was included in the clinical notes. Whether or not kratom caused a health problem for patients was not studied.

But that didn’t stop researchers from sounding the alarm about the growing use of kratom and its potent alkaloid, 7-hydroxymitragynine (7-OH). 

“Clinicians should routinely inquire about kratom use and inform patients of its risks and benefits. While additional research on kratom’s therapeutic potential may be warranted, a focus on the serious adverse effect profile from kratom, 7-hydroxymitragynine, and other kratom alkaloids is urgently needed,” wrote lead author Anika Kopczynski, a clinical researcher at Brigham and Women’s Hospital..

Researchers found that doctors who mentioned kratom in their patient notes were mostly treating white males between the ages of 20 and 49. 

Kratom has been used for centuries in Southeast Asia as a natural stimulant and pain reliever, but its use in the United States is relatively new. Estimates on the number of Americans who have used kratom vary widely, from 1.7 million to as many as 20 million.

“The significant increase of encounters with kratom mentioned in our health care system indicates a need for greater clinical awareness,”  said Kopczynski.

Kratom has not been approved by the FDA for any medical condition, and health officials say it has opioid-like effects that can lead to addiction and overdoses. The evidence supporting those claims is thin however, as most of the overdoses involve other substances. 

While “greater clinical awareness” of kratom and 7-OH is probably a good idea, it’s unclear what advice healthcare providers should give to patients about kratom’s “risks and benefits.”  

Should they tell them kratom is “gas station heroin” – as it is often depicted in the media? 

Or should they say it is “safe and well tolerated” with “no evidence of meaningful abuse potential,” as a recent study found?  

The gap between those two conclusions is likely to confuse both patients and doctors, and lead to less discussion, not more.

Unfortunately, opioid-phobia has turned many patient-doctor appointments into something closer to a visit with a probation officer. And the last thing you want to tell your probation officer about is additional substance use. 

Pain sufferers are rightly worried that anything they say will be used against them, and cited as a reason to reduce or even eliminate opioid prescriptions. Even non-opioid patients have a right to be worried about discussing kratom, because they won’t know how that information will be perceived or used. 

So it’s a little short-sighted to advise clinicians to ask patients about their kratom use, without also noting how uncomfortable patients may be with that line of questioning. 

While I have long called for more research into kratom, the predictable focus on its “serious adverse effect profile” is frustrating. I would argue that research into kratom’s potential benefits is needed just as urgently.

Clearly there’s a need for more education about kratom for medical professionals, but my hope is that some of that education is based on research into actual patient experiences.   

U.S. Overdose Deaths Down Significantly

By Pat Anson

The number of fatal drug overdoses fell sharply in the U.S. in 2024, led by a significant decline in deaths involving illicit fentanyl, according to a new analysis.

Over 79,000 Americans lost their lives to a drug overdose in 2024, compared to 105,000 in 2023, a 24.5% decline in one year. Over 54,000 of the deaths in 2024 involved an opioid of some kind. 

The analysis by KFF further demonstrates the declining role of prescription opioids in the nation’s drug crisis. Prescribed opioids are now involved in about one in seven (13.6%) drug overdoses. 

In 2024, 10,851 Americans died from an overdose involving a natural or semi-synthethic prescription opioid, compared to 47,735 deaths involving synthetic opioids, mostly illicit fentanyl. 

Deaths from prescription opioids peaked at 17,029 in 2017 and have steadily declined.

U.S. Opioid Overdose Deaths 2004-2024

SOURCE: KFF

“Since the opioid epidemic was declared a public health emergency in 2017, it has claimed more than half a million lives. While the epidemic was initially driven by prescription opioids and heroin, it has evolved in recent years, to be dominated by illicit synthetic fentanyl — a substance significantly more potent than morphine,” KFF said. “Provisional CDC data suggest opioid deaths have continued to decline through 2025.”

The KFF analysis also looked at deaths involving alcohol, suicide and firearms.

In 2024, 48,824 American lives were lost to suicide, down slightly from the previous year. Firearms accounted for 57% of those deaths. There were 46,714 “alcohol-induced” deaths in 2024 caused by health conditions attributed to excessive alcohol use, about the same number of fentanyl overdoses.

Those deaths greatly outnumber fatal overdoses involving prescription opioids.

U.S. Deaths in 2024

Source: KFF

As PNN has reported, a recent study ranked alcohol as the 5th most harmful drug In the United States, behind illicit fentanyl, methamphetamine, crack and heroin. Prescription opioids ranked as the 7th most harmful drug in the U.S.

The analysis not only looked at the direct harm to drug users, but the indirect harm to families, communities and society at large caused by excessive drug use.

A panel of experts said the analysis shows how misdirected U.S. drug policy is, which is focused on crime and punitive measures to stop drug use, rather than public health measures to address substance use disorders. Criminalizing drug use may also be making the drug crisis worse, by taking legal drugs away from people who benefit from them.   

“All drugs have benefits to people who use them at least initially, and some may have ongoing benefits. For legal drugs, there may be social benefits like employment in related industries and taxation to fund public services,” wrote lead author Michael Broman, PhD, an Assistant Professor at The Ohio State University College of Social Work.

“Redirecting resources towards harm reduction may reduce social harms by reducing the economic cost of policing and surveilling people who use drugs. Concurrently, PWUD (people who use drugs) could remain contributing members of their families and communities.”

Reflecting on 13 Years of Chronic Pain

By Crystal Lindell

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

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

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

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

I was 29.

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

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

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

I also got extremely depressed.

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

I mostly lingered without a diagnosis.

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

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

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

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

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

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

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

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

Lessons Learned

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Low Vitamin D Levels Linked to Chronic Low Back Pain

By Pat Anson

Low levels of Vitamin D are a leading cause of disability worldwide and have been associated with fibromyalgia, rheumatoid arthritis, migraines, and musculoskeletal problems. 

A new study in India suggests the “sunshine vitamin” may also play a role in the development of chronic low back pain.

Researchers at a teaching hospital in eastern India took blood samples from 75 adult patients with chronic low back pain and found a remarkably high rate of low vitamin D serum levels – a condition known as hypovitaminosis D.

Over two-thirds of the patients (69.3%) had “deficient” levels of Vitamin D, while the remaining ones had serum levels that were below normal and considered “insufficient.” 

“Notably, none of the participants had sufficient serum vitamin D levels. These findings are in agreement with existing literature reporting a high prevalence of hypovitaminosis D in the Indian population, even in regions with adequate sunlight exposure,” wrote lead author SK Imran Ali, MD, an orthopaedic surgeon at Dr. Bidhan Chandra Roy Hospital in Haldia. 

Ultraviolet rays in sunlight are the principal source of Vitamin D for most people. India usually gets a significant amount of sunshine, especially from October to May, so why would Vitamin D levels be so low?

Vitamin D deficiency rates on the Indian subcontinent range from 50% to as high as 95%, a phenomenon attributed to darker skin pigmentation, poor diets, and increasingly sedentary (indoor) lifestyles with little sun exposure.

While researchers found an association between chronic low back pain and hypovitaminosis D, they did not establish a causal link. Pain severity and disability levels were about equal between the “deficient” and “insufficient” groups, and between men and women.

Researchers did find that patients from lower socioeconomic classes were statistically more likely to have inadequate Vitamin D levels compared to those in the upper class.

“This observation aligns with existing evidence indicating that socioeconomic factors influence nutritional status, sun exposure, dietary quality, and access to healthcare services, all of which may affect vitamin D levels,” researchers found. “Individuals from lower socioeconomic backgrounds may have limited access to vitamin D-rich foods, reduced opportunities for outdoor activity, and decreased healthcare access, thereby increasing the risk of hypovitaminosis D.”  

In addition to sunshine, you can increase your Vitamin D levels by eating oily fish and eggs. Vitamin D has a wide range of positive health effects, such as strengthening bones and teeth, and inhibiting the growth of some cancers. Vitamin D also improves immune function and reduces inflammation.

I Am Being Forced Off Oxycodone in the Name of Opioid Rotation

By Neen Monty

The current myth in opioid science is that buprenorphine is inherently safer than oxycodone.

The truth is far more ordinary: it depends on the individual. Some people do better on buprenorphine. Others do better on oxycodone. There is no universal “safer” opioid for every patient.

I have trialed buprenorphine before. It was profoundly sedating. I could not function on it.

Despite this, I was required to trial it again.

Here’s what happened.

Week One: Hope

The first few days were incredible.

Less pain.

More functional hours.

And I was sleeping until 5am!

I was thrilled to be wrong about buprenorphine. I ignored the severe nausea and the nagging headache because I could go back to the archery range. I started planning a fitness routine. I allowed myself to feel hopeful.

Week Two: Wearing Down

The nausea intensified. Even with ondansetron (Zofran), it was relentless.

The headache persisted. Not dark-room migraine territory, but just constant enough to make thinking difficult.

Panadol. Nurofen. Naproxen. Nothing touched it.

I also realised my mood had shifted. I felt low. Irritable. Short-tempered. Sad. Defeated.

I controlled it. I always do. I don’t take out my moods on others. My children didn’t see it. They saw normal. They did not see the enormous effort it took for me to stay calm and reasonable. 

The crying happened in the one private space I have: the bathroom. The sadness stayed hidden.

Week Three: Something Was Wrong

By week three, I was done.

My pain doctor told me to persevere. I did, as long as I could. At the end of week three, I ripped the buprenorphine patch off and did not apply the next one.

Enough was enough.

Within four days the nausea was gone.

The headache was gone.

I could think again. I could function again.

You never realise how severe something is until it stops.

Why did I tolerate it for so long? Because if I am labelled “non-compliant,” if I am judged not to be trying hard enough, I risk being forcibly tapered off all opioid medication.

And that would be catastrophic for me.

So, I tried.

Positive attitude! Yes, Doctor. I will trial it. With a smile on my face.

But I cannot continue with buprenorphine.

Next: Palexia

Now the rotation moves to another opioid: Palexia (tapentadol).

Doctors have been convinced that these newer opioids are “safer” than oxycodone. There is no high-quality evidence showing they are safer for stable, long-term chronic pain patients. But the safety narrative has been repeated so often, it is treated as fact.

Palexia is now the most commonly prescribed opioid in Australia. It has overtaken oxycodone. This did not happen because Palexia offers improved pain control. Or because it has fewer side effects. Or because it’s safer.

It happened because doctors were encouraged — in some cases pressured — to rotate patients off their “old school” opioids, to “atypical opioids” like Palexia, buprenorphine, and even tramadol.

A patient’s preference is no longer central. Being stable on a dose is no longer enough.

Opioid rotation is being enforced on me for two reasons.

First, because policies and guidelines position buprenorphine and tapentadol as the “safest” opioids. This is not evidence based; it is opinion.

Second, because I am not getting enough pain relief from my current regimen. My 20mg of oxycodone stops working after 6-8 hours, when it should last 12 hours.

The obvious solution is to prescribe it every 8 hours, instead of every 12 hours. That’s what happened in the past and was the standard of care. Because it is well recognised that the 12-hour formula rarely lasts 12 hours. 

But that would put me over the arbitrary daily dose ceiling of 100 MME. Which is also not evidence based. 

What is evidence based is that I was happier, healthier, fitter and more functional on 120 MME, rather than 100 MME.

But my well-being, pain control and function are not the important issues here.

Instead of the simple and obvious solution, the only solution is opioid rotation. The theory being that I have built up tolerance to oxycodone, but I have not built up tolerance to buprenorphine or tapentadol. So those medications will supposedly work better for me.

Except that’s not how it works in the real world.

Pain relief is not the goal here. It’s just not that important. It’s a money-making policy masquerading as “safety.”

Follow the money if you want to understand rapid prescribing shifts. Pharmaceutical policy rarely moves without financial incentive.

But here is the uncomfortable truth: My GP is not corrupt. She is not malicious. She is a very good GP. She is following guidelines.

She does not have time to audit every citation behind every recommendation on every guideline for every condition she treats. She has to trust her medical college, her training, and the documents placed in front of her.

That trust is not deserved. At least when it comes to treating chronic pain.

The current Australian guidelines are built on expert opinion, not randomised controlled trials. Opinion, layered over selective and cherry-picked evidence. Shaped heavily by academic pharmacology and population-level policy concerns. Not patient outcomes, preference, function or stability.

And patients like me pay the price.

A Four-Week Pause

I told my GP I cannot continue buprenorphine.

She immediately began discussing Palexia.

I asked for four weeks. Just four weeks to stabilise. I am only just beginning to feel like myself again. I am only just becoming functional again. I just lost four weeks of my life to the last rotation attempt. I don’t feel ready to tackle the next medication yet.

I need to take a breath. I need to get back to “normal.” Albeit my normal.

This rotation destabilised me. Made me far worse, not better. 

Also, it would make medical sense to start the next medication from a steady baseline, not during biochemical and emotional turbulence.

She agreed. Very readily. I didn’t have to argue my case. I very much appreciate that. She prescribed my usual regimen of oxycodone extended release and immediate release.

So, for four weeks, I remain on oxycodone. For four weeks, I will stabilise. And feel like myself again.

After that, the forced rotation begins again. I have trialed Palexia before, a few years ago. It did not go well. But still, I am being forced to trial it again.

Round and round.

None of this is my choice.

None of this is evidence based.

None of this is for my benefit.

The Systemic Problem

This is not just about me.

Patient choice has been steadily displaced by policy-driven prescribing. Stability is no longer considered sufficient. Long-term patients who are functioning are being told their medication is “unsafe.” Not because of their individual outcomes, but because of population-level risk narratives built on low-quality evidence and relative risk framing.

Meanwhile, newer opioids are positioned as “safer” without robust comparative long-term data in stable chronic pain populations. 

When prescribing patterns shift this dramatically and this quickly, it is reasonable to ask whether evidence alone is driving the change.

Medicine should be individualised. Instead, it is being standardised around risk optics, regulatory anxiety, and market forces.

And patients bear the instability.

Yes, some patients can safely be rotated, with no adverse events. But not all patients.

A large percentage are objectively and substantially worse off. But this does not matter. Patient satisfaction, patient function, pain relief are all secondary concerns. Often not considered at all. Or, if acknowledged, are dismissed as the patient being difficult or non-compliant.

Patients no longer have any agency, any choice, any control, or even a voice.

Neen Monty is a patient advocate in Australia who lives with rheumatoid arthritis and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), a progressive neurological disease that attacks the nerves.

Neen is dedicated to challenging misinformation and promoting access to safe, effective pain relief. For more information on chronic pain, the science, the politics and the lived experience, got to Pain Patient Advocacy Australia. You can also subscribe to Neen’s free newsletter on Substack, “Arthritic Chick on Chronic Pain.”

More Kids Are Going to ERs for Dental Pain

By Farrell Brenner and Angela Y. Zhang, KFF Health News

Eight-year-old Jonah woke up one May morning with a swollen face and a toothache. He refused the pain medication that his mom, Geneva Reynolds, tried to give him. He didn’t sleep or eat and cried constantly.

Within a few days, Reynolds became so desperate that she and her husband had to physically restrain Jonah, dumping pain medication down his throat as he screamed in pain.

“It broke our hearts,” said Reynolds, who lived in Georgetown, Kentucky, at the time. “And I remember just thinking that it shouldn’t have to come to that.”

JONAH REYNOLDS

Reynolds couldn’t find a dentist with an opening who could treat Jonah, who is autistic and often resists dental exams due to hypersensitivity and anxiety.

Over the course of five days, Reynolds took Jonah twice to a nearby emergency room as he struggled with persistent pain and a fever due to a likely infected tooth with an exposed nerve.

The ER had no dentists; both times, the family was sent home with only pain medication and an ice pack.

Across the nation, more children are entering ERs for preventable tooth problems. Dentists, hygienists, and researchers attributed that trend to a shortage of pediatric dental care professionals in rural areas and worsening oral hygiene since the covid-19 pandemic. 

Tens of thousands of kids end up in the hospital for dental emergencies each year, according to Melissa Burroughs, senior director of policy and advocacy at the national health nonprofit CareQuest Institute for Oral Health.

ER visits for tooth problems unrelated to physical injuries rose almost 60% nationally for children under 15 years old from 2019 to 2022, according to a report released late last year by CareQuest. 

And local data reflects that national trend: At Children’s Hospital Colorado in the Denver area, nontraumatic dental cases, such as cavities or gum infections, in its ER increased 175% from 2010 to 2025, according to hospital spokesperson Sarah Bonar. In Kentucky, where Jonah lives, children’s visits to the ER for dental problems rose 72% from 2020 to 2024, according to the state.

Policy changes under the Trump administration are poised to worsen the trend. President Donald Trump’s 2025 federal budget reconciliation law, known as the One Big Beautiful Bill Act, called for billions in cuts from Medicaid, which may force states to limit or drop dental coverage from the public insurance program for those with low incomes or disabilities. 

New eligibility requirements for Medicaid in some states could affect kids’ access to dental care, even though children are guaranteed dental coverage under the program. Research shows that when parents lose Medicaid, even kids with coverage are more likely to have untreated cavities and less likely to go to a dentist.

The Trump administration has also promoted skepticism about fluoride. Decades of research show that fluoride in drinking water and topical fluoride treatments dramatically reduce tooth decay and prevent cavities. 

In recent months, the Food and Drug Administration warned health professionals against the use of fluoride supplements and the Environmental Protection Agency released an assessment of “potential health risks of fluoride in drinking water.” 

Health and Human Services Secretary Robert F. Kennedy Jr. has called fluoride a “neurotoxin” and “industrial waste.” A 2025 study in JAMA Pediatrics linked high levels of fluoride with lower IQ in children — but only at concentrations far exceeding the recommended level in public drinking water.

Donald Chi, a pediatric dentist at the University of Washington who studies fluoride hesitancy, worries that these anti-fluoride stances will further erode trust in fluoride treatment. Since the start of 2026, lawmakers in at least 15 states have introduced bills prohibiting or limiting fluoride in public drinking water. Utah and Florida in 2025 became the first states to enact fluoride bans.

“Will that have an effect on cavity rates?” Chi asked. “Absolutely.”

Severe Dental Cases Rise

Pediatric dentists Katherine Chin and Chaitanya Puranik said they are treating more patients like Jonah at Children’s Hospital Colorado. More severe cases have become more common, too. Puranik said he used to typically see patients with only one cavity, but now his patients are often coming in with tooth decay throughout their mouth.

During the pandemic, many dental offices closed temporarily, and studies show children also increased their sugar intake, a major risk factor for cavities. Severe cavities that lead to tooth extraction can affect children’s developing jaws, sometimes causing long-term problems with talking or sleeping.

Millions of people live in dental care shortage areas in the U.S., with scant dentists within driving distance. On top of that, only 1 in 3 dentists treat Medicaid patients, due to low reimbursement rates, which are on average less than 40% of their typical dental charges, according to the American Dental Association.

Children with intellectual or developmental disabilities may especially struggle to access quality dental care. Few general dentists have sufficient pediatric training to care for kids with disabilities such as Jonah, who are easily overwhelmed or need to be sedated for an exam, according to KFF, a health information nonprofit that includes KFF Health News. 

Over 26% of children have special health care needs, and those children are twice as likely to have unmet dental needs. Their parents are also more likely to report challenges finding a dentist.

When he was younger, Jonah would not let his parents brush his teeth, which led to cavities in his baby teeth, his mother said. After Jonah’s first visit to the ER, Reynolds found a general dentist with an opening. But unlike a trained pediatric dentist, she said, the dentist did not know how to examine Jonah in a way he could tolerate and wasn’t prepared to provide sedation. Jonah left without treatment and was soon back in the ER when his fever returned.

ERs Rarely Provide Solutions

Bradley Weitz, a pediatrician in Washington County, Maine, said he is fielding “the most horrifying cavities” at Down East Community Hospital.

ERs are often ill-equipped to treat dental concerns, Weitz said. Similar to the ER Jonah went to in Kentucky, Down East has no dentists on staff. Weitz often finds himself prescribing antibiotics as a temporary measure.

“But a month later, they’re back again because it’s flaring up again,” Weitz said.

As a potential solution, states such as Maine and Alaska are proposing to use money from the $50 billion Rural Health Transformation Program to develop the oral health workforce or to create specialized dental care centers, which can better serve children with special health care needs on short notice. 

But those initiatives won’t address the loss of coverage anticipated from Medicaid cuts. California last year awarded $47 million in state grants to develop or expand over 120 dental facilities to serve patients with special health care needs.

Jonah’s dental emergency cost Reynolds a week of work from her job as a dog groomer and Jonah three days of third grade, plus hundreds of dollars in out-of-pocket costs.

Eventually, Reynolds found an oral surgeon who extracted the tooth. But even that went poorly, she said. When Jonah became upset over a needle stick, the surgeon threatened to hold him down, Reynolds said. She said the surgeon left quickly after the procedure and never gave her a clear diagnosis of what caused Jonah’s pain. 

The procedure did resolve his toothache, but Reynolds said more professionals should know how to handle cases like Jonah’s, with sensitivity to the families. Four years later, forcing Jonah to take his pain meds still lives fresh in her memory.

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

Why I Recommend Living with Family if You Have Chronic Pain

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Every Chronic Pain Patient Should Have Their Hormone Levels Tested

By Dr. Forest Tennant

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

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

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

Six hormones that you should test for:

• Pregnenolone

• Progesterone

• Dehydroepiandrosterone (DHEA)

• Estradiol

• Testosterone

• Cortisol

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

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

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

Hormone Therapies

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

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

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

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

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

Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis. Readers interested in learning more about his research should visit the Tennant Foundation’s website, Arachnoiditis Hope. You can subscribe to its research bulletins here.   

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

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

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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