Physical Therapy Provides Only Modest Relief For Chronic Lower Back Pain

By Pat Anson

Physical therapy, cognitive behavioral therapy (CBT), and mindfulness are often recommended as non-pharmacological treatments for chronic lower back pain. The World Health Organization even calls them first-line treatments in a 2023 guideline for back pain that discourages the use of most pain medications. 

But a new study, published in the Annals of Internal Medicine, found that physical therapy provided only minor improvements in physical function for patients with chronic low back pain, with no change in pain intensity compared to CBT and mindfulness.

A research team led by the University of Utah enrolled 749 adults with chronic low back pain (cLBP) to compare the effectiveness of physical therapy with other non-pharmacological treatments.

Participants were randomly assigned to 8 weeks of either physical therapy or CBT. Those who did not improve were reassigned to a second treatment, either switching therapies or trying mindfulness-based care for another 8 weeks.

The physical therapy was provided by licensed therapists, while mental health care professionals provided CBT and mindfulness training. CBT is a form of psychotherapy, in which a therapist works with a patient to reduce unhelpful thinking and behavior; while mindfulness focuses on increasing awareness and acceptance of physical discomfort to minimize its impact on daily life.

After 10 weeks, participants who started with physical therapy showed a small improvement in function, while pain levels were similar between groups. After one year, no meaningful differences were seen among the second-stage treatments. 

The findings suggest physical therapy (PT) may be a reasonable first option for chronic low back pain, but switching or adding other psychological therapies may not change long-term outcomes.

“We found some benefits to PT as the first treatment offered to patients, but we could not detect subgroup differences and effect sizes were small. Our results support PT as a first-line option for cLBP and no differences in potential benefits of second-line care with mindfulness or switching for nonresponders,” researchers concluded.

The study does not mean that CBT and/or mindfulness are ineffective, just that they’re impact is minor. That finding is similar to another recent study of patients with chronic low back pain, which found that CBT and mindfulness reduced pain levels by about 10% after a year. 

That’s nice, but not the kind of pain relief most people are looking for. 

Chronic low back pain is the leading cause of disability worldwide. It usually begins with acute pain caused by muscle strain or musculoskeletal injuries, and becomes chronic over time when it fails to resolve. Chronic low back pain mostly affects adults of working age in lower socioeconomic groups, who often have physically demanding jobs.  

For such a common disorder, affecting about 500 million people at any given time, there is little consensus on how to treat it. 

A 2018 review in The Lancet by an international team of researchers found that cLBP is often treated with bad advice, inappropriate tests, risky surgeries and painkillers. The authors said there was limited evidence to support the use of opioids for chronic low back pain, and epidural steroid injections and acetaminophen (paracetamol) were not recommended at all.

Medical Cannabis Significantly Reduced Use of Opioids and Other Rx Drugs

By Pat Anson 

A new survey of cannabis users in Germany found a significant reduction in their use of painkillers, sleep medications, anti-depressants and other prescription drugs after starting medical cannabis treatment.

Over 3,500 cannabis patients participated in the online survey, published by Bloomwell, which found an average 84.5% decrease in the use of medications overall. Over half of respondents (58.9%) said they stopped taking at least one medication completely.

The reduced consumption of prescription drugs led to a corresponding change in side effects. Over 60% of patients said they no longer had any medication-related side effects, while nearly 38% said their side effects were reduced. 

Less than 2% said their side effects remained the same or intensified after they started using medical cannabis.

“Cannabis is often portrayed as dangerous and addictive, even though the most severe side effects and addiction potential have only been proven with other prescription medications,” said Julian Wichmann, MD, co-founder and CEO of Bloomwell, one of the leading providers of medical cannabis in Europe.

The reduced use of prescription drugs was associated with major improvements in quality of life and productivity. Most patients reported better concentration (67.8%), more social interactions (61.9%), and fewer days of missed work (53.9%) after they started using medical cannabis.

“Patients benefit significantly when they are able to replace other prescription drugs with medical cannabis. The often completely absent side effects are also associated with a marked improvement in quality of life and work performance. This is likely the most important finding of our survey,” said Wichmann.

The steepest reduction in the use of a prescription drug class was for sleep medications; 93.6% were able to reduce their use of sleeping pills by at least half, and 75.5% were able to discontinue them completely. 

Patients who took the stimulant methylphenidate (Ritalin) reported an average reduction of 88.4% after starting medical cannabis, while 77.3% were able to discontinue it completely. 

Patients were able to reduce their use of opioids by an average of 83.9%, while 61% were able to completely discontinue opioids.

That finding mirrors those of other studies in the US and UK. 

A large 2022 survey of medical cannabis users in Florida found that those who have chronic pain were able to reduce or even stop their use of opioids. Patients reported less pain and better physical and social functioning once they started using medical cannabis. 

A recent survey of UK adults prescribed medical cannabis for anxiety, depression, insomnia, PTSD and other mental health conditions found that 97% said it improved their well-being and happiness, while 68% said it enabled them to work.

Germany first legalized medical cannabis in 2017, allowing patients with certain medical conditions to access it with a prescription. In 2024, the German Narcotics Act declassified cannabis as a narcotic and allowed adults to possess and cultivate limited amounts for recreational use.

According to Bloomwell, cannabis reforms in Germany have led to significant reductions in the price of cannabis flowers and an increase in cannabis prescriptions.  

Vertanical, a German pharmaceutical company, hopes to soon get regulatory approval in Europe and the UK for the first cannabis-based medicine for chronic pain. In clinical trials, the full spectrum cannabis extract provided better pain relief for low back pain in a head-to-head comparison with low doses of opioids.

Psilocybin Is Going Mainstream, but Research and Regulation Lag

(Editor’s Note: President Trump has signed an executive order directing his administration to speed up the review of psychedelic drugs. Although the order focuses on treating mental health conditions, psychedelics such as psilocybin mushrooms have shown promise as treatments for chronic pain.)

By Hollis Karoly and Kent Hutchison

Amid a renaissance in the science of psychedelics, public interest in psilocybin – or magic mushrooms, as they’ve long been known – is surging.

One study found that rates of psilocybin use increased 44% among adults ages 18-29 from 2019 to 2023, and 188% among those over age 30. This amounts to more than 5 million adults using psilocybin in 2023 alone. And those numbers are rising: A study published in early 2026 found that about 11 million adults in the United States used psilocybin in the previous year.

In many ways, the growing scientific and public interest in psilocybin mirrors the early days of recreational cannabis legalization in the U.S. Much like how cannabis commercialization quickly outpaced the development of regulations necessary to protect public health, the expanding psilocybin market and surging public interest are moving faster than the science and regulations needed to ensure it is used safely.

We are substance use researchers who have spent more than a decade studying the many new, high-THC cannabis products that have flooded the legal-market.

Now, we similarly aim to bridge the gap between public enthusiasm for psilocybin and the limited scientific evidence available about its potential benefits and risks. Currently, this type of real-world data on the effects of psilocybin mushrooms is almost nonexistent.

How Do Psilocybin Mushrooms Work?

Psilocybin is a prodrug, which means that it has very low activity until the body converts it into psilocin. Psilocin is the compound primarily responsible for the psychoactive effects of psilocybin mushrooms.

Psilocin resembles the chemical messenger serotonin, which is involved in regulating a range of physiological and psychological functions, including mood, appetite, cognition and sensory perception. As a result, when psilocin binds to serotonin receptors, it alters how people think, feel and experience the world.

Importantly, research suggests that psilocin also alters the brain’s ability to strengthen or weaken neural connections, referred to as synaptic plasticity. This process likely underlies the profound and sometimes long-lasting effects psilocybin mushrooms can have on thoughts, emotions and perception.

Psilocybin mushrooms contain numerous other compounds, together known as tryptamines, such as baeocystin, norbaeocystin and aeruginascin. Research on rodents shows that mushrooms containing these compounds may elicit stronger and longer-lasting effects than psilocybin alone.

But very little is known about how these other tryptamines affect humans. This is because federal regulations require researchers to use an isolated, synthetic version of psilocybin in clinical studies rather than the entire mushroom.

Thus, the many ongoing clinical trials testing psilocybin as a treatment for various mental health conditions use synthetic psilocybin that does not contain these other tryptamines.

A Legal Gray Area

Psilocybin is more accessible than ever before.

In 2019, Denver, Colorado, became the first American city to decriminalize psilocybin mushrooms. This means that possession becomes the lowest law enforcement priority and criminal penalties are reduced or eliminated, but it does not fully legalize them.

Over the next two years, several other U.S. cities including Oakland and Santa Cruz, California; Seattle, Washington; and Detroit, Michigan, followed suit. In 2020, Oregon legalized psilocybin for supervised use in licensed settings, and Colorado did the same in 2022. These legal, supervised-use programs allow access to psilocybin mushrooms in regulated environments without a prescription.

Even for people living outside those states and cities, the barriers to accessing psilocybin mushrooms are low. With a quick Google search and around US$35, anyone can legally purchase kits containing the materials needed to grow psilocybin-containing mushrooms.

These kits are legal to buy and sell because they contain only mushroom spores, which are tiny reproductive cells from which mushrooms grow. Once these spores begin growing into mushrooms, they can produce psilocybin, making the mushrooms a federal Schedule 1 substance.

Because psilocybin mushrooms exist in this legal gray area and are governed by different rules across states, psilocybin mushrooms are essentially unregulated across most of the U.S.

As a result, consumers lack reliable information about what their mushrooms contain, how much they should take and how to use them safely.

Psilocybin Potency Is Increasing

Much like the cannabis industry, which has seen a steady increase in product variety and product strength since legalization, the psilocybin mushroom market is experiencing rapid growth.

For instance, psilocybin edibles are now available and increasingly popular.

In addition, selective cultivation practices are being used by individual and commercial growers to systematically increase the amount of psilocybin contained in their mushroom strains. For example, the Oakland Hyphae Cup, a community contest intended to identify the best mushroom strains, has shown wide variability in psilocybin content across samples.

Researchers are identifying a similar pattern of widely variable psilocybin content in scientific studies of psychedelic mushrooms from around the world.

Potential Harms of Psilocybin

Despite psilocybin’s therapeutic promise, it also carries risks. Psilocybin can cause headaches, nausea, dizziness and changes in blood pressure.

Less commonly, some people experience psychotic symptoms, suicidal thoughts, anxiety, paranoia, confusion or emotional distress.

Another serious potential side effect of psychedelic drugs is what’s known as hallucinogen persisting perception disorder. It involves ongoing perceptual distortions similar to those experienced while directly under the influence of psilocybin, which can persist for weeks, months or years, even once the psilocybin has left the body.

Harms are more likely when people take high doses.

As mushroom potency increases without market regulation, consumers may inadvertently ingest more psilocybin than intended, increasing the risk of harm. Without sufficient research on modern psilocybin products, consumers have little guidance on how to reduce potential harms.

Next Steps in Research and Regulation

Studying psilocybin in the real world requires creative research approaches.

Our team hopes to work within federal restrictions to study people using their own psilocybin mushroom products at home, while providing real-time data to our research team using app-based surveys.

Independent laboratories using state-of-the-art measurement techniques can aid researchers like us by providing information about the potency of the mushroom products that people are using.

While ongoing clinical trials provide important data about the effects of psilocybin under tightly controlled conditions, real-world data is needed to understand how modern psilocybin mushrooms are used and experienced by consumers.

These insights matter not only for scientists and policymakers but for the growing number of people trying psilocybin mushrooms for relief, self-improvement or out of curiosity. In a largely unregulated market, and with few clear guidelines on safe use, consumers are left to simply figure it out on their own.

Hollis Karoly, PhD, is a clinical psychologist, neuroscientist and Associate Professor of Psychiatry at the University of Colorado Anschutz Medical Campus. Her research is funded by the National Institutes of Health.

Kent Hutchison, PhD, is a Professor of Psychology and Neuroscience at the University of Colorado in Boulder and the Founder of the Center for Research and Education Addressing Cannabis and Health. His research is also funded by the National Institutes of Health.

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

Getting a Second Opinion From a Doctor Isn’t Always Practical

By Crystal Lindell

The first thing I did when I started dealing with debilitating chronic pain was go to the emergency room. The second thing I did was follow up with a local primary care physician.

But when nothing improved after a few months and multiple appointments with the doctor, I did what I had always been told to do in such a situation: I sought out a “second opinion.”

Alas, the second doctor wasn’t any help either. Neither were the third, fourth, or fifth.

If you’re dealing with any sort of complex health issue, odds are high that you’ve also had a bad experience with a doctor. Perhaps they dismissed your symptoms, refused to treat your pain, or maybe they were just plain mean.

A common refrain from healthy people in such a situation is: “Just get a second opinion.”

It comes across like common sense, especially in a consumer-culture where it’s smart to shop around. And while I wouldn’t advise against getting a second opinion – I have obviously done it myself on many occasions – there are some very important warnings that need to be included here.

One, getting a second opinion is both expensive and time consuming – assuming it’s even possible in the first place.

You can’t just leave your doctor’s office, walk next store and ask for a different doctor. You have to call around, find someone willing to take your insurance, and hope to get an appointment sometime in the next six months.  A lot of people, understandably, just don’t have the resources for such a task, especially when they aren’t feeling well.

Plus, when you do finally get in to see them, there’s a good chance they won’t be any help. So, you’re just out the time, the money, and the energy it took to get to their office.

Not to mention the fact that if you live in a rural area, a second opinion could be next to  impossible. There are many places in the United States where there literally is no second doctor within 100 miles to opine. 

Personally, I spent thousands of dollars traveling around the Midwest seeking out second opinions – including two fruitless trips to the Mayo Clinic. In the end, I was left with insurmountable medical debt and medical system burnout.

While I was eventually diagnosed with Ehlers-Danlos Syndrome, that did not happen because I sought a second opinion. It happened because multiple readers emailed me to suggest I look into it, so I brought it up to my doctor, and they sent me to a specialist to confirm it. 

Second opinions don’t just drain you though. There’s another, more hidden aspect to them as well. 

If you go to a different doctor to get a second opinion, you could be accused of something called “doctor shopping.”

The term is specifically used to dismiss patients who seek out second opinions, and most commonly, pain patients. 

It’s a code doctors use to frame a patient's desire for a second opinion as an effort to “score” opioid pain meds like a criminal.

Of course, in real life, if you’re actually dealing with horrible pain and the doctor you see is refusing to treat it, it makes total sense to look for a physician who will treat it. Any human in that situation would do the same thing. Pain refuses to be ignored. 

But common sense is not a factor if you are given the label of “doctor shopping” in your chart. Such a note will be used to dismiss all of your pain going forward.

Plus, in the age of easily transferable electronic health records, once anything like that gets put in your file, every doctor you visit will likely see it. 

So, while it’s entirely understandable that loved ones will often advise their sick family and friends to get a second opinion if they aren’t finding relief or answers from their doctor, it’s important to remember that it’s not always that simple. 

Of course, in a perfect world, patients wouldn’t even need to worry about second opinions, because the first doctor they saw would be kind, thorough and effective. We don’t live in that world though, so patients are left to navigate a lot of imperfect choices.

Doctors More Likely to Use Negative Terms for Sickle Cell Patients

By Crystal Lindell

Sickle cell patients are more likely than other patients to have negative descriptions in their medical charts, such as “noncompliant” and “noncooperative,” according to a new study published in JAMA Network Open.

The results are concerning because prior research has shown that such descriptors make doctors less likely to aggressively treat pain, a common symptom of sickle cell disease. The genetic disorder causes red blood cells to form in a crescent or sickle shape, which creates painful blockages in blood vessels. About 100,000 Americans have sickle cell disease, primarily people of African or Hispanic descent.

Researchers at the University of Chicago used artificial intelligence to analyze electronic health records and clinician notes for over 18,000 adult patients. They looked for seven negative words in patient charts: aggressive, agitated, angry, nonadherent, noncompliant, noncooperative, and refuse.

The descriptive words for sickle cell patients were then compared to those of four other groups without sickle cell disease: Black patients, patients diagnosed with chronic pain, patients diagnosed with opioid use disorder (OUD), and non-Black patients. 

They found that patients with sickle cell disease had higher odds of having negative descriptions than Black patients, non-Black patients and patients with chronic pain, but had similar odds of negative descriptors as patients with opioid use disorder. Non-Black patients had the fewest negative descriptors than the other patient groups.

Black patients with sickle cell disease, chronic pain, and OUD had the highest frequency (19%) of negative descriptors in their medical notes.

The researchers said their findings suggest there is bias against patients with sickle cell disease, particularly when opioids are involved.

“Although patients with sickle cell disease routinely use opioid medications to manage their chronic pain, the vast majority do not have an opioid use disorder,”  said senior author Monica Peek, MD, a Professor for Health Justice at University of Chicago Medicine. 

“It is a testament to the strength of their character that they do their best to live full lives while managing debilitating pain with the minimum amount of medication. And yet, within health professions and society as a whole, there is a persistent bias that stereotypes these patients primarily as ‘drug-seekers’ rather than regular people managing a chronic disease.”

The bias and stigma have real life consequences: If a doctor or nurse sees negative descriptors in a patient’s chart, they are less likely to effectively treat their pain.

When it comes to terms like “noncompliant,” the issue can be a bit of a chicken-egg situation — it’s difficult to know what came first. 

Prior research has shown that patients with sickle cell disease who experience discrimination in health care are less likely to follow physician recommendations. These same patients may then be labeled as “noncompliant,” which could perpetuate discriminatory behavior against them. 

The researchers said that clinicians should work to understand why a patient may not want to take a medication or has trouble adhering to treatment, and then adjust their treatment plan to support the patients from there. And they should avoid using negative terms in patient charts.

People With Chronic Pain Are Almost Twice As Likely to Smoke

By Pat Anson 

Cigarette smoking in the U.S. has fallen dramatically over the last few decades, from 45% of the adult population in the 1960’s to less than 10% in 2024. The decline was steep and across the board for both men and women, and for every age group.

But while fewer Americans are smoking overall, the rate of decline is much slower for people with chronic pain, according to a new study.

“We know that cigarette smoking rates overall are going down, which is good,” says co-author Jessica Powers, PhD, an Assistant Professor of Psychology at the University of Kansas. “But what these results show is that the decline isn’t happening as fast for people with chronic pain. People with chronic pain are about twice as likely to smoke cigarettes and to use other types of tobacco products, including e-cigarettes, and to use multiple products together.”

Powers and her colleagues analyzed a decade of smoking data from the National Health Interview Survey, which monitors the health of the U.S. population through face-to-face interviews with 27,000 adults every year. 

Their findings, recently published in the American Journal of Preventive Medicine, show that cigarette smoking among individuals with chronic pain declined marginally from 17.7% in 2014 to 13.1% in 2023. Smoking rates actually increased among chronic pain sufferers who use e-cigarettes.

“We’re seeing a lot of data showing that those with chronic pain are much more likely to use tobacco — cigarettes, e-cigarettes and other types of nicotine or tobacco products,” Powers explained in a news release.

The 13.1% smoking rate for people living with chronic pain is almost double the 7.5% rate for people who don’t have pain. The smoking rate is even higher for people with more frequent or disabling pain.

The study did not examine why people with chronic pain are more likely to smoke, but there are two likely reasons: 

One is that smoking provides a pleasurable distraction from pain and serves as a coping mechanism. The other is that nicotine helps reduce pain signalling. 

“We know pain drives tobacco use. Tobacco has short-term pain-relieving properties, so a lot of people find it helpful in the moment, but it actually causes negative effects in the long term. Tobacco smoking can actually make pain worse,” said Powers. “People get caught in this really vicious cycle where pain is driving smoking, smoking makes the pain worse, which makes it really hard to quit.”

Previous studies have also shown a strong association between smoking and chronic pain. A large UK study in 2020 found that smoking has a long-lasting effect on pain, even after people quit. Former smokers reported higher levels of pain than people who never smoked, and their pain levels were similar to current smokers.

Studies have also found that smoking increases your chances of having some chronic pain conditions, such as degenerative disc disease, fibromyalgia, back pain, and neck pain.

Many Women Suffer from Chronic Pain After Mastectomies

By Brett Kelman and Amy Maxmen, KFF Health News

Three weeks after Sophia Bassan’s mastectomy, she felt a stabbing pain beneath her right armpit. In the following months, painful shocks radiated through her chest and back. Her body became so sensitive that at times she couldn’t wear a shirt or lift a fork to her mouth.

Bassan slept sitting up because it hurt to lie down, and she would flinch at the slightest touch.

“I remember thinking I was losing my mind,” said Bassan, 43. “One time I was in so much pain that I had to take off my top, and then my cat’s tail brushed against my back. I screamed.”

Mastectomies are lifesaving surgeries that remove a patient’s breasts to treat breast cancer, which affects 1 in 8 American women over their lifetimes, according to the American Cancer Society.

Some women also undergo mastectomies as a preventive measure after a genetic test shows they have an increased risk for breast cancer.

In the months following surgery, many women are afflicted by post-mastectomy pain syndrome, or PMPS, which spans from uncomfortable to disabling and can last years.

Yet PMPS is inconsistently diagnosed and treated, leaving women like Bassan in agony as they hunt for relief and struggle to find doctors who take their pain seriously, according to a KFF Health News review of peer-reviewed research studies and interviews with pain specialists, surgeons, patients, and patient advocates.

Another problem is that PMPS is poorly defined, which contributes to the wide range of estimates for how common it is, reaching as high as more than 50% of mastectomy patients, according to studies. Even the low-end estimates, around 10%, would amount to tens of thousands of women.

PMPS care could improve if lawmakers pass the Advancing Women’s Health Coverage Act, which was introduced in October to ensure insurance coverage after breast cancer treatment, including preventive mastectomies. 

The bill, which does not mention PMPS by name, covers complications including chronic pain. More research would help, but pain research has long been fractured across several medical specialties and, more recently, has been undermined by the administration of President Donald Trump, who last year proposed deep cuts to research funding at the National Institutes of Health. After Congress rejected those cuts earlier this year, the White House slowed the release of NIH grant money, hindering ongoing and future scientific research.

“I’ve known women who’ve had chronic pain — itching, burning, stabbing pain — for years after mastectomies,” said Kathy Steligo, an author of multiple books on breast cancer who said she has spoken with hundreds of patients. “Of all the problems, that is probably the one least talked about by surgeons.”

Four mastectomy patients interviewed by KFF Health News told similar stories. In separate interviews, patients said their presurgery consultations did not raise the possibility of post-mastectomy pain syndrome, although each said they had signed forms that may have disclosed the chance of this complication. All said that they felt blindsided by the chronic pain, and some said their doctors dismissed their symptoms.

“Women don’t know about this, and when they have complications, the doctors act like it is so rare, like they’re so baffled,” Bassan said. “But this is statistically predictable.”

Jennifer Drubin Clark, 42, struggled with pain after her mastectomy in 2018, and it worsened after reconstructive breast surgery in 2019.

But her surgeon seemed to focus only on the appearance of her breast implants, she said.

“I couldn’t play the piano. I wanted to blow-dry my hair, but I couldn’t hold my arm above my head for more than two seconds. I couldn’t hold my kids,” Clark said. “Everything made me cry.”

Pain Often Dismissed

Breast cancer survival rates have steadily increased since the 1980s thanks to improved cancer screening, genetic testing, better treatments, and a rise in mastectomy surgeries.

Post-mastectomy pain syndrome is a consequence of that success, according to recent research papers from anesthesiologists at Baylor University in Texas and surgeons in Chicago and New York. Both papers called for an increased focus on PMPS so that breast cancer patients can not only live longer but live well.

“In the past, when concern was predominantly on patient survival, this pain was often considered acceptable,” plastic surgeons Jonathan Bank and Maureen Beederman wrote in a 2021 paper, adding that mastectomies and other breast surgeries “should be considered truly successful only if patients are pain-free.”

Treatment for post-mastectomy pain has a long way to go, said anesthesiologist Sean Mackey, who leads the pain medicine division at Stanford University. Mackey said this “undertreated” condition has no consistent definition for diagnosis, no standardized screening, and no treatment approved by the Food and Drug Administration.

Even the name is a misnomer, Mackey said, since the same pain can arise among women who’ve had other procedures, including lumpectomies and lymph node surgeries.

“The condition was historically dismissed,” Mackey said. “Basically women were told: ‘You’re lucky to be alive. Some pain is expected. Suck it up and deal with it.’”

“That attitude has been slow to change,” he said.

Bank, a New York surgeon who founded a clinic focused on post-mastectomy pain, said the pain is believed to be triggered by nerves that are severed during surgery and then left that way.

The nerves can be sutured back together to minimize pain, Bank said, but most breast surgeons haven’t been trained to do this. So it is not surprising, he said, that some patients say their surgeons were dismissive of their pain after mastectomies.

“When doctors don’t have an answer or don’t know the solution, the easiest thing to do is say there is no problem,” Bank said.

PMPS has been documented among cancer patients since the 1970s. Although the condition does not have an official definition, many researchers describe it as frequent pain in the chest, shoulder, arm, or armpit lasting at least three months after surgery.

‘Angelina Jolie Effect’

Mastectomies intended to prevent breast cancer have become more common among women with elevated risks, including genetic mutations and a family history of the disease.

Bassan’s grandmother died of breast cancer when she was 40. After her father died of cancer in 2023, a genetic test showed that she was at risk. Grieving and afraid, Bassan sought a preventive mastectomy without hesitation, she said.

Bassan said she was also inspired by actor Angelina Jolie, who disclosed her own preventive mastectomy in a 2013 column in The New York Times. Her account had such a significant impact on rates of genetic testing and preventive mastectomies that medical researchers have studied what they call the “Angelina Jolie effect.”

“I was really swayed by that,” Bassan said. “She made it sound, in a way, quite effortless.”

The aftermath of Bassan’s surgery was far worse than she expected. Using a computer for hours triggered paralyzing pain, so she lost her job and has been out of work for more than a year.

Prescription pills dulled the pain but left her in a fog, she said. Desperate, she consulted with multiple doctors until one suggested a nerve stimulation machine, which provided fleeting relief.

About nine months after her mastectomy, a breast reconstruction surgery lessened Bassan’s pain, although she said it still returns in occasional waves.

Even though her surgeries were covered by insurance, Bassan estimated her pain has cost her more than $200,000 in lost wages and drained savings.

SOPHIA BASSAN

“I did not expect to pay this price to have this surgery,” Bassan said. “I don’t know if it was worth it.”

Other women have no real choice.

No ‘Gold Standard’ Solution

Jeni Golomb, 48, was diagnosed with stage 2 cancer in both breasts in 2023 and had a double mastectomy as soon as she could.

Doctors made boilerplate disclosures of possible complications, Golomb said, but she never heard the words “post-mastectomy pain syndrome” until after she had it.

Golomb now manages her chronic pain by taking 1,500 milligrams a day of gabapentin, an anti-seizure drug that can also be used to treat nerve pain. Golomb said she expects to take the drug for years. If she misses a dose, her pain comes roaring back.

“It was the worst pain I ever felt,” Golomb said. “I labored to 10 centimeters, unmedicated, with one of my children, and that was not as bad as this. It was excruciating.”

Gabapentin has proved effective at helping some mastectomy patients with stubborn pain, while others have responded to electrodes implanted in their spinal column, according to the Baylor study, published in 2024.

But that study also said there is “no current gold standard” for how to treat post-mastectomy pain and a scarcity of high-level evidence for what treatments are effective.

Baylor anesthesiologist Krishna Shah, who co-authored the report, said many patients eventually find a helpful treatment, but it often takes “a bit of trial and error” to identify what works for each.

And sometimes they never find it.

Susan Dishell, 67, said that after her 2017 mastectomy for breast cancer and reconstruction surgery, she struggled for five years with pain in both shoulders, plus a burning sensation that her medical records identified as nerve pain.

Another surgery swapped out her breast implants to erase her shoulder pain in 2022, Dishell said, but doctors warned her then that her other pain was unlikely to improve.

Since then, she has tried prescription drugs, steroid injections, CBD oil, acupuncture, physical therapy, and chiropractor treatments.

None of it worked, she said, so she stopped trying.

“I have not slept through the night since I’ve had this,” Dishell said. “But it’s OK. It’s not the most terrible price to pay to not have breast cancer.”

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

Researchers Say Opioid Risk Tool Has ‘Too Many False Alarms’

By Pat Anson

The use of artificial intelligence (AI) continues to grow in healthcare, with patient health data and behavior increasingly being used to assess whether a patient is at risk of an illness or chronic health condition.

NarxCare and Epic, for example, scan electronic health records and prescription drug databases to create Opioid Risk Scores (ORS) for patients, which are then shared with healthcare providers to flag patients at risk of opioid misuse or an overdose. Patients deemed to be at high risk may not be able to get a prescription for opioids or they may be abandoned as “too risky.”

But a new study – the first of its kind – suggests that using opioid risk scores to predict patient outcomes is flawed, with unacceptably high rates of false positives.   

The study, recently published in the Journal of General Internal Medicine, looked at Epic’s opioid risk scores for over 700,000 U.S. patients being treated by primary care providers. The vast majority of patients (99.6%) were classified as low risk, with only 0.4% considered at high risk of an overdose or OUD.

It’s reassuring to see so many patients deemed low risk. But how accurate is the risk score in predicting patient outcomes? 

Of the 702,099 patients deemed low risk, only 2,177 went on to have an overdose or OUD diagnosis within the next 12 months. That means the system correctly predicted outcomes 99.7% of the time.

Conversely, of the 2,665 patients deemed high risk, only 185 later had an overdose or OUD diagnosis. That means Epic’s scoring system correctly predicted outcomes only about 7% of the time. 

Researchers say the false positive rate of 92.2% in the high risk category means that Epic’s ORS “produces too many false alarms” and is of little value to providers.  

“In this study, most high-risk patients were false positives, and most who developed OUD or overdosed were false negatives. Because these outcomes are rare, achieving adequate PPV (the proportion of cases that are accurate) is challenging. The ORS’s misclassification could undermine its external validity, leading to misallocated resources and missed interventions,” wrote lead author Stephanie Hooker, PhD, a Research Investigator at HealthPartners Institute.

“Missed interventions” in this case could mean a patient being denied opioid medication or being referred to addiction treatment, when neither move is justified.

On the flip side, Epic’s 99.7% success rate in identifying low risk patients also isn’t foolproof. 

Of the 2,362 patients who experienced an overdose or OUD diagnosis, Epic’s system flagged only 185 of them as high risk — which suggests that over two thousand were incorrectly labeled as “low risk.”

Maybe the lesson here is that “low risk” doesn’t mean no risk, and “high risk” doesn’t provide any certainty either.  

Pain management expert Dr. Lynn Webster says no opioid risk score — whether Epic’s or NarxCare’s – should be viewed as authoritative by doctors and pharmacists in making clinical decisions.     

“Both tools can be harmful if used punitively. The NarxCare scores have shown that overestimated risk may lead to forced tapering, abandonment, or other punitive responses, which could paradoxically increase overdose risk. With Epic, the harm is a bit different: the score can both stigmatize flagged patients and falsely reassure clinicians about the much larger group labeled low risk,” said Webster, a Senior Fellow at the Center for U.S. Policy (CUSP).

In 2023, CUSP petitioned the FDA to take Narxcare’s ORS software off the market as an unproven and misbranded medical device. The FDA rejected the petition on procedural grounds. 

In the case of Epic’s ORS, Webster says it is a mistake to count OUDs and overdoses in the same prediction model because they are distinct events. Someone can overdose without having OUD, while someone can have OUD without ever experiencing an overdose.   

“Opioid risk tools will always struggle to predict overdose death risk because overdoses can occur in patients who have no opioid use disorder and no aberrant drug-related behavior,” Webster told PNN. “Some patients overdose even when they take their medications exactly as prescribed. Overdose can also occur because of comorbid medical conditions or other factors unrelated to OUD.”

As flawed as they might be, Epic and NarxCare are already embedded in the U.S. healthcare system. Data on over 190 million patients has been collected by Epic’s MyChart software, while NarxCare is used by Walmart, Rite Aid, CVS and other major pharmacy chains to analyze patient risk.

“Whether the score comes from NarxCare or Epic, the core danger is the same: once a proprietary risk label is embedded in the chart, it can take on a false authority that changes how patients are treated,” says Webster.

Long Covid May Increase Risk of Heart Disease

By Pia Lindberg, Artur Fedorowski and Axel Carl Carlsson

Most people who get COVID recover within a few weeks. But for some, symptoms persist for months – a condition now known as long COVID. While it’s often associated with fatigue, breathlessness and “brain fog”, growing evidence suggests it may also affect something less visible, but potentially more serious: the heart.

In our recent study, we found that people with long COVID had higher risk of developing cardiovascular disease – including cardiac arrhythmias, heart attack and heart failure. Importantly, the increased risks were seen in people who had never been hospitalised during their initial COVID infection.

Much of the early research on long COVID and heart health focused on patients who were hospitalised, particularly those treated in intensive care. These patients often had multiple risk factors for cardiovascular disease such as being overweight and having hypertension or diabetes. This made it difficult to separate the effects of severe acute illness from the long-term effects of the infection.

However, the majority of people who had COVID were never admitted to a hospital – yet many still developed chronic symptoms of so-called long COVID. To explore the potential risks in this much larger group, we focused specifically on patients who had experienced a mild-to-moderate COVID infection which they managed at home.

We used healthcare data from more than 1.2 million adults living in Stockholm, Sweden. Among them, 9,000 were diagnosed by a doctor with long COVID. We then followed up these patients over time and compared occurrence of new cardiovascular disease – including heart attack, heart failure, arrhythmias, stroke and peripheral arterial disease – with people who did not have long COVID and had no previous cardiovascular disease.

After a follow-up period of up to four years, cardiovascular disease was more common among people with long COVID.

Among women with long COVID, 18% experienced some form of cardiovascular event, compared with 8% of women without long COVID. Among men, the corresponding figures were 21% versus 11%.

These results did not substantially differ even when we adjusted analyses for age, socioeconomic status and underlying health status – including conditions such as high blood pressure, diabetes, high cholesterol, obesity, depression, smoking and alcohol consumption which are known risk factors of cardiovascular disease.

Women with long COVID had more than double the risk of developing cardiovascular disease overall compared with women without long COVID, while men had around a 30% higher risk.

The strongest associations were seen for irregular heart rhythm and coronary heart disease. In women, we also observed an increased risk of heart failure and peripheral arterial disease. However, we did not find an association between long COVID and stroke risk.

Why Long Covid Might Affect the Heart

It’s not fully understood why long COVID is associated with cardiovascular disease, but several biological mechanisms have been proposed.

The virus can affect the lining of blood vessels, leading to what is known as endothelial dysfunction. It may also trigger long-lasting inflammation and changes in the immune system. Together, these processes can affect how blood flows through the body and how the heart functions.

There’s also growing evidence that long COVID can disrupt the autonomic nervous system – the automatic mechanisms that control heart rate and blood pressure. This may potentially explain why irregular heart rhythms and conditions such as postural orthostatic tachycardia syndrome (Pots) are more common in long COVID patients.

Another possibility is that long COVID may not necessarily cause entirely new disease, but rather reveal underlying conditions that had not yet been diagnosed. In some cases, symptoms such as chest pain or palpitations may lead to further medical evaluation, increasing the likelihood that cardiovascular disease is detected.

Our findings suggest that long COVID is not simply a transient condition, even among people who were never severely ill during the acute infection. Instead, it may have longer-term implications for cardiovascular health.

At the same time, it’s important to put the results into context. The overall risk of cardiovascular disease remains relatively low at the population level. But the relative increase in risk is meaningful and comparable to that seen with established cardiovascular risk factors such as hypertension or diabetes.

The increased cardiovascular risk in long COVID has also important implications for healthcare. Patients with long COVID – particularly women and younger patients – may benefit from more structured follow-up, including assessment of cardiovascular symptoms and better management of cardiovascular risk factors

It also suggests that long COVID should be included in future strategies for cardiovascular risk assessment and prevention, not only in specialist care but also in primary care settings where most of these patients are managed.

More research is now needed to understand the long-term trajectory of these risks and whether they persist, decrease or increase over time. Future studies should also explore whether early identification and management of cardiovascular symptoms in long COVID could help reduce the risk of more serious complications later on.

As the number of people living with long COVID continues to grow, understanding its broader health consequences will be essential – not only for each patient, but for healthcare systems as a whole.

Pia Lindberg is a registered nurse at the Karolinska Institutet in Sweden.  

Artur Fedorowski, MD, is Professor of Cardiology at the Karolinska Institutet and Senior Consultant at the Cardiology Clinic of Karolinska University Hospital in Sweden.

Axel Carl Carlsson, PhD, is a Researcher in the Department of Neurobiology at the Karolinska Institutet.

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

Doctor Faces Backlash After Claiming Four Chronic Illnesses Are Overdiagnosed

By Crystal Lindell

This week, a doctor on X (formerly Twitter) decided it was a good time to infuriate a bunch of patients with chronic illnesses.

Adam Gaffney, MD, a pulmonary and critical care doctor at Cambridge Health Alliance and Assistant Professor at Harvard Medical School, wrote this:

“Over-diagnosis / misdiagnosis / self-diagnosis of EDS, MCAS, POTS & Lyme is a real problem, and it would appear that there is little appetite by medical professionals to discuss this issue publicly.”

For those of you unfamiliar with the acronyms, EDS stands for Ehlers-Danlos syndrome,  MACS is Mast Cell Activation Syndrome, POTS is Postural Orthostatic Tachycardia Syndrome, and Lyme refers to Lyme disease. All four are serious chronic illnesses that are painful, can last a lifetime, and are difficult to diagnose and treat. 

I would link to Gaffney’s post itself, but amidst the backlash, he made his entire X account private. 

As of April 8 though, Gaffney had more than 20,000 followers, which is to say that this wasn’t some random provocateur on X/Twitter trying to stir up controversy by sharing his flawed viewpoint. Rather, it was a highly accomplished doctor with real influence. He teaches at Harvard!

Gaffney is not alone in his thinking. Indeed, any chronic illness patient will tell you that a lot of doctors feel this way. But those doctors are wrong, and I think it’s worth taking some time to discuss it, especially since I have EDS myself.

Gaffney’s post almost instantly went viral in the chronic illness community, and not in a good way. My X feed, which admittedly tends to include an outsized number of chronic illness patients, was filled with people pushing back.

DR. ADAM GAFFNEY / cha

Lorelei Lee (@MissLoreleiLee) wrote: 

“This is disgusting to say at a time when so many sick people are suffering because of the constant dismissal by doctors undertrained in these types of illness, overworked by a dysfunctional healthcare system, & seeing increased numbers in the wake of a debilitating pandemic.” 

While Barry Hunt (@BarryHunt008) wrote:

“Dear Adam,

When medicine takes a decade to name what’s destroying your life 

And calls you hysterical in the interim

"Self-diagnosis" isn’t the problem

It’s the solution.”

Of course, most patients with chronic illness already know the truth: the four ailments that Gaffney thinks are overdiagnosed actually tend to be under-diagnosed.  

Here is a 2025 study showing that of 429 patients who were eventually clinically diagnosed with hypermobile EDS, 405 of them experienced misdiagnosis in at least one of the five evaluated categories. They were told their symptoms were all in their head; that they were making it up; seeking attention; or labeled with Munchausen syndrome by proxy or some other factitious, made-up disorder.

Meanwhile, Dysautonomia International reports that – on average – it takes nearly six years for a patient to be correctly diagnosed with POTS.  And since COVID causes POTS, that means cases are rising and doctors need to adjust their thinking on how common it is. 

As for MCAS, the Mayo Clinic says that because MCAS has so many symptoms similar to other diseases, patients “can experience lengthy diagnostic delays while seeing various specialists to try to find answers."

And when it comes to Lyme disease, John Hopkins says many patients with Lyme are initially misdiagnosed because “early symptoms of fever, severe fatigue, and achiness are also common in many other illnesses."

Personally, it took me five years to get an EDS diagnosis after I first started suffering from chronic pain. And that 5-year span included two long trips to the Mayo Clinic, where it was missed both times.

All this despite the fact that one look at my over-extending elbows should have immediately put EDS on the radar of any doctor who saw me.

In the end, it was not a doctor, but PNN readers who led me down the right path, after multiple people emailed to encourage me to look into EDS.

EDS is also a dominant genetic gene, which means it runs rampant in my family. I’m sure that at least seven relatives on my mom’s side have it, but only one has been officially diagnosed besides me.

The ailments that Gaffney mentions also tend to be more likely to affect women, so it’s impossible to ignore the underlying misogyny in his assertions. Afterall, women are never sick, only hysterical and anxious.   

I also think part of this current hysteria about overdiagnosing illnesses is related to the fact that opioids and other controlled substances have been severely restricted in the last decade. The medications help people with EDS and chronic illnesses in general, and in the past patients may have just treated their symptoms and gone about their lives.  

Now though, people are forced to get an official diagnosis if they want any hope of using a controlled substance to help them get through the day.

In the end, I feel deep sorrow for Gaffney’s patients. 

My hope is that this whole ordeal will inspire him to reflect on where his thinking may be wrong. But I fear that instead, all the push-back will just make him double down. And he will just go on dismissing his patients and encouraging other doctors to do the same.  

Co-Prescribing of Opioids and Gabapentinoids Grows Despite Warnings

By Pat Anson

In 2019, the FDA warned that serious breathing problems can occur in patients who take gabapentinoids with opioids or other medications that suppress the central nervous system. The agency said elderly patients and those with pre-existing lung problems were at highest risk of respiratory depression, which can lead to a fatal overdose.

Those warnings went unheeded by many doctors, according to a new study that found the co-prescribing of gabapentinoids to patients on long-term opioid therapy increased over the past decade, rising from 47% in 2015 to 58.7% in 2023.

Gabapentinoids are a class of nerve medication originally developed to prevent seizures, but are widely prescribed off-label to treat pain. They include gabapentin (Neurontin) and pregabalin (Lyrica), as well as generic versions of the drugs.

Not only did co-prescribing with gabapentinoids increase, but the age of patients on long-term opioids also rose, from 52.5 years in 2015 to 60.5 in 2023. Nearly half of those patients (48.7%) are on Medicare. 

“Because older adults are at higher risk of adverse events from polypharmacy, the increased rates of coprescribing, particularly with gabapentinoids, raises additional safety concerns,”  said Thuy Nguyen, PhD, Assistant Professor of Health Management and Policy at the University of Michigan’s School of Public Health.

Nguyen and her colleagues' findings, published in a JAMA research letter, also document a steady decline in long-term opioid use, which coincides with federal and state guidelines that were imposed to limit opioid prescriptions.  

Between 2015 and 2023, the number of U.S. patients on long-term opioid therapy for at least 90 days fell from 5.6 million to about 4.2 million — a 24.3% decrease. 

At the same time, the average daily dose of opioids also declined, from 47.9 morphine milligram equivalents (MME) in 2015 to 38.6 MME in 2023 – which is in line with CDC guidelines that recommend caution when doses exceed 50 MME.

Researchers think more work is needed to reduce opioid use and to find alternative ways to relieve pain.

“With almost 5 million Americans on long-term prescription opioids for chronic pain, and likely millions more who are taking shorter courses of prescription opioids for acute pain, most clinicians are likely to care for someone using prescription opioids for pain, highlighting the pressing importance for investing in better treatment models for pain,” said senior author Pooja Lagisetty, MD, Associate Professor of Internal Medicine at the University of Michigan Medical School.

In addition to gabapentinoids, researchers tracked overlapping prescriptions for other controlled substances. They found that co-prescribing of long-term opioids with benzodiazepines declined from 43.8% in 2015 to 33.5% in 2023; while co-prescribing for stimulants rose from 5.9% to 6.7%.

In short, polypharmacy is relatively common with patients on long-term opioids, despite the known risks of combining certain drugs. 

Common side effects from gabapentin include brain fog, dizziness, weight gain, headache, fatigue, and anxiety. The drug has also been linked to a higher risk of dementia.

Those side effects may lead to a “prescribing cascade,” in which doctors mistakenly prescribe unnecessary medications to patients that cause even more side effects – never suspecting that gabapentin was the cause and they should consider discontinuing the drug.

In 2024, gabapentin was the fifth most prescribed drug in the U.S., with prescriptions nearly tripling since 2010. The number of patients prescribed gabapentin reached 15.5 million in 2024.

The off-label prescribing of gabapentin is legal and, in some cases, appropriate. But it has reached extreme levels, with studies estimating gabapentin is prescribed off-label up to 95% of the time. 

Patients Are Becoming Less Open to AI in Healthcare

By Crystal Lindell

Many of us are using artificial intelligence (AI) in our everyday lives, such as learning more about our medical conditions and symptoms. But when it comes to actually using AI in their own healthcare, patients are less open to it.

That’s according to a new poll by The Ohio State University Wexner Medical Center, which surveyed 1,007 adults across the country about their opinions about AI in healthcare.

They found that just 42% of adults are open to AI being used as part of their healthcare in 2026. That’s down from the 52% who supported it in 2024. The belief that AI can make healthcare more efficient also fell, from 64% to 55%.

However, the survey found that over half of the adults (51%) still used AI to help them make important health decisions, without consulting with a medical professional.

Participants said they use AI for a variety reasons:

• 62% use AI to help understand symptoms

• 44% use AI to help explain test results or a medical diagnosis

• 25% use AI to compare treatments and help make a treatment decision

• 20% use AI to prepare for an upcoming medical appointment

The drop in patient trust with AI is on par with the natural “hype cycle” of any new technology, according to Ravi Tripathi, MD, chief health informatics officer at Ohio State Wexner Medical Center.

“When we first see something new and shiny, we think it's going to fix the world and replace health care and solve all of our medical problems,” Tripathi said. “People are learning that there are pros and cons of artificial intelligence, where it has actual use and where it really doesn't have a place.”

Tripathi predicts that over the next two to five years, trust in AI will increase, as people become more familiar with artificial intelligence and it becomes more common in healthcare technology.

But he warned patients against relying too heavily on AI for their own medical research.

“We know that 2% of the time AI is going to be inaccurate or it will potentially hallucinate,” Tripathi said. “Physicians are not using AI 100%. We're not trusting it 100%. I would be really concerned about a patient who is following AI. The artificial intelligence doesn't understand your story.” 

Tripathi suggests using AI in partnership with your doctor. AI can help patients compile their health data, explain test results and diagnoses, and help identify questions to ask providers.

“There's a strong value for using artificial intelligence as augmented intelligence,” Tripathi said. “Patients should have oversight of what the technology is doing but consult with their health care team for the final plan.”

While patients have mixed feelings about AI, doctors appear to be more open to it. 

According to a recent survey by the American Medical Association, 81% of physicians use AI to stay current on medical research and to help them with record keeping. That’s about double the rate in 2023, when the AMA first polled doctors on their AI use.

While 76% of physicians say AI technology can help with patient care, about 40% said they are both excited and worried about it – citing concerns about patient privacy and the integrity of the patient-physician relationship.

The global AI healthcare market is projected to reach $868 billion by 2030, with its influence on the overall healthcare market more than doubling from roughly 15% today to over 30% by 2030.

Can Hypnosis Therapy Treat Chronic Pain?

By Pat Anson

The same academic institution that helped launch a nationwide crackdown on opioid medication has a new suggestion on how to treat chronic pain: hypnosis.

Researchers at the University of Washington enrolled 127 people with moderate to severe pain from spinal cord injuries in a study to see if hypnotic cognitive therapy could reduce their pain levels. 

For one hour every week for six weeks, half the participants met with a psychologist over the telephone or online Zoom calls for instructions on how to practice self-hypnosis. The other half did not get hypnosis and served as a control group. 

Both groups continued to get “usual care” for their pain throughout the study. About 75% of them were taking opioids or another prescription pain medication. 

Patients who received hypnosis were not put into a trance, like you might see on TV or in comedy acts, but received a form of cognitive behavioral therapy. Through hypnotic suggestions, patients were told to relax, breathe deeply, and imagine themselves in a comfortable place without pain. Participants were given recordings of each therapy session, and told to listen to them daily and practice self-hypnosis three times a day.

After six weeks of hypnotic therapy, participants reported that their pain levels dropped by 19.3%. Self-reported pain continued to decrease after the sessions stopped, falling by 24.5% after 12 weeks. Nearly half (46%) said their pain improved meaningfully. There were also significant improvements in sleep and depression, compared to patients in the control group.

The study was completed four years ago, but the findings are only now being published in the journal Neurology. 

“Not only did the study show that this treatment is effective, but unlike most medications used for pain, it is a treatment with many positive side effects, like improved sleep and a greater sense of self-control,” senior author Mark Jensen, PhD, a Professor of Rehabilitation Psychology at UW, said in a press release.

 “I think that, based on the evidence, including the side-effect profile, this is the first treatment that people with chronic pain should be offered.” 

Although Jensen said hypnosis should be the “first treatment” for pain, the published study indicates otherwise. The research team called hypnosis an “adjunctive treatment” for pain – which means it should be used as a secondary treatment, alongside a primary treatment such as pain medication.

Like cognitive therapy, hypnosis helps patients stop thinking that their pain won’t go away and will only become worse.  

“Hypnosis helps patients be more open to ideas about changing their thinking and internalizing those ideas,” said first author Charles Bombardier, PhD, a psychologist and Professor of Rehabilitation Medicine at UW. 

Although there’s a certain amount of stigma about hypnosis, co-author Elena Mendoza, PhD, told The Seattle Times that hypnosis is an effective way to reduce pain and is less risky than opioids.

“Hypnosis is not about what you see on the movies. It is a clinical, therapeutic technique. We use it every day in a clinical context, and it’s working well,” said Mendoza, a Research Assistant Professor at UW who specializes in hypnosis and conducted the study’s therapy sessions. 

“We really want to give people ways to manage their pain that are nonopioids. We hope this research is a step toward that,” she said.

Professors at the University of Washington have a long history of campaigning against the use of opioids. In 2007, several helped develop Washington state’s medical guideline on the use of opioids, one of the first in the country to set dosage limits.   

Professors Jane Ballantyne, MD, Gary Franklin, MD, Mark Sullivan, MD, and David Tauben, MD, were among the original members of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group.

Ballantyne, Franklin and Tauben also helped draft the CDC’s controversial 2016 opioid guideline. Opioid prescribing nationwide has fallen in half since the guideline’s release.

GLP-1 Drugs Offer Real Hope for People With Pain or Addiction

By Dr. Lynn Webster

In Greek mythology, the goddess Panacea carried a potion that could heal any disease. It’s a seductive image, and it’s how GLP-1 drugs can start to feel as reports pile up about their potential in treating conditions besides diabetes and obesity.

A recent Washington Post article alludes to Panacea before describing the emerging signs that people living with pain or addiction might benefit from GLP-1s.  

The promise is real. So are the risks. If GLP-1s are going to move from metabolic medicine into the worlds of pain and substance use disorders, we should talk about them the way we would talk about any powerful new class: with evidence, not mythology.

What We Know About GLP-1s and Pain

The most solid pain evidence so far involves knee osteoarthritis — a condition where weight, inflammation, and function are tightly linked. In a 68-week placebo-controlled trial, once-weekly semaglutide (Ozempic, Wegovy) injections in people with obesity and moderate knee osteoarthritis produced significantly greater reductions in body weight — along with significant improvements in pain scores and better physical function.  

That is meaningful. But it doesn’t automatically make semaglutide a “pain drug.” Weight reduction can relieve joint pain, and metabolic improvements may dampen inflammation. Researchers are still sorting out what portion of the pain relief is caused by weight loss alone.  

Outside osteoarthritis, the evidence is thinner. Preclinical studies suggest GLP-1 receptor agonists may reduce neuropathic pain through anti-inflammatory and neuroprotective effects.  

One promising real-world signal comes from fibromyalgia. A large analysis of over 96,000 patients found GLP-1 use associated with significantly lower odds of needing an opioid prescription or of being diagnosed with chronic pain and/or fatigue.   

These observational data are hypothesis-generating, but require confirmation in future studies. More rigorous randomized trials for fibromyalgia, diabetic neuropathy, and other chronic pain syndromes are needed.

What We Know About GLP-1s and Addiction

Here the signal is surprisingly strong — but still preliminary. The evidence so far suggests that GLP-1s appear to modulate reward pathways in the brain that shape craving and compulsive drug use.

A large 2026 observational study of over 600,000 U.S. veterans with type 2 diabetes found that GLP-1s were associated with lower risk of developing substance use disorders (SUDs) involving alcohol, cannabis, cocaine, nicotine or opioids. Among those with preexisting SUDs, GLP-1s were linked to lower risks of emergency room visits, hospitalizations, mortality, overdose, and suicidal thoughts or attempts.

Observational data can’t prove causation, but the consistency across substances and outcomes provides a strong rationale for clinical trials.

We also have randomized evidence in alcohol use disorder. A small Phase 2 trial of 48 adults with alcohol use disorder found that once-weekly semaglutides reduced drinking and cravings over nine weeks compared with placebo.

More research is underway. A recent systematic review identified 33 registered trials looking at GLP-1s for SUDs, predominantly for alcohol and nicotine, but with growing interest in opioid and stimulant SUDs.  

The Risks We Can’t Minimize

The common side effects of GLP-1s — nausea, vomiting, diarrhea, constipation and appetite suppression — are often manageable, but they can be therapy-ending. That matters, because many GLP-1 benefits appear to fade when treatment stops.

In pain and addiction care, “stop-start” patterns are common when insurance coverage shifts or supply is disrupted. Those interruptions are often risky.

A 2026 Washington University School of Medicine analysis of veterans with type 2 diabetes found that even brief interruptions of GLP-1 treatment -- as little as six months -- were associated with higher risk of heart attack, stroke, and death compared with continuous use. The risks rise even further the longer the gap, with up to 22% higher risk of a major cardiovascular event after two years off therapy.  

More concerning are rare but serious complications. Reports of severe delayed gastric emptying (stomach paralysis) remain a clinical concern. Cohort studies have also reported an association between semaglutides and neuropathy in patients with diabetes, although causality remains debated and the absolute risks are low.  

Emerging observational data have raised questions about musculoskeletal safety, with special relevance for people already limited by pain. Some analyses link GLP-1 use to modest reductions in bone mineral density and possible increases in osteoporosis or fracture risk in older adults. Tendon injuries have also appeared in some patients with obesity.  

These findings need replication. Because GLP-1s can slow stomach emptying, clinicians must plan around procedures. The American Society of Anesthesiologists recommends individualized perioperative strategies, including temporary liquid diets for some higher-risk patients.

A Measured Path Forward

GLP-1s may end up helping people with pain and addiction — and if they do, that would be a genuine advance. But we should not rush from “promising” to “proven,” or expand GLP-1 use without a clear plan for monitoring and safety.

Panacea was a Greek myth about curing everything. The modern task — identifying who benefits, who is harmed, and how to use powerful medicines in ways that reduce suffering without creating new forms of it — is harder.

That will require larger, dedicated randomized trials in addiction, targeted studies in pain syndromes beyond knee osteoarthritis, longer-term musculoskeletal safety data, and honest communication about both the promise and the risks of GLP-1s.

Lynn R. Webster, MD, is Senior Fellow at the Center for U.S. Policy and is co-author of the forthcoming book, “Deconstructing Toxic Narratives: Data, Disparities, and a New Path Forward in the Opioid Crisis,” to be published by Springer Nature.

The Fear Mongering Over Tiger Woods’ Hydrocodone

By Crystal Lindell

Famed Golfer Tiger Woods was involved in a rollover car accident this week.

While the crash was likely caused because he was reportedly looking at his phone and changing the radio station when it happened, something else has taken up nearly all the coverage of the event: Two hydrocodone tablets.

Police said Woods failed a sobriety test at the scene and that they found two hydrocodone tablets on him at the time of the accident. The pills were marked “M367” which means they were likely 10mg hydrocodone and 325mg acetaminophen combination tablets, commonly known as a generic form of Norco or Vicodin.  

For context, hydrocodone is a Schedule Two controlled substance. A 10mg tablet is equal to 10 morphine milligram equivalents (MME). The CDC recommends caution when taking daily doses that exceed 50 MME. 

A hydrocodone tablet is routinely given out for post-operative pain or extensive dental work, such as wisdom tooth removal. I think anyone who’s ever had an out-patient surgery is probably familiar with the medication.

For chronic pain patients who already have a tolerance to opioids, hydrocodone is typically something that can be taken to reduce pain while also performing routine daily tasks, like cleaning the house and working. In fact, I took one right before writing this column.

It’s very likely that Tiger Woods takes them for chronic pain, seeing as how he has had multiple back surgeries. As such, he likely has a tolerance. 

That’s not to say that taking a couple hydrocodone couldn’t cause impaired driving and lead to a crash. It most definitely could. Especially if the reason Woods had two hydrocodone on him was because he had taken a bunch more.

It’s just that the way the media has covered the accident and the two pills would make you think he was basically found with two pounds of street fentanyl on him.

The Palm Beach Post ran a story headlined, "What is hydrocodone? Tiger Woods had the pills during DUI arrest.” In it, they write: 

“Hydrocodone is an opioid used to treat severe, chronic pain. The medication has a high risk of addiction and misuse with some of its most common side effects including dizziness, loss of consciousness and severe tiredness.”

I mean, yes, technically that’s true-ish. Hydrocodone is indeed used to treat severe chronic pain, but they left out “among other things.” Most people who take hydrocodone for chronic pain build up a tolerance and have no severe side effects, especially “loss of consciousness.”

Meanwhile, the New York Post ran a story headlined, "The dangerous risks of the pills found in Tiger Woods’ pocket in DUI arrest"

The article was especially egregious. In it, they write:

“While the drug is prescribed to treat chronic pain or manage pain after surgery or injury, using it is not without risks — and serious ones at that.

A highly addictive opioid, hydrocodone is in the same class as oxycodone, morphine and fentanyl — with a high enough risk of abuse that prescriptions have dropped by as much as a third since their peak in 2011.”

Trying to equate hydrocodone to fentanyl isn’t just disingenuous, it’s also potentially harmful to pain sufferers..

For those who don’t really know what hydrocodone is, that kind of messaging means a pain medication that will almost certainly be prescribed to them or a loved one at some point will become something to avoid. They may not take it when they need it. Or they may shame a loved one for taking it when they need it.

Not to mention how harmful coverage like this is to chronic pain patients in general, who have been trying to fight the stigma around opioid medications for years now.

There is legitimate concern that media stories like this will make already overly-cautious doctors even more hesitant to prescribe hydrocodone to patients who really need it.

On Reddit you can already find chronic pain patients worried about the ramifications of this type of coverage. One user referred to the New York Post article as, "Just another opportunity to demonize opioids and chronic pain patients."

Another poster lamented: "I see my PM (pain management) physician on Friday. I'm sure this will be a topic he'll bring up. Sigh..."

In another Reddit thread, a user writes:

“Everyone knows that people who take opioids long term get used to the effects of the opioids as their tolerance grows and you learn to have a pretty normal life and do things like work, go to school, and yes… drive. I mean, are we supposed to lock ourselves in our houses and never come out again and just wither away? No, we still have a life.”

It’s disappointing to see the news media jump on any chance to continue demonizing opioids. Reporters should know better by now. 

One day, they themselves will likely need Norco or Vicodin for some sort of pain. And because of their own work, they may have trouble getting it.