‘Hyperactive’ Stem Cells May Cause Spinal Stenosis

By Pat Anson

Stem cells are often touted for their ability to reduce pain, restore damaged tissues and joints, and even treat cancer.

But researchers at Weill Cornell Medicine and Hospital for Special Surgery have found that when a certain type of stem cell becomes hyperactive in the lower spine, it can lead to lumbar spinal stenosis – a painful back condition that affects over 100 million people worldwide.

These specialized stem cells help generate and restore tendon and ligament cells – normally a good thing –  but in the lower spine they can grow too rapidly, pressing against nerves in the spinal canal, causing pain, numbness and difficulty walking.

“Given that this cell appears to be the ultimate origin of all tendon and ligament cells, defects in this cell are likely at the heart of a wide range of tendon and ligament disorders,” said Matthew Greenblatt, MD, Associate Professor of Pathology and Laboratory Medicine at Weill Cornell and co-author of a study published in the journal Cell.

Greenblatt and his colleagues first identified the stem cell in mice and then looked for it in humans, finding it in kneecaps, Achilles tendons and spines.

“Everywhere we looked, we found this cell,” said Greenblatt. “So, we think this is the universal stem cell for tendons and ligaments throughout the body.”

MRI image of spinal stenosis with two arrows that show narrowing of the spinal canal. (Credit: Dr. Sravisht Iyer)

The researchers found unusually high stem cell numbers in ligaments taken from people with spinal stenosis. When these stenosis-derived cells were transplanted into mice, they produced more tendon cells than healthy stem cells did. The cells showed higher levels of calcium signaling than their healthy counterparts, a sign they are growing too quickly. 

“Though spinal stenosis is a complex condition, this really showed us that these cells are contributing to the pathology,” said Greenblatt.

The good news here is that once you identify the problem, you can start looking for solutions.

Researchers think a class of drugs currently used to manage high blood pressure -- calcium channel blockers – could be repurposed to treat spinal stenosis by reducing calcium signals and slowing the growth of the specialized stem cells. Clinical studies will be needed to explore that theory.

“This is probably the first work that's shown a potential therapeutic target for one of the most common spine conditions in the world,” said co-author Stravisht Iyer, MD, an Associate Professor of Orthopedics at Weill Cornell and a spine surgeon at Hospital for Special Surgery. “The findings are exciting for their potential to change the way we deliver spinal care.

“Identifying these specialized stem cells unlocks a new area of research that allows us to address this disease much more mechanistically, rather than just waiting until a patient’s condition worsens and requires surgery to relieve the nerve compression.”

Spinal stenosis is currently treated with painkillers, physical therapy and steroid shots. If those methods don’t provide enough relief, surgery can be used to remove bone and tissue pressing on spinal nerves or “spacers” can be inserted to relieve pressure on the spine.

In addition to stenosis, researchers hope to explore the role that specialized stem cells play in other conditions, such as Marfan syndrome, a genetic disorder that affects the body’s connective tissues.

The findings could also lead to new treatments for tendons and ligaments that heal poorly after injuries, including rotator cuff tears, Achilles tendon injuries, ligament reconstruction and chronic tendon degeneration.

California Seizes More Kratom and 7-OH, but Online Orders Continue

By Pat Anson

With 7-OH consumers still awaiting final word from the DEA on whether the concentrated kratom alkaloid will be classified as an illegal Schedule One controlled substance, individual states are pursuing regulatory action of their own.  

In California, Governor Gavin Newsom announced the state’s enforcement efforts have so far resulted in nearly 8,000 “deadly kratom/7-OH items” being removed from store shelves. 

Trace amounts of 7-OH (7-hydroxymitragynine) alkaloid occur naturally in whole leaf kratom, but manufacturers have developed ways to concentrate 7-OH in tablets, gummies and shots, which are potent pain relievers with “opioid-like” effects.  

Although the DEA is only considering a ban on 7-OH – leaving natural leaf kratom alone – California says kratom and 7-OH products both pose “serious health risks.” 

California’s crackdown began last October, when state health officials issued a consumer warning claiming that kratom and 7-OH are dangerous and resulted in several overdose deaths. Enforcement actions stepped up in January, with state agents seizing millions of dollars worth of kratom and 7-OH products. To date, they’ve issued 181 citations. 

The state also warned vendors they could lose their licenses to sell alcohol if they sold kratom and 7-OH. That threat – in effect saying it was safe to sell beer, wine and other intoxicating beverages but not kratom and 7-OH – has resulted in a 98% compliance rate by Alcoholic Beverage Control licensees.

“If a product is sold in California, people should be able to trust that it follows the law. We’ve made the rules clear, giving businesses the opportunity to comply, and we’re holding accountable those who don’t. That’s how you protect kids and consumers while standing up for responsible businesses doing things the right way,” Gov. Gavin Newsom said in a news release.

But California’s enforcement efforts are uneven because they mainly target brick-and-mortar stores. Some online vendors are still shipping kratom and 7-OH products directly to California consumers, even though the California Department of Public Health (CDPH) said it has taken “significant enforcement action” against out-of-state kratom distributors.  

“CDPH has taken enforcement action on multiple orders of kratom shipped from out-of-state to California distribution facilities,” the agency said in a statement to PNN. "CDPH continues to monitor and enforce compliance with state law, including when products are sold or shipped directly to consumers in California. When CDPH becomes aware of unlawful kratom shipments, CDPH may take appropriate regulatory or enforcement action in coordination with local partners." 

The CDPH says it has the legal authority to ban kratom and 7-OH because they are “adulterated and misbranded” products that violate the California Health & Safety Code.

North Dakota Amends Kratom Ban

Dozens of other states, counties and cities have enacted laws banning or regulating kratom and 7-OH sales.

On Friday, North Dakota Governor Kelly Armstrong signed legislation that bans the sale, possession and use of 7-OH and other synthetic kratom products, and restricts the sale of natural kratom products to adults 21 and older.

Armstrong signed an executive order last month banning all kratom products, but under the new law passed by the North Dakota legislature during an emergency session, it will be legal again to sell natural leaf kratom as long as there are accurate labels and age restrictions.

“This is a victory for public health and safety, keeping dangerous synthetic kratom products off the shelves and protecting our young people from the adverse and unknown long-term effects of natural kratom, which is not regulated by the FDA but will now be subject to strict state regulations,” said Armstrong, who preferred a total ban on kratom.

Meanwhile, the DEA continues to slow walk enforcement action against 7-OH, even though it’s considered “an imminent threat to public health.” It’s been over a year since the FDA asked DEA to classify concentrated 7-OH as an illegal Schedule One substance, explicitly saying such a ban should not include natural kratom leaf.

DEA finally began the formal scheduling process for 7-OH in July, but federal health officials recently extended the public comment period until September 10. It’s not clear when DEA will act once that deadline passes or if it will make any changes in its scheduling order. 

As currently written, the order limits the amount of 7-OH to no more than 0.05% of a product by weight or volume, the equivalent of about 1 mg per tablet or gummie. That is well below the current dosage levels of 7-OH products. 

Pain Can Make You Mean. Don’t Let It

By Crystal Lindell

As a child, I grew up hearing stories about just how viciously mean my late great-grandmother was. Her son, my late grandpa, was also described as “mean.”

Nobody wanted to be around them. Everybody wanted to be different from them. 

The moral of the tale – as I was so often told as a little girl – was to make sure I didn’t grow up to be “mean.”

As I got a little older though, I started to also hear the stories about their various medical ailments.  

My great grandma suffered from rheumatoid arthritis. She moved to Arizona in her later years hoping the dry desert air would bring her relief. And she started drinking a single beer every day to treat the pain, because her only other option was aspirin.  

Meanwhile, my grandpa regularly spent months in the hospital because of his scoliosis. He wore a back brace, and when he was home, he was either in bed or sitting at the kitchen table chain smoking cigarettes.

As an adult, with my own medical ailments, the picture has become much clearer. My great-grandmother and grandpa probably were very mean – but it’s only because they were both in a lot of pain.

They suffered every day. And they did what millions of others before them have done in that situation – they let the pain make them mean.

The healthy adults who told me these family fables never seemed to make the connections between the pain and temperament. They saw the mean personalities as something inherent in both my great grandma and my grandpa, as though it were some wholly separate thing from the health conditions that ravaged their bodies.

To my relatives, they were mean because they were bad people.

As an adult with chronic pain myself, I have come to understand things that were impossible for me to grasp as a child: They weren’t bad people, they just had bad bodies.

When you’re dealing with chronic pain, even the nicest, kindest person will develop an insatiable urge to lose their temper on those around them. After all, you can’t waste time with fake pleasantries and patience when your body feels like it’s been through a war zone.

I don’t want to be mean though.

Even on my worst pain days, I make a specific effort to ensure that I’m not taking out my physical pain on those around me.

But I struggle. There are so many times that I want to snap at my fiancé, yell at my mom, lose my temper on my friend. Can’t they see? I’m in pain! Why are they talking to me and annoying me when I’m in pain?

I stop myself though. Or, worst case, when I don’t have enough strength to stop myself, I apologize afterwards.

Beyond that though, when I know someone is struggling with physical pain, I don’t take their meanness personally. Instead, I offer sympathy.

All of us are just a few bad pain days away from becoming mean. Knowing that can help us offer understanding to others. But more than that, it can help us fight off the urge within ourselves.

So yes, pain can make someone “mean” - and those of us with chronic pain often are. But if we’re diligent, it doesn’t have to become our whole personality.

Cannabis Detected in One in Five U.S. Overdose Deaths

By Pat Anson

A new study by the CDC seems likely to revive an old debate about cannabis: Can you overdose on cannabis?

The study, published in the CDC’s Morbidity and Mortality Weekly Report (MMWR), looked at U.S. overdoses from 2021 to 2025 and found that cannabis was “detected” in 43,880 deaths. That’s over one in five overdoses (21%).

It’s an alarming statistic, and also misleading because it doesn’t tell us the cause of those deaths – only that cannabis was detected in a toxicology test after someone died.

A deeper reading of the study shows that cannabis was listed as causing death (i.e., involved) in 0.8% of drug deaths and was the only drug involved in 0.004% of them. That represents just nine deaths over a five year period. 

Most of the cannabis-related deaths also involved more risky substances, such as illicit fentanyl (73.5%) and stimulants like cocaine or methamphetamine (60.4%).

“This evidence indicates that overdose deaths caused by cannabis are rare, and detection of cannabis among overdose deaths is primarily indicative of polysubstance use,” wrote lead author Lauren Tanz, ScD, Senior Scientist of Overdose Prevention in the National Center for Injury Prevention and Control.

“Because cannabinoids are rarely implicated in the cause of death, cannabinoid screening and confirmatory testing is not universally conducted. Thus, the identification of cannabis use among overdose deaths is likely underestimated.”

The CDC study is in line with previous ones, which found that the risk of death due to cannabis poisoning is “negligible.” Unlike opioids, cannabis doesn’t cause respiratory depression, which can stop people from breathing. 

But even the caveat of a cannabis overdose being “rare” is a bridge too far for cannabis advocates.

“Since it is well understood and acknowledged that cannabinoids are incapable of causing overdose death, and since the DEA continues to acknowledge even now that "no deaths from overdose of marijuana have been reported,” it seems irresponsible for the authors to put this statement out there at face value,” said Paul Armentano, Deputy Director of NORML, which advocates for marijuana legalization.

Armentano says the nine fatal overdoses in which cannabis was the only drug detected could be laboratory coding errors. Or some untested substance or health condition may have played a role.      

“Perhaps it’s also possible that a person suffered cardiac arrest following cannabis use and this death was miscoded as an overdose involving cannabis. Again, neither I nor anyone else have any idea because this report is presented without any details necessary to give it any sort of probative value whatsoever,” Armentano said in an email.

A cannabis overdose may be rare or unlikely, but you can become impaired by consuming too much cannabis, which increases the risk of an accident or a traumatic physical injury. Regular consumption can also contribute to cannabis use disorder (CUD), cognitive decline, mental health problems, or lung disorders if cannabis is smoked or vaped.

With the potency and availability of cannabis increasing, it’s not surprising that CUD rates are also rising. A recent study by the National Institute of Drug Abuse (NIDA) estimates that 19.4 million Americans have CUD, or about 7.3% of all adults. 

Increasingly, those adults tend to be older. The steepest increases in CUD occurred among adults aged 35 to 49 years and males 50 or older.

While CUD rates are going up, the number of Americans abusing alcohol has stabilized and is going down for some age groups, such as adults aged 21 to 34 years – the prime drinking age for earlier generations.

“This divergence may reflect behavioral and cultural shift – including increasing cannabis preference over alcohol – and declines in binge or heavy drinking,” wrote senior author Nora Volkow, MD, NIDA’s Director. “Findings repudiate conventional assumptions that cannabis carries a low addiction risk and that most young adults with CUD have mild symptoms.”    

In the end, the biggest risk from cannabis isn’t the “negligible” or “rare” risk of an overdose – it’s the risk of dying from something else. 

A recent JAMA study found that 3.5% of patients receiving hospital-based care for CUD in Canada died within five years — a rate 6 times higher than the general population. CUD patients had an elevated risk of dying from suicide, trauma, opioid poisoning, and lung cancer. 

Fans of Heavy Metal Music Have More Pain Tolerance

By Crystal Lindell

Angry and loud heavy metal music may not be good for your hearing, but it might actually be good for increasing pain tolerance. That’s according to a new study published in Nature by German researchers.  

The researchers asked attendees at the German Wacken Open Air festival in 2023 if they experienced “music-induced analgesia” while listening to heavy metal music. 

Sixty people were recruited before the festival began and put through a series of tests. Their results were then compared with those of 62 people who were recruited on the third and fourth day of the festival.

Before we go any further, take a look and listen to a sample of the Wacken Open Air festival, which bills itself as “the biggest metal festival on planet earth.” 

Researchers from the Max Planck Institute for Human Cognitive and Brain Sciences did several tests to see if being at the festival had any impact on pain tolerance, pain sensitivity, or unpleasantness. 

To test pain tolerance, they had participants place their hand and forearm in cold water for as long as they could tolerate it, up to four minutes maximum. An electrocardiogram was also used to measure their heart rate and “emotional processing.”

The researchers hypothesized that accepting unpleasant emotional experiences or difficult situations plays a central role in being resilient and tolerating pain – as opposed to masking those unpleasant emotions. Heavy metal music is known to help people express unpleasant emotions like anger.

“This aligns with common themes in metal music, which often expresses difficult emotions and life challenges, avoiding attempts to mask them with happiness,” the researchers wrote. “Combining such expression of negative emotionality with an energetic and activating soundscape may foster self-efficacy, an important component of resilience.”

Researchers found the music had no effect on pain sensitivity or unpleasantness, but they did find that pain tolerance was significantly increased for those who attended the festival.

"Participants perceived their pain during the festival not as less unpleasant or were less sensitive in perceiving it, but they could endure it for a longer time,” the authors said. “This seems to indicate that participants got more resilient, which means that they might have to a greater degree accepted feelings of unpleasantness towards the pain experience.”

Of course, it’s hard to say how much of a role heavy metal music played in the increased pain tolerance, since it could have also been caused by the social aspects of attending a music festival that is known to be “especially inclusive and friendly.” 

One might guess the 85,000 people who attended the festival also engaged in some drug and alcohol use, which may have impacted pain tolerance. The researchers say any individual displaying observable signs of intoxication was excluded from the study.  

In the end though, the only takeaway here is that sometimes you just need to scream along to some metal music to better tolerate pain – and honestly, that tracks.

Little Evidence Back Braces Work for Chronic Low Back Pain

By Pat Anson

Lumbar supports – also known as back braces – are widely used around the world for low back pain. They’re designed to stabilize the lower back and apply gentle compression to the abdomen, giving relief to sore muscles and aching backs.

There’s also little evidence that they work, according to a new Cochrane review by Italian researchers, who looked at the findings of eight randomised controlled trials involving over 500 adults with chronic low back pain. Five of the studies were conducted in low and middle-income countries and three were in high-income countries. 

Researchers found that lumbar supports showed little to no benefit, with the possible exception of a small short-term reduction in pain intensity when used with pain relievers like ibuprofen. The authors were cautious about drawing any further conclusions from the eight trials, and rated the quality of evidence as very low.

“Lumbar supports are widely used in clinical practice despite the fact we know virtually nothing about their effectiveness,” says lead author Chiara Arienti, PhD, an Assistant Professor in the Clinical Epidemiology Research Centre at Humanitas University in Milan. “Drawing from a very thin research base, we still don’t have enough evidence to make broad recommendations for or against their use.”

Arienti and her colleagues say lumbar supports may provide pain relief for three to four weeks when combined with nonsteroidal anti-inflammatory drugs (NSAIDs), but offer little to no benefit when used alone. They were also “very uncertain” about the benefits of lumbar support when combined with exercise and education.

None of the studies tested mobility devices like walking aids or wheelchairs, which could potentially be helpful for older adults and people with disabilities.

Lumbar Supports More Common in Poorer Countries

One interesting finding was the geographic distribution of the research. Most of the trials were conducted in low- and middle-income countries, where lumbar supports are used more routinely. 

In higher income countries, patients are more likely to get exercise therapy, education, and cognitive behavioral therapy for chronic low back pain. Those “active” therapies are less likely to be offered in poorer countries.

"It's striking that most of the research on lumbar supports is coming from areas where active treatments are harder to access," says senior author Stefano Negrini, PhD, a Professor in Physical and Rehabilitation Medicine at the University of Milan. “There’s enough data now showing that active treatments have a clinical effect on low back pain, but these treatments can be very expensive because they require rehabilitation professionals' involvement.”

As the population ages around the world, demand for low-cost treatments is likely to grow. The authors say more research is needed in low to middle-income countries to better understand the value of lumbar supports, particularly for older adults who may not have access to other treatments. 

“We have to ask ourselves whether we are looking at this problem only through the lens of the Global North, and whether that is the right perspective. These devices may play a different and important role in contexts where the alternative simply isn't available," Negrini said.

Chronic lower back pain is the leading cause of disability worldwide. Over 72 million U.S. adults suffer from it, according to a 2022 Harris Poll. About a third of those surveyed rated their pain as severe and nearly half said they experienced chronic back pain for at least five years. 

Although lower back pain is quite common, there is little consensus on how to treat it. Most of the clinical trial evidence is considered low or very low quality, a persistent problem.in many medical guidelines dealing with pain. 

Guideline for Migraine Prevention Finds Strongest Evidence for CGRP Inhibitors

By Pat Anson

New guidelines for medications that prevent migraines show that the strongest evidence supports the use of three CGRP inhibitors: Emgality, Ajovy and Aimovig. There is also strong evidence for using Botox injections to prevent chronic migraine.

The updated guideline was developed by the American Academy of Neurology and American Headache Society, and published in the journals Neurology and Headache. The update is the first since 2012 and incorporates several new treatments that have been developed since then, such as medications that inhibit calcitonin gene-related peptides (CGRPs), a protein that triggers migraine pain. 

Migraine affects about 39 million people in the United States and 1.1 billion worldwide. In addition to headache pain, migraine can cause nausea, blurriness, and sensitivity to light or sound. Women are three times more likely to suffer from migraines than men.  

Acute migraine medications help treat headache pain and other symptoms as they occur, while preventive medications stop migraines from starting. Oral migraine preventive medications need to be taken every day or every other day, while injectable medications are taken once a month or once every three months.Only one oral medication (Nurtec) both treats and prevents migraine attacks.

“There are a variety of effective preventive medications that work in different ways, including newer classes of medications that have been released in the past several years,” said guideline co-author Tamara Pringsheim, MD, a Professor at the University of Calgary. “For people experiencing frequent migraine attacks or attacks that affect the ability to function normally, this guideline can help clinicians determine which preventive medications may be able to help.”

The guideline update is based on a review of 217 studies that evaluated dozens of medications, and includes recommendations for preventing both chronic and episodic migraine. People with chronic migraine have 15 headache days or more each month, while episodic migraine occurs less often.

The guideline ranks each medication based on the evidence being either strong, moderate or weak. No evidence was found to support the use of over a dozen medications sometimes prescribed off-label for migraine, including Klonopin and Cymbalta. 

While the strongest evidence supports the newer CGRP inhibitors, moderate evidence exists for some old-line medications such as beta-blockers and anti-seizure medications. However, many of the older drugs are more likely to have side-effects, such as constipation and weight loss. 

Some medications, like antidepressants or medications that lower blood pressure, are primarily intended for other health conditions but have been effective in reducing migraine pain for some patients. 

“The research shows many different types of medications may be effective for preventing migraine attacks and reducing symptoms,” said co-author Rebecca Burch, MD, Associate Professor at the University of Vermont Larner College of Medicine. “The guideline includes recommendations for both previously established and newer medications. If one type of medication is not working well, a different type may still be effective. It is important for clinicians and patients to know that there are many options.”

The guideline says preventive treatments should be offered to adults who experience four or more migraine days per month or four or more moderate to severe headache days per month, or if migraine is affecting their ability to work or complete daily tasks.

When working with patients to choose medications, the guideline says clinicians should discuss the strength of the evidence, possible side effects, insurance coverage and out-of-pocket expenses. While CGRP inhibitors are some of the most effective medications, they often cost substantially more than older treatments.

A 2023 study found that some cheaper drugs are just as effective at preventing migraine as CGRP inhibitors. Researchers at the Norwegian Center for Headache Research found that two drugs commonly used to treat depression and high cholesterol – amitriptyline and simvastatin – help reduce the use of medications used to treat acute migraine pain. Both drugs are used off-label for migraine prevention. 

How I’m Able to Work Again with Chronic Pain

By Crystal Lindell

How do I do it?

On my days off, I sleep for 15 hours, waking up only to eat and pet my cats.

I can’t get out of bed without Norco, morphine, Advil, 7-OH, and Tums.

And I have a super supportive partner who does all the house work, all the grocery shopping, and changes all the litter boxes.  

That’s the short answer for how I manage to work a full-time job outside of the home while living with debilitating chronic pain. It takes a lot of drugs, a lot of sleep, a lot of support, and a lot of luck.

I also eat the same meals nearly every day to make food prep and decision-making easier. And I make zero plans for days off.

I started working again in April – my first full-time job in over four years. 

Despite my years of experience as a professional journalist working in the corporate world, I took a job as a gas station cashier close to home. I was fed up with corporate culture and just wanted to see if I could even handle working full-time again in any capacity with my health issues.

I also needed health insurance and the gas station offered me that after just one month.

Now that it's been a little over three months, it felt like a good time to reflect on how it’s going.

To be honest with you, I absolutely love it!

I love going to work every day. I love interacting with the public and making friends with my co-workers. I love getting out of the house. And I have already been promoted to the first level of management, with hopes of continuing up the ladder.

But it has taken a major toll on my body. 

I wake up in so much pain that walking to the bathroom feels like I’m using muscles for the first time in years. And after my shifts, I only have enough energy to change out of my work clothes and get into bed. 

I really don’t know if I’ll be able to keep it up if 7-OH is officially made into a Schedule One controlled substance.

I really, really want to keep it up though. 

I want to keep working, being good at my job, and forming surprisingly deep connections with my fellow employees. I want to keep feeling productive and living like I have a purpose in this world – even if that purpose is just helping truckers get back on the road.

That’s because, despite all the stereotypes about people with chronic illnesses, I desperately want to work. 

In reality, it’s the people constantly trying to take away my access to opioids and 7-OH who want me to be unemployed and bed bound. 

They may soon get their wish if 7-OH is banned – a policy being pushed in the name of “protecting me.”

Protection I do not want and didn’t ask for.

If it happens, the anti-7-OH advocates and federal health officials won’t take any responsibility. They won’t even offer me health insurance. Instead, I suspect they will tell me to go out and get a job.

$10 Million Worth of 7-OH Products Destroyed

By Pat Anson

The Kansas City-based company that developed and launched the first 7-OH products destroyed $10 million worth of the concentrated kratom alkaloid this week, in anticipation of 7-OH soon being banned nationwide.

7-OH products made by CBD American Shaman have already been taken off the market in its home state, after Missouri’s attorney general sued the company, claiming its 7-OH tablets, gummies and shots are “deadly opioids” that pose significant risks. The company still sells 7-OH tablets online, but won’t ship to Missouri and 13 other states where 7-OH is banned.

The DEA has begun the process of classifying concentrated 7-OH (7-hydroxymitragynine) as an illegal Schedule One controlled substance, which would make the sale and possession of 7-OH a felony. The DEA has already put the kratom alkaloid mitragynine pseudoindoxyl, along with synthetic alkaloids MGM-15 and MGM-16, in that category.

In addition to 7-OH, American Shaman developed the first concentrated mitragynine pseudoindoxyl products, which are more potent pain relievers than 7-OH.

“Unfortunately, of all the things, pseudoindoxyl is probably the very best pain medicine ever to hit earth,” Vince Sanders, Founder and CEO of American Shaman, told the Missouri Independent.

“I mean, very little mind change, very slow addictive properties, and just an incredible painkiller. But it’s gone. I’m sure it’ll show up as a pharmaceutical in five years or so, but as of now, people don’t have it available, which is truly a shame.”

The Department of Justice (DOJ) views pseudoindoxyl differently, calling it an “imminent hazard to public safety.”

“These are potent opioids being manufactured and sold in consumer products, often under labels that obscure their true risks. This action will protect our nation’s children and communities from the dangers of drug addiction and abuse,” Attorney General Todd Blanche said in a news release.

AKA Lawsuit

The DOJ’s news release makes a point of saying the agency has no desire to take natural leaf kratom off the market, and that it will “exercise enforcement discretion” by only targeting products that contain concentrated kratom alkaloids.

The American Kratom Association (AKA), which represents natural leaf kratom vendors, filed a lawsuit against the DEA and DOJ this week, seeking assurances that kratom leaf will be exempted from any federal bans. 

In recent years, kratom vendors have lost a considerable amount of business to 7-OH competitors. The AKA has actively encouraged state and federal governments to ban 7-OH and similar products..      

“The federal government made the right decision to target dangerous chemically manipulated opioid products,” says Mac Haddow, an AKA lobbyist and spokesman. “But that objective is undermined if legitimate natural kratom leaf products are swept into Schedule I because laboratories can now detect trace compounds at levels that do not present the public safety threat DEA sought to address.” 

To be clear, kratom and its alkaloids are not traditional opioids derived from poppy plants. Kratom comes from the leaves of the Mitragyna speciosa tree in Southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. 

Powdered kratom leaf gained in popularity in the United States nearly a decade ago, after many pain sufferers lost access to prescription opioids. The more potent 7-OH products went on the market in 2022 and quickly built up a following. Several million Americans have used kratom leaf or the concentrated kratom alkaloids, which have “opioid-like” effects but do not have the same risk factors as traditional opioids.

Norway 7-OH Death

In its scheduling order for 7-OH, the DEA claimed that “fatal overdoses involving 7-hydroxymitragynine have been reported,” but cited only one death. PNN discovered that lone case involved a middle-aged man in Norway who had a history of drug abuse and mental illness, as well as other health problems. 

In addition to 7-OH and a “high concentration” of mitragynine, toxicologists found a sedative, antidepressant, and anti-seizure medication in the man’s blood and urine. Death was attributed to “intoxication by these substances.”

Most overdoses blamed on 7-OH involve other substances, making the precise cause of death unclear.

Undermining the DEA’s case against 7-OH even further is that the overdose in Norway occurred in 2014, long before 7-OH products appeared on the market.   

7-OH advocates were successful in getting federal health officials to reopen and extend the public comment period on the trace amount of 7-OH that would be allowed after scheduling. That extension until September 10 is not binding on the DEA, but it appears the agency has agreed to postpone any further scheduling action until additional public comments can be made and evaluated. 

The original 30-day comment period received over 32,000 responses, one of the highest number of public comments ever recorded in the Federal Register.      

Illicit Fentanyl Use Twice as Common as Medical Use

By Pat Anson

Fentanyl has long played an essential role as a potent analgesic that can treat the most severe types of pain. But illicit versions of the synthetic opioid have been a scourge on the U.S. black market for over a decade, making it one of the leading causes of fatal overdoses.

The largest study to date has quantified how far those dual roles have gone, showing that illicit use of fentanyl is more than twice as common as medical use.

Analyzing urine drug tests for nearly 300,000 people who tested positive for fentanyl, researchers at The Ohio State University say 71.1% of them did not have a prescription for fentanyl, compared to 28.9% who had a legitimate medical reason for taking it.

“Fentanyl is a big problem, but we don’t actually know how serious illicit drug use is compared to medical use,” co-lead author Ping Zhang, PhD, a Professor in the College of Pharmacy at Ohio State said in a news release.

“Finding that illicit use has reached 70% among all fentanyl users is a surprise. And this is also a contribution of this paper. To make something that’s been a black hole visible to the healthcare system is significant.” 

Zhang and his colleagues, who published their study in the journal eClinicalMedicine, also found that illicit fentanyl users were three times more likely to suffer an overdose than patients who were given fentanyl in a hospital or were prescribed the drug. 

In 2023, over 105,000 people in the U.S. died from a drug overdose, with nearly 73,000 of those deaths involved synthetic opioids, primarily illicit fentanyl. That represents about 92% of all opioid-related deaths.

Until about a decade ago, the CDC counted all fentanyl overdoses as prescription drug deaths, a mistake that significantly inflated the number of overdoses attributed to prescription opioids. 

The misclassification of those deaths affected public policy. A CDC public awareness campaign, for example, focused entirely on the risks associated with prescription opioids, rather than the dangers posed by illicit fentanyl. When asked why it wasn’t warning people about fentanyl, a CDC spokesperson said the agency didn't want to risk “diluting” the primary message of its advertising campaign.

The Ohio State analysis found that illicit fentanyl users were younger, less likely to be married, had a higher concentration of fentanyl detected in their urine, and were more likely to have a mental health or substance use disorder.

Medical users of fentanyl were more likely to have a chronic health condition, such as cancer, cardiovascular disease, hypertension, and diabetes. They were also significantly less likely to overdose, abuse or become dependent on fentanyl compared to illicit users.

Geographically, Ohio had the highest proportion of illicit fentanyl users – 12.2% – followed by Massachusetts (10.5%) and California (8.8%). 

The number of fatal overdoses involving synthetic opioids like fentanyl peaked in 2022 at nearly 74,000 deaths and have since declined significantly. By 2025, the number of fentanyl-related overdoses was estimated at 38,084 deaths.

How Messaging in Patient Portals Impacts Care

By Crystal Lindell

What you write in texts and messages to your doctor can impact the quality of care that you receive, according to a new study published in JAMA. 

Researchers at Harvard and Columbia University analyzed over 3.5 million patient messages sent by over half a million patients through patient portals like MyChart. They wanted to see how a patient’s race, education and other demographics might influence how doctors respond to their messages.

Researchers found “substantial differences” in how providers responded to historically marginalized groups, such as Blacks and Hispanics, but found that a patient’s writing style had more impact on how care teams responded. If they were polite and positive, a patient was more likely to get a response.

“Writing style was a more important factor. Seemingly minor differences among messages, such as whether the opening included the target clinician’s name, were associated with significantly different response rates,” researchers reported.

For example, when patient messages included a clinician’s last name in the opening line, such as “Dear Dr. Smith,” those messages had a 38.7% response rate.

But when a message had no greeting at all -- no salutation or even a simple “hello” – those messages had just a 25.7% response rate.

Providers were also more likely to respond to messages that had a positive sentiment; used expressive punctuation such as question and exclamation marks; and higher word counts. 

To illustrate what they found, researchers asked ChatpGPT to write two messages from the perspective of a patient with respiratory symptoms. 

One message was polite and positive – written in a way to get a high response rate: 

"Dear Dr. Liu, 

I hope you're doing well! I wanted to reach out because I've been experiencing some new respiratory symptoms that I'm a little concerned about and would really appreciate your perspective. Over the past two days, I've developed a dry, persistent cough along with some chest tightness and mild shortness of breath -- especially when walking or going up stairs. 

I haven't had a fever, but the symptoms are definitely noticeable and seem to be getting a bit worse, which is making me wonder if there could be something more going on? I know you've helped me manage my asthma in the past, could this be a flare-up or something else entirely?? 

Thanks so much again for all you do! I really appreciate your time and guidance. 

Warmly, 

Peter Parker

The other patient message was short and blunt – written in a way that researchers thought would get a poor response rate: 

"I've had a cough and congestion for a few days now, and it's been pretty uncomfortable. Still no fever, but it's been dragging on and making it harder to get through the day."

See the difference? The more polite and positive message, though much longer, is more likely to get a response. Writing style was a possible explanation for about half of the disparities that researchers found in response rates. 

“In many message triage systems, nurses and medical assistants must quickly assess messages — often with little context — and make snap judgments on their urgency, complexity, and need for escalation. Given these constraints, it is not surprising that writing style factors might influence the triage process,” researchers said.

Patient portals provide an easy and convenient way for patients to send messages to their physicians, but put an extra burden on doctors to respond. Some do and some don’t – depending on the patient.

So the next time you write a text or message to your doctor, make an effort to be polite and positive. Use words like “please” and “thanks.” Simply being polite can have some surprisingly positive outcomes.  

Extension of Comment Period Buys 7-OH Advocates More Time

By Pat Anson

Pain patients and advocacy groups who support the continued sale of a concentrated kratom alkaloid have apparently been successful in getting the Trump administration to postpone plans to classify 7-OH (7-hydroxymitragynine) as an illegal Schedule One controlled substance.

In a notice soon to be published in the Federal Register, the Office of the Assistant Secretary for Health (OASH) said it was extending for 15 days the public comment period on the threshold of 7-OH that can be legally allowed in commercial products. 

7-OH occurs naturally in whole leaf kratom, but manufacturers have developed ways to concentrate 7-OH into tablets, gummies and shots, which have “opioid-like” effects and are potent pain relievers. 

The earlier 30-day public comment period by HHS ended on July 31 with over 32,000 comments received. The new HHS notice reopens and extends the comment period through September 10.

“Public comments submitted to this docket will be provided by the Secretary for Health and Human Services for consideration by the Attorney General. We are taking this action in response to a request for an extension to allow interested persons additional time to provide comments and input,” wrote Brian Christine, Assistant Secretary for Health at HHS.

“Note that OASH is not soliciting comments on any permanent scheduling decision, the general safety or utility of kratom-derived products, or other policy questions outside the scope of the threshold determination for temporary scheduling.”

In July, the Drug Enforcement Administration published plans to limit the legal threshold of 7-OH to no more than 0.05% of a product by weight or volume, the equivalent of about 1 mg 7-OH per tablet. Virtually all 7-OH products on the market have much higher dosages. 

Although the extension of the HHS public comment period is not binding on the DEA, it seems likely the DEA will also postpone any action on its plan to classify concentrated 7-OH products as Schedule One controlled substances, the same category as heroin and LSD. 

The DEA reports to Attorney General Todd Blanche, who has the ultimate authority to decide how drugs are scheduled under the Controlled Substances Act (CSA). 

“They (DEA) could have a 7-OH ban right now. I think it more likely, given that the Assistant Secretary for Health has requested the 15-day extension, that they’ll give it time to be evaluated,” said Mac Haddow, a lobbyist and spokesman for the American Kratom Association (AKA), which supports the scheduling of rival 7-OH products. 

“So you may see at the earliest, in my opinion, a month before we’ll see the 7-OH schedule come out.”

The extension of the public comment period was sought by 7-HOPE Alliance and other 7-OH advocacy groups, who said they needed more time to respond to the “highly technical and largely unprecedented scientific and regulatory questions” being asked by HHS about a safe threshold for 7-OH.

“Preparing a meaningful response requires consultation with scientific advisors, review of the available literature, coordination with affected stakeholders, and careful analysis of complex pharmacological and analytical issues. These are precisely the types of substantive, evidence-based comments the Agency seeks, yet they cannot reasonably be assembled within the current timeframe.” wrote Jackie Subeck, Executive Director of 7-HOPE Alliance, in a letter to OASH.

“A modest 60-day extension would significantly improve both the quality and breadth of the administrative record before the Agency. It would allow consumers to have their voices heard while providing organizations, researchers, and technical experts sufficient time to develop thoughtful, science-based submissions.”

Doctors for Drug Policy Reform made a similar request for an extension, asking that OASH “coordinate with the Drug Enforcement Administration (DEA) to defer implementation of any temporary scheduling action.”

While 7-OH advocates didn’t get the lengthy extension they asked for, they appear to have accomplished their primary goal, which was to postpone the nationwide banning of 7-OH products.

Anticipating that DEA action was imminent, many vendors have already stopped selling 7-OH products, in some cases slashing their prices to dispose of 7-OH inventory before a ban took effect. Several states and dozens of cities and counties have already banned the sale of 7-OH products in their jurisdictions.

Pseudoindoxyl, MGM-15 and MGM-16 Scheduled

Meanwhile, the DEA is going ahead with plans to classify mitragynine pseudoindoxyl, MGM-15 and MGM-16 as Schedule One controlled substances that pose “an imminent threat to public health.” .

MGM-15 and MGM-16 are synthetic versions of kratom alkaloids, while mitragynine pseudoindoxyl is a concentrated formulation of a natural alkaloid found in whole leaf kratom. The three substances are not as widely used as 7-OH, but are more potent and have more potential for addiction.

“The population likely to abuse mitragynine pseudoindoxyl, MGM-15, and MGM-16 appear to be the same as those abusing Mitragyna speciosa and prescription opioid analgesics,” DEA claimed in its scheduling order.

Because testing methods for mitragynine pseudoindoxyl are limited, there is some concern that scheduling it as an illegal substance — even trace amounts — could lead to an outright ban on kratom itself. The obtuse language used by DEA in scheduling mitragynine pseudoindoxyl seems likely to cause confusion:

“Since nomenclature of this substance is not internationally standardized, compounds of this structure, regardless of numerical designation of atomic positions are covered.”

“Kratom critics, the ones that want everything banned, are going to come out and say, ‘You just banned all natural kratom,’” says Mac Haddow with the AKA.

Haddow believes the DEA will only enforce a ban on concentrated forms of mitragynine pseudoindoxyl, but is worried that trial lawyers and the addiction treatment industry will seek more rigid enforcement.

“(DEA) is never going to enforce against anything naturally occurring. But someone else will, using that language. And that’s why the confusion needs to be clarified,” Haddow told PNN. 

(8/27/26 Update: The AKA filed a lawsuit against the DEA, seeking clarity on how its scheduling of mitragynine pseudoindoxyl as an illegal substance applies to natural kratom leaf. The lawsuit in U.S. federal court does not challenge the DEA's scheduling order, but asks the court to confirm that it does not apply to botanical kratom, which contains trace amounts of the alkaloid.)

Building a Life With Adhesive Arachnoiditis

(Editor’s note: Dawn Gonzalez developed adhesive arachnoidits (AA) in 2008 after her spinal cord membrane was accidentally punctured by an epidural needle during childbirth. The severe pain Dawn felt that day grew worse as chronic inflammation spread in her spinal nerves, and soon she was disabled and bedridden. Her future looked bleak, because there is no cure for AA.

Thanks to the work of Dr. Antonio Aldrete and Dr. Forest Tennant, both now deceased, new treatments were developed to ease the symptoms of AA and make life somewhat livable again for AA sufferers like Dawn. This is her story today.) 

By Dawn Gonzalez

Around 18 years ago, my world suddenly became four walls and intractable pain.

Day after day was spent staring at the walls of my bedroom, wondering if this was really going to be the rest of my life. Would I ever make it out again? Just getting out of bed and making it to the bathroom felt like climbing Mt. Everest. One step took everything, and then somehow there had to be enough left for another.

There were also two little girls who still needed their mom. Getting up to be with them, finding them something to eat, taking care of even the most basic things took every ounce of strength available to me. Things that had once been so ordinary had suddenly become enormous.

Life was happening outside that bedroom, and there were times when it honestly felt like those four walls might be all I would ever see again.

That is where the battle began. It would take everything I had to make it to the living room with my girls for a few hours a day. Then came the front porch.

Just a few steps. Nothing remarkable to anyone else. But after being trapped inside for so long, sitting outside and feeling the air again felt huge. My world had gotten a little bigger. I remember the day I finally made it to the back yard with my girls in 2013. Just feeling the sun on my back and breeze against my skin again for the first time in a very long time.

That was only the beginning.

What followed were years of doctors, appointments, different treatments, setbacks, small improvements, and a constant fight to get some kind of life back. There was never a miracle moment when everything suddenly got better. Recovery happened painfully slowly, sometimes so slowly it was hard to see it happening at all.

Treatment after treatment, supplement after supplement, diet tweaks, and trying everything I thought might possibly help.

A little more strength. A few more steps. A little more independence. Another piece of life back.

There were many setbacks when I had to start again. Every hospital stay, every flare, every illness. Losing access to treatments that helped so much. I would be back to square one.

Nearly 18 years later, life looks very different. Most days aren’t spent in bed anymore. They’re spent with my beautiful kids, with my plants and animals, working on projects, and usually thinking about ten more things I’d like to be doing.

Every morning I wake up and have to face it again. Before the plans, the projects, the plants, or anything else, there is the reality of this body and what it will take just to get through another day.

Some days I win more of that fight than others. Some days pain wins and the plans have to wait. But every morning still means getting up and trying again. Every morning when I make it outside to have my morning coffee on the porch is a victory for the day. Every day when I leave behind those four walls is a huge accomplishment.

It’s easy to look at my life today and only see the limitations. The things I still can’t do, the help I still need, and all the ways life has to be worked around what my body will allow. So often I’m told “you can’t do that” instead of asking about and focusing on what I can do.

What’s harder to see is the distance between here and where this started.

The struggle didn’t end when I made it out of that bedroom, either. So much of life still has to be figured out differently. I’m still working to make my home actually work for the body I have now. 

I’m trying to get a vehicle (preferably with hand controls) to allow me more independence and more opportunity to do the things I really want and need to do. Things need to be accessible and where they’re actually used. Every unnecessary trip across the house costs energy, and there’s only so much of that to go around.

My goal every day is pretty simple: to be as self-sufficient as possible. To take care of myself, to need as little help as I can, and to have enough of myself left for the people and things I love.

That probably doesn’t look like much from the outside.

Making my own food. Taking care of my plants. Getting something I need without asking someone else to get it. Doing a little around the house. Spending the day out of bed. Being able to go to the grocery store or go on a small shopping trip or outing with my kids without a babysitter is my dream. To have the things I need accessible and usable to me without expending all of my energy just hunting everything down.

They’re ordinary things.

But there was a time when ordinary felt impossible.

There was no miracle that got me here. It took years of doctors, treatments, setbacks, adjustments, and thousands of tiny victories stacked on top of one another.

Many moons ago, the goal was making it to the bathroom.

Then it was the front porch.

Today, the goal is to build a life I can participate in as fully and independently as possible. A home that works with my limitations instead of making them harder. Enough independence to take care of myself. Enough energy left over to actually enjoy the life I’ve fought so hard to get back.

This life is still a work in progress. So is my home. So is my body. There is still more independence to fight for and more of my world to make accessible.

I’m not trying to get my old life back anymore. I’m trying to build a life that works for the person I am today.

I know what it took to get from staring at those four walls to standing (or wheeling) outside tending my plants. I know what it took to go from giving everything I had for a single step to having a head full of projects and things I still want to do.

The fight isn’t over. Every morning, it starts again.

But when the starting point was four bedroom walls, it’s hard not to look around now and realize just how much of my world I’ve already taken back.

And I’m still making it bigger.

Dawn and her husband Jose have created a GoFundMe account to help Dawn regain her mobility and independence, and continue her treatment.   

How Should I Carry My Prescription Opioids When I Leave Home?

By Crystal Lindell

Personally, I carry my daily dose of morphine and Norco in a Tylenol bottle whenever I leave the house. Just two or three pills rattling around in there, mixed with some regular OTC pain meds and a couple of TUMS thrown in for good measure.

I have been taking prescription opioids on a daily basis since 2013 and, like all long-term opioid users, I had to figure out how to store and travel with controlled substances.

A lot of guidelines you’ll get from your doctor about this seem to be based on the idea that anyone taking daily Norco must be spending all day, everyday in bed.

But if you have chronic pain, you know the truth: The whole point of daily opioids is that they help you get out of bed.

I take prescription opioids so that I can work, spend time with loved ones, and run errands.

In other words, I specifically take them so that I can leave the house. That means, a lot of the time, when I’m popping a pill with a bottle of water, I’m not at home.  

Unfortunately, this reality doesn’t mesh with some of the absurd rules a lot of pain patient contracts have. I’m supposed to store all my pills in their original bottles at all times. I also have been told that they will not be replaced if stolen.

As such, I can only assume that the people who wrote those contracts envision pain patients being bed-bound with a locked safe on their nightstand that they can only open when a dose is due. 

Because that’s the only scenario where it would make sense to keep all your pills in their original bottle. I highly doubt that my doctor actually wants me walking around Walmart with 53 hydrocodone pills rattling around in the original bottle, just in case I need to take a single pill before I get home.

That’s a massively high-risk situation. 

If anyone robbed me, they would walk away with almost a month’s worth of my prescription. And then, based on my pain contract, none of them would be replaced – even if I filed a police report. So I’d literally just be forced into immediate opioid withdrawal.

And I’m not exactly going to carry around a locked safe in my purse to keep the pills protected. That’s absurd. Anything that would actually keep the pills safe from a potential robber would be way too big to carry around with me as I browse the clearance section for pajamas.

Of course, this all means that if I ever run into legal trouble, a cop might wonder why I have a Norco pill in the Tylenol bottle in my purse. 

Some states allow for "reasonable repackaging" of medication into more convenient containers, like a daily pill planner. But state laws are usually more strict about controlled substances being kept in their original pharmacy container, because that makes it easier for the police to verify the medication is yours.

I fully understand that I could get in legal trouble, but I personally would rather risk that scenario than the possibility of a month’s worth of my prescription being lost or stolen during a trip to Taco Bell.

So yes, I keep some of my prescription opioids in a bottle that they did not originally come in. And yes, I mix them with other pills in that bottle. And while that scenario comes with some legal risk, I think it actually comes with much less personal risk. 

And, I will add, the rest of my prescriptions are always at home in their original bottles, safely stored in a very secure locked safe.

I’m not a perfect pain patient, but I’m not sure there’s any such thing. All we can do is all we can do.

Hot Weather Raises Risk of Chronic Pain for Older Adults

By Feinuo Sun

When a heat wave arrives, the public health advice follows a familiar script: drink water, watch for heat stroke, check on people with heart or lung conditions. That list saves lives. But it leaves out something that shapes daily life for millions of older Americans – chronic pain.

In a new study, public health professor Kai Zhang and I followed over 35,000 adults over age 50 across two decades, matching each person and their reports of chronic pain to the temperature history of their neighborhood.

We wanted to know whether living with extreme heat or cold – not one bad week, but months or years – changes whether pain interferes with people’s lives.

The results suggest that chronic pain deserves a place in how the country prepares people for extreme weather. They also show that rural residents may be the least protected.

What High-Impact Pain Means

Researchers use the term high-impact chronic pain for pain lasting at least three months that limits what a person can do: work, socializing and self-care. It is not occasional aching. It is pain that affects your decisions.

For adults over 50, that matters enormously. Pain that makes it hard to stand, carry groceries or sleep through the night is a leading reason people lose the ability to live on their own.

Temperature affects the body in different ways that can lead to pain:

Cold appears to increase pain sensitivity and stiffen joints, which is why people with arthritis often brace for winter.

Heat affects the body through dehydration, broken sleep and the way it quietly shrinks the range of things a person is willing to do in a day. On hot days, for example, people may walk less, and less movement can lead to stiffer joints and weaker muscles, which makes the pain worse.

What makes heat waves dangerous is often not the afternoon temperature peak but the hot nights that don’t cool off, leaving the body with no opportunity to recover.

What We Found

We tracked when each neighborhood hit temperatures that were extreme for that place. 

A day topping 84 degrees Fahrenheit (28.9 Celsius) in Maine, for example, would be among the hottest 5% of days there over the past decade. In Houston, meanwhile, it would have to reach 96 F (35.4 C) to be in the top 5% for heat, considered extreme.

We compared every community against its own 10-year record rather than a single national cutoff to see how months or years of exposure to extreme cold or heat temperatures in those communities affected their residents.

Two things stood out:

Among the one-fifth of our sample who lived with many extreme-cold days, reports of high-impact pain went up. However, those facing occasional cold spells didn’t report the same effect. People seemed to adapt to one hard winter, but adapting became harder over years of extreme cold.

Extreme heat was split by geography and by wealth:

• For urban residents, sustained heat showed no link to developing new pain. For rural residents, the connection was stronger. One likely reason is that people in rural areas may spend more time working outside or have older homes that are harder to cool and less access to cool places.

• Among the poorest older adults, sustained heat was also associated with a higher chance of developing high-impact pain. Among the wealthiest, it was not, likely because of better access to air conditioning, healthcare and being able to stay out of the heat.

Those who could get out of the heat were least likely to report feeling new chronic pain.

Three Key Lessons

Nearly every tool U.S. communities use to lower heat risk is designed for a city environment: cooling centers, tree canopy programs, urban heat island maps.

Rural areas have different challenges. Rural homes are often older and harder to keep cool. Energy costs tend to take a larger share of income. On top of that, rural hospitals have been closing across the country, leaving residents driving farther to reach healthcare.

Agriculture has the oldest workforce in the country – the average producer with decision-making roles on a farm is now about 58 years old, and nearly 40% of the farmland is owned by farmers who are 65 or older. Retirement does not move people out of the heat in rural areas, either.

The findings hold three key lessons for helping older adults:

1. Chronic pain belongs on lists of heat-related health risks, in our view. State and county heat plans flag cardiac and respiratory patients, but not the people whose independence depends on managing pain. With warning, people can plan ahead and get help, knowing chronic pain may worsen.

2. Cooling assistance programs need to be tailored to rural needs – the weatherization, energy assistance and delivery through trusted local channels that those homes need – rather than offering scaled-down versions of urban programs.

3. In the clinic, a patient’s housing and local climate details belong in their documented pain history, next to diagnosis and medication, to help better direct treatment.

Rising global temperatures are increasing the risk that people will be exposed to extreme heat for weeks at a time. In one high-risk summer, 2024, Phoenix saw 39 days with temperatures that didn’t drop below 90 F (32.2 C), even at night.

So, if you have a parent or grandparent facing a heat wave, particularly in a rural area, consider asking not just whether they’re drinking enough water to stay healthy but also whether their back or knees have been worse than usual. The pain may be connected.

Feinuo Sun, PhD, is an Assistant Professor of Demographics, Sociology and Population Health at the University of Texas at Arlington.

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