You Might Have Chronic Pain If…

By Crystal Lindell

Back in the 90s, comedian Jeff Foxworthy had this whole bit about, “You might be a redneck if…”  

He’d start off with a funny description and then make the obvious conclusion, like: “If you ever cut your grass and found a car… you might be a redneck.”

It was an in-joke among people who proudly saw themselves as rednecks. Foxworthy wasn’t laughing at them, he was laughing with them — because he portrayed himself as one of them.

Whether or not a rich comedian was ever authentically a redneck is a debate for another day. But regardless, I very much am a member of the chronic pain community, and as such, I think there’s a few of these I could share.

So without further ado:

• If your favorite breakfast is coffee and pain pills… you might have chronic pain.

• If you have ever wanted to argue with a pharmacist… you might have chronic pain.

• If you need at least 24 hours notice to leave the house… you might have chronic pain.

• If you know exactly how long you can go without showering… you might have chronic pain.

• If your favorite outfit is pajamas… you might have chronic pain.

• If you think your “Dr. Google” search results are more valuable than your doctor’s degree… you might have chronic pain.

• If the words “Have you tried yoga?” trigger your PTSD… you might have chronic pain.

• If you have ever slept for 24 hours and then woken up and needed a nap… you might have chronic pain.

• If your medical bills are higher than the GDP of a small country… you might have chronic pain.

• If your “desk” is just your bed with a pillow propped up behind you… you might have chronic pain.

• If you have ever had to diagnose yourself… you might have chronic pain

• If you currently have a 500-count bottle of ibuprofen at home — and another one in the car… you might have chronic pain.

• If your idea of a perfect date night is sitting at home under a heated blanket while watching Lord of the Rings … you might have chronic pain.

• If your favorite food is THC gummies… you might have chronic pain.

• If you ever used up all of your sick days in the month of January… you might have chronic pain.

• If you use more dry shampoo than regular shampoo… you might have chronic pain.

• If you ever hoped that a test actually showed you had cancer, so that then you’d at least have an explanation… you might have chronic pain.

• If your most worn accessory is some sort of medical brace… you might have chronic pain.

• If all your shoes have arch support… you might have chronic pain.

• If your entire social media feed is posts about surviving chronic pain… you might have chronic pain.

• If you have ever worn the same outfit for 5 days in a row… you might have chronic pain.

If you can relate to any of these… you might have chronic pain.

Here’s hoping today is one of your good pain days. 

And if you have any “You might have chronic pain if…” examples that you’d like to share, we’d love to read them in the comments. 

Medicare Pilot Program Could Deny Coverage of Pain Treatments

By Grace Mackleby and Jeff Marr

Medicare has launched a six-year pilot program that could eventually transform access to health care for some of the millions of people across the U.S. who rely on it for their health insurance coverage.

Traditional Medicare is a government-administered insurance plan for people over 65 or with disabilities. About half of the 67 million Americans insured through Medicare have this coverage. The rest have Medicare Advantage plans administered by private companies.

The pilot program, dubbed the Wasteful and Inappropriate Service Reduction Model, is an experimental program that began to affect people enrolled in traditional Medicare from six states in January 2026.

During this pilot, medical providers must apply for permission, or prior authorization, before giving 14 kinds of health procedures and devices. The program uses artificial intelligence software to identify treatment requests it deems unnecessary or harmful and denies them. This is similar to the way many Medicare Advantage plans work.

As health economists who have studied Medicare and the use of AI in prior authorization, we believe this pilot could save Medicare money, but it should be closely monitored to ensure that it does not harm the health of patients enrolled in the traditional Medicare program.

Prior Authorization Required

The pilot marks a dramatic change.

Unlike other types of health insurance, including Medicare Advantage, traditional Medicare generally does not require health care providers to submit requests for Medicare to authorize the treatments they recommend to patients.

Requiring prior authorization for these procedures and devices could reduce wasteful spending and help patients by steering them away from unnecessary treatments. However, there is a risk that it could also delay or interfere with some necessary care and add to the paperwork providers must contend with.

Prior authorization is widely used by Medicare Advantage plans. Many insurance companies hire technology firms to make prior authorization decisions for their Medicare Advantage plans.

Pilots are a key way that Medicare improves its services. Medicare tests changes on a small number of people or providers to see whether they should be implemented more broadly.

The six states participating are Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. The 14 services that require prior authorization during this pilot include steroid injections for pain management and incontinence-control devices. The pilot ends December 2031.

If the Centers for Medicare & Medicaid Services, which administers Medicare, deems the pilot successful, the Department of Health and Human services could expand the program to include more procedures and more states.

An Extra Hurdle for Providers

This pilot isn’t changing the rules for what traditional Medicare covers. Instead, it adds an extra hurdle for medical providers before they can administer, for example, arthroscopic treatment for an osteoarthritic knee.

If Medicare issues a denial rather than authorizing the service, the patient goes without that treatment unless their provider files an appeal and prevails.

Medicare has hired tech companies to do the work of denying or approving prior authorization requests, with the aid of artificial intelligence.

Many of these are the same companies that do prior authorizations for Medicare Advantage plans.

The government pays the companies a percentage of what Medicare would have spent on the denied treatments. This means companies are paid more when they deny more prior authorization requests.

Medicare monitors the pilot program for inappropriate denials.

‘Low Value’ Treatments Targeted

Past research has shown that when insurers require prior authorization, the people they cover get fewer services. This pilot is likely to reduce treatments and Medicare spending, though how much remains unknown.

The Centers for Medicare & Medicaid Services chose the services targeted by the pilot because there is evidence they are given excessively in many cases.

If the program denies cases where a health service is inappropriate, or of “low value” for a patient’s health, people enrolled in traditional Medicare could benefit.

But for each treatment targeted by the pilot, there are some cases where that kind of health care is necessary.

If the program’s AI-based decision method has trouble identifying these necessary cases and denies them, people could lose access to care they need.

The pilot also adds to the paperwork that medical providers must do. Paperwork is already a major burden for providers and contributes to burnout.

AI’s Role

No matter how the government evaluates prior authorizations, we think this pilot is likely to reduce use of the targeted treatments.

The impact of using AI to evaluate these prior authorizations is unclear. AI could allow tech companies to automatically approve more cases, which could speed up decisions. However, companies could use time saved by AI to put more effort into having people review cases flagged by AI, which could increase denials.

Many private insurers already use AI for Medicare Advantage prior authorization decisions, although there has been limited research on these models, and little is known about how accurate AI is for this purpose.

What evidence there is suggests that AI-aided prior authorization leads to higher denial rates and larger reductions in health care use than when insurers make prior authorization decisions without using AI.

Winners and Losers

Any money the government saves during the pilot will depend on whether and how frequently these treatments are used inappropriately and how aggressively tech companies deny care.

In our view, this pilot will likely create winners and losers. Tech companies may benefit financially, though how much will depend on how big the treatment reductions are. But medical providers will have more paperwork to deal with and will get paid less if some of their Medicare requests are denied.

The impact on patients will depend on how well tech companies identify care that probably would be unnecessary and avoid denying care that is essential.

Taxpayers, who pay into Medicare during their working years, stand to benefit if the pilot can cut long-term Medicare costs, an important goal given Medicare’s growing budget crisis.

Like in Medicare Advantage, savings from prior authorization requirements in this pilot are split with private companies. Unlike in Medicare Advantage, however, this split is based on a fixed, observable percentage so that payments to private companies cannot exceed total savings, and the benefits of the program are easier for Medicare to quantify.

In our view, given the potential trade-offs, Medicare will need to evaluate the results of this pilot carefully before expanding it to more states – especially if it also expands the program to include services where unnecessary care is less common.

Grace Mackleby, PhD, is a research scientist of Health Policy and Economics at the University of Southern California. She is also a visiting scholar at the University of Utah Department of Population Health Sciences in Salt Lake City.

Jeff Marr, PhD, is an Assistant Professor of Health Services, Policy, and Practice at Brown University. His current work focuses on Medicare, prior authorization, and the use of AI in healthcare. 

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

Can Long-Term Opioid Use Be Predicted Before Surgery?

By Pat Anson

Patients on Medicaid and those who have a history of anxiety, mood disorders, or benzodiazepine use are significantly more likely to use opioids long-term after surgery, according to a new analysis.

The study, published in the journal Pain Medicine, could provoke fresh debate over whether opioid addiction can be predicted, and whether risk assessments unfairly stigmatize patients and affect how they are treated.

“Identifying who is at risk before the first incision is made is a critical step in combatting the opioid crisis,” said lead author Yoonjae Lee, DNP, a second-year PhD student at the University of Pennsylvania’s School of Nursing..

“Our findings provide a roadmap for clinicians to implement targeted interventions, ensuring that high-risk patients receive enhanced monitoring and alternative pain management strategies.”

Lee and her colleagues analyzed data from 27 clinical studies to see what raises the risk of patients new to opioids becoming long-term users after surgery. 

They found that “opioid-naïve” patients with Medicaid coverage and those with a history of taking benzodiazepine anti-anxiety medication had 77% higher odds of developing new persistent opioid use (NPOU). 

Patients with a history of depression or other mood disorders had 24% higher odds, while those with anxiety had a 17% higher risk of persistent opioid use.

Based on these findings, researchers say every patient should be screened before surgery for the risk of long-term opioid use, so that changes can be made in their treatment.

“Minimizing the development of NPOU requires a thorough preoperative medication review, as our findings indicated that certain drugs including antidepressants, muscle relaxants, anticonvulsants, and sedatives are linked to a higher risk of NPOU. Among these risk factors, preoperative benzodiazepine use stands out as the strongest,” researchers concluded.

“With respect to clinical implications, clinicians should adopt a comprehensive and individualized approach to assessing and managing these predictive factors in each surgical patient, given the complex interaction of multiple factors affecting the development of NPOU. Although insurance status cannot be changed, mood disorders, anxiety, and benzodiazepine use can be modified preoperatively.” 

The idea of pre-screening surgery patients is similar to female patients being screened for potential opioid misuse through a questionnaire called the Opioid Risk Tool. In some cases, the questionnaire has been used as an excuse to deny opioids to women who have a history of childhood sexual abuse.

Penn Nursing researchers may have an exaggerated notion of just how common long-term opioid use is after surgery. They cited a study claiming that “up to 65% of patients” continue to use opioids 90 days after surgery, a “significant postoperative complication” that leads to higher healthcare costs, as well as opioid misuse, diversion, overdose and addiction.

That’s a misleading reference to a 2024 analysis, which found that 2% to 65% of surgery patients are at risk of long term opioid use. That assessment is based on a review of over 30 clinical studies, which came up with a wide range of estimates on the risk of persistent opioid use. The Penn Nursing study only cited the higher 65% estimate, while ignoring the lower ones. 

Other studies have found that surgery patients rarely misuse opioids or become long-term users. A large 2018 Harvard Medical School study found that only 0.6% of patients had signs of opioid misuse after surgery.

A large 2016 study in Canada put the risk of long-term opioid use after one year at only 0.4% of surgery patients. “Our study thus provides reassurance that the individual risk of long-term opioid use in opioid-naive surgical patients is low,” researchers reported.

Neither the Canadian or Harvard study were included in the Penn Nursing analysis because researchers didn’t include studies conducted prior to 2019.

It’s fairly common for patients to need pain management for months after surgery. Post-operative pain becomes chronic in about 10% to 50% of surgery patients, depending on the type and invasiveness of the surgery. That’s why opioids and other analgesics are essential in post-op care. 

UK researchers say “great efforts must be made to provide effective post-operative pain relief for a long enough period” to prevent acute post-op pain from becoming chronic.

The Penn Nursing study was funded by the National Institutes of Health.

How Should the U.S. Regulate Medical Marijuana?

By Chris Meyers

Medical marijuana could soon be reclassified into a medical category that includes prescription drugs like Tylenol with codeine, ketamine and anabolic steroids.

That’s because in December 2025, President Donald Trump signed an executive order to reschedule marijuana to a less restricted category, continuing a process initiated by President Joe Biden in 2022.

Currently, marijuana is in the most restrictive class, Schedule I, the same category as street drugs like LSD, ecstasy and heroin.

For years, many researchers and medical experts have argued that its current classification is a hindrance to much-needed medical research that would answer many of the pressing questions about its potential for medicinal use.

In January 2026, Republican Senators Ted Budd, of North Carolina, and James Lankford, of Oklahoma, introduced an amendment to funding bills trying to block the rescheduling, claiming that it “sends the wrong message” and will lead to “increased risk of heart attack, stroke, psychotic disorders, addiction and hospitalization.”

As a philosopher and drug policy expert, I am more interested in what is the most reasonable marijuana policy. In other words, is rescheduling the right move?

Broadly speaking, there are three choices available for marijuana regulation. The U.S. could keep the drug in the highly restricted Schedule I category, move it to a less restrictive category or remove it from scheduling altogether, which would end the conflict between state and federal marijuana laws.

As of January 2026, cannabis is legal in 40 of 50 states for medical use and 24 states for recreational use. Rescheduling would only apply to medical use.

Let’s examine the arguments for each option under the Controlled Substances Act, which places each prohibited drug into one of five “schedules” based on proven medical use, addictive potential and safety.

Drugs classified as Schedule I – as marijuana has been since 1971, when the Controlled Substances Act was passed – cannot be legally used for medical use or research, though an exception for research can be made with special permission from the Drug Enforcement Administration. Schedule I drugs are believed to have a high potential for abuse, to be extremely addictive and to have “no currently accepted medical use.”

As a Schedule I drug, marijuana has been more tightly controlled than cocaine, methamphetamine, PCP and fentanyl, all of which belong to Schedule II.

Option One: Keep the Status Quo 

Some policy analysts and anti-marijuana activists argue that marijuana should remain a Schedule 1 drug.

A common objection to rescheduling it is the assertion that 1 in 3 marijuana users develop an addiction to the drug, which stems from a large study called a meta-analysis.

A careful reading of that study reveals the flaws in its conclusions. The researchers found that about one-third of heavy users – meaning those who use marijuana weekly or daily – suffered from dependence. But when they looked at marijuana users more generally – meaning people who tried it at least once, the way addiction rates are normally measured – they found that only 13% of users develop a dependency on marijuana, which makes it less habit-forming than most recreational drugs, including alcohol, nicotine and caffeine, none of which are scheduled under the Controlled Substances Act.

Further, if the 1-in-3 figure were accurate, then marijuana would be more addictive than alcohol, crack cocaine and even heroin. This defies both common sense and well-established studies on the comparative risk of addiction.

Critics of rescheduling also deny that there is convincing evidence that marijuana or its compounds have any legitimate medical use. They cite research like a 2025 review paper that assessed 15 years of medical marijuana research and concluded that “evidence is insufficient for the use of cannabis or cannabinoids for most medical indications.”

This claim is problematic, however, given that the Food and Drug Administration has already approved several medicines that are based on the same active compounds found in marijuana. These include the drugs Marinol and Syndros, which are used to treat AIDS-related anorexia and chemotherapy-induced nausea and vomiting. Both of these contain delta-9-tetrahydrocannabinol, or THC, the substance that is responsible for the marijuana high.

If the active ingredients of marijuana have legitimate medical use as established by the FDA, then it stands to reason that so must marijuana.

Option Two: Move Marijuana to Schedule III

Moving marijuana to schedule III would make it legal at the federal level, but only for medical use. Recreational use would remain federally prohibited, even though it is legal in 24 states as of early 2026.

The most obvious benefit to rescheduling, noted above, is that it would make research on marijuana easier. The system of cannabinoid receptors through which marijuana confers its therapeutic and psychoactive effects is crucial for almost every aspect of human functioning. Thus, marijuana compounds could provide effective medicines for a wide variety of ailments.

Contrary to the 2015 review mentioned earlier, studies have shown that cannabis is effective for treating nausea and AIDS symptoms, chronic pain and some symptoms of multiple sclerosis, as well as many other conditions.

Rescheduling could also improve medical marijuana guidance. Under the current system, medical marijuana users are not provided with accurate, evidence-based guidance on how to use marijuana effectively. They must rely on “bud tenders,” dispensary employees with no medical training whose job is to sell product. 

If cannabis were moved to Schedule III, doctors would be trained to advise patients on its proper use. On the other hand, medical schools need not wait for rescheduling. Given that many people are already using medical marijuana, some medical experts have argued that medical schools should provide this training already.

Rescheduling, however, is not without complications. To comply with the law, medical marijuana programs would have to start requiring a doctor’s prescription, just like with all other scheduled substances. And it could be distributed only by licensed pharmacies. That might be a good thing, if marijuana is as dangerous and addictive as critics claim. 

But advocates of medical marijuana might be concerned that this would increase costs to the consumer and restrict access. That concern might be mitigated, however, if health insurance companies are required to cover the costs of medical marijuana once it is rescheduled.

In addition, it is unclear how rescheduling would affect state-level bans on medical marijuana. Generally speaking, states cannot legally restrict access to pharmaceuticals that have been approved by the FDA. However, this principle of federal preemption is currently being challenged by six states claiming they have the authority to restrict access to the abortion medication mifepristone.

Option Three: Unschedule Marijuana

The debate over rescheduling ignores a third option: that marijuana could be removed entirely from the Controlled Substances Act, giving states the authority to allow medical marijuana to be distributed without a prescription.

Some of the objections to rescheduling come from marijuana advocates. Given that marijuana is safer and less addictive than alcohol – which is not scheduled under the Controlled Substances Act – a case could be made for removing it entirely from the list of scheduled substances and allowing states to legalize it for recreational use, as many states have already.

In fact, many drugs as, or more powerful than, marijuana are also not scheduled. For example, most over-the-counter cough medicines contain dextromethorphan, a hallucinogenic dissociative, which in large doses causes effects similar to PCP.

Removing marijuana from the list of controlled substances would also decriminalize the drug. Over 200,000 Americans were arrested for marijuana in 2024, over 90% of them for mere possession.

At the moment, the third option seems very unlikely. Although over 60% of Americans are in favor of full marijuana legalization, it lacks support in Congress.

Medical marijuana rescheduling looks likely to occur in 2026. After all, it has been proposed by both Biden and Trump. Whether it is the right move, only time will tell.

Chris Meyers, PhD, is an Adjunct Professor of Philosophy at George Washington University. 

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

Medicine for the Soul: Friends Are Important When You Have Chronic Pain

By Crystal Lindell

Every month before book club, I count out some pain pills.

I have to make sure I have a dose to take before I leave the house, so that they will be fully working when I arrive. And I have to make sure I have another dose to bring along – in case things run late and my pain starts to creep back before I make it home.

Without doing that, I know there’s no way I’d be able to physically endure the hours-long social interaction – even if that social interaction is literally just sitting on the couch and talking about a book. That’s just how my life is with the type of chronic pain I have. 

And it’s a social interaction that I absolutely love, by the way. In fact, I love it so much that I sacrifice both before and after every meet-up to make sure I can show up for it.  

On the day of a book club meeting, I also have to cut back on things like chores so that I can make sure I have the energy to shower, get dressed and put on makeup before I leave the house. While I’m sure the group wouldn’t mind if I showed up disheveled, I would.  

And I have to plan my schedule after the book club to allow time for me to go to bed early, because I know I’ll need to. Being alert and upright for a few hours is that hard on my body. 

Living with chronic pain means all my friendships require planning, extra work, and usually pain medication. It’s a level of effort that would make it easy, even understandable, to give up on the whole ordeal. But I don’t.

The priorities each day for me with chronic pain are basic hygiene, nutrition, housework, and maybe earning some money. All of that usually only leaves time and energy for one other thing: Sleep.  

Driving somewhere to get coffee with an old friend just doesn’t feel as urgent. Especially if you’re also in a romantic relationship or taking care of loved ones who themselves have health problems.

And making new friends? Forget about it!  

But please trust me when I tell you that “maintaining friendships” and even “making new friends” truly is just as crucial as taking a shower and doing the dishes – especially when you have chronic pain.

I have only been in this book club for about a year now, and most of the people in it are completely new friends to me. But I’m so glad that I have prioritized going, even when my physical pain is especially bad. 

Meeting with them always enriches my spirit in ways I can’t predict. 

That’s the thing about friendships: They are literally medicine in and of themselves. Often comforting, rejuvenating, and even healing.

In fact, a few months ago, during the book club meeting we played a game where we each anonymously wrote three compliments about everyone else in the group. And then we each got to hear what the others said about us.

The things everyone said about me were like medicine for my soul. For weeks afterward, when I felt like the physical pain was too much, I would think of those compliments. And they would help me mentally to endure it.

It’s the kind of thing that makes counting out pills before we meet more than worth it.

The Most Dangerous Drug in Canada Is Not Prescription Opioids

By Pat Anson

The most dangerous drug in Canada doesn’t require a prescription. You can’t smoke, vape, snort, or inject it. It doesn’t come in a pill, patch or edible.

It’s responsible for as many as 18-thousand deaths every year in Canada and can result in a lifetime of addiction. It ruins marriages, families, friendships and careers, and costs society about $20 billion a year in added healthcare expenses and lost productivity.

Yet it is readily available in most stores and can be purchased by anyone over the age of 19. In some provinces, the age limit is 18.

By now you’ve probably guessed that I’m talking about alcohol.

A new report by the Centre for Addiction and Mental Health (CAMH) found that alcohol causes more harm in Canada overall than any other drug — ranking well above tobacco, illicit fentanyl, cocaine, cannabis, methamphetamine and, yes, prescription opioids.

CAMH put together a diverse panel of 20 experts in public health, epidemiology, addiction, criminology, psychology and public policy to assess the short and long-term impact of 16 commonly used psychoactive drugs. In addition to the direct “harm to users” – such as addiction and overdose – they evaluated the indirect “harm to others” – families, communities and society at large.

“This is the first time this approach has been used to assess drug harms in Canada, and it gives us a much more complete picture than we had before,” said Jean-François Crépault, Senior Policy Advisor at CAMH and lead author of the study published in the Journal of Psychopharmacology. 

“When we look at harm to people who use drugs and harm to others together, alcohol clearly stands out. Our findings highlight a major gap between the harms linked to alcohol and the way it is currently regulated in Canada.”

Based on a ranking system of 0 to 100, with zero meaning no harm and 100 being the most harmful, alcohol was given a score of 79, followed by tobacco (45) and non-prescription opioids (33). The latter category includes illicit fentanyl, xylazine, and other opioid-based street drugs.

Cocaine (19), methamphetamine (19), cannabis (15) and crack (10) are next, with “prescription opioids” (8) ranked as the eighth most harmful drug category.

Even that ranking is a bit misleading, as it includes morphine, oxycodone and other pharmaceutical opioids that are diverted and used without a prescription – which probably should be counted as non-prescription opioids.

Prescription opioids were ranked so low in terms of harm, they barely beat out ENDs (7), an acronym for electronic nicotine delivery systems, more commonly known as vapes or e-cigarettes.

Most Harmful Drugs in Canada

JOURNAL OF PSYCHOPHARMACOLOGY

The finding that alcohol causes the most harm aligns with previous studies in the United Kingdom, the European Union, Australia and New Zealand.

In the United States, a recent study that used a slightly different methodology ranked alcohol as the 5th most harmful drug, behind illicit fentanyl, methamphetamine, crack and heroin. Prescription opioids ranked as the 7th most harmful drug in the U.S.

Experts say these studies point to a clear need for government drug policies to better align with the actual harm that a specific drug causes – and not be based on laws, guidelines, class action lawsuits, or whatever drug hysteria is popular at the moment. 

Despite all the harm it causes, no one talks about banning alcohol, yet natural leaf kratom and the kratom extract 7-OH are being demonized as “gas station heroin” and “legal morphine” that should be banned. Never mind that there is little solid evidence they are dangerous when used appropriately. Neither substance made the “harmful” list in Canada, United States, or anywhere else.

“The key message here is that harm is not just about what a drug does to the body,” said Crépault. “How a drug is regulated shapes who uses it, how it is used, and how much harm it causes. Evidence-based policy can significantly reduce harm, and governments have a real opportunity to use regulation to protect public health.”

Three Clichés That Help Me Get Through Bad Pain Days

By Crystal Lindell

As the old cliché goes: clichés are clichés for a reason. They tend to convey a lot of fundamental truth about the world and life itself.

While dealing with chronic pain for more than a decade now, I have come to appreciate certain clichés in ways that I couldn’t before I got sick and lived to tell the tale.

They may sound corny, but below are three clichés that I have found really do help me get through a day with chronic pain: 

Cliché #1: This Too Shall Pass

When I first started having chronic pain, flares felt eternal. I genuinely worried that the pain would last forever. Any relief felt like an impossible dream.  

But eventually, the pain would ease a bit. Over time, I was also able to find calming techniques, as well as pain medications and supplements that helped relieve my symptoms. 

Even during the worst pain flares, I take heart in knowing that it too shall eventually pass.

It goes both ways too. On the other side of this equation, I’m also now significantly more aware of just how fleeting my health truly is. While the bad pain flares will pass, that also means the good days will pass as well – making it that much more important to savor them.

As it turns out, losing your health is the best way to finally learn how to appreciate the good days.

Cliché #2: Other People’s Opinions Don’t Matter

This concept is, for me, the simplest and yet the most difficult to truly internalize. 

But when you have chronic pain, you have to learn to ignore other people’s opinions about what you’re going through. And trust me, people will rush to share their opinions with you as much as possible, whether you ask for them or not.

You have to tune it out though, otherwise you’ll just fall into a dark despair of guilt and impossible standards.

I also have realized that what people say they would do if they were in pain, and what they would actually do are two very different things. 

People love to say they would never take opioids, or that they would just use yoga to “cure” their chronic pain. But I have been dealing with my own pain long enough now to see those same people eventually have to put their money where their mouth is, and they always fail their own test.

People who are the most judgmental of your choices are also the first to crack under the pressure that pain causes. It then becomes clear that most of their judgmental comments are reflections of their own issues, rather than anything to do with you.  

People claiming they would never use opioids are trying to convince themselves of that, as opposed to making a statement about your choices. 

And people who quickly say they’d just do yoga to cure their pain are trying to mentally process the fear they have at the thought of ending up like us. It’s a coping mechanism that allows them to think that even if it did happen to them, they’d be fine.

If you’re struggling with chronic pain, it’s good to remember you’re doing the best that you can, under the circumstances. Whether or not other people agree is irrelevant.

Cliché #3: The Best Days of Your Life Haven’t Happened Yet

This cliché is honestly the most magical for me, and it has truly helped me get through some rough patches in my own life.

When you’re drowning in chronic pain, it’s easy to spiral physically and emotionally, and to assume that nothing good will ever happen to you again. But take it from me, good things will still happen.

When I first developed chronic pain in 2013, I still had not met the love of my life, I’d never had a cat, and I had never gone to Paris. In the years since though, I met my fiancé; I acquired six cats (all of whom I’m obsessed with); and I have been to Paris not once, but TWICE!

There are incredible things in store for you, too — and that’s worth hanging around for. 

While none of these clichés can cure chronic pain, they do make it a little easier to endure. And sometimes, that little extra is all you need to make an extraordinary life. 

If you have any clichés that you find helpful, I’d love for you to drop them in the comment section below. After all, we could also use a little life advice, especially when that advice has been tried and tested by people strong enough to survive chronic pain.

CDC Opioid Guideline Raised Cost of Pain Care

By Pat Anson

The CDC’s 2016 opioid prescribing guideline not only had disastrous consequences for many pain patients, but raised the cost of treating them in primary care practices, according to a new analysis.

Researchers at the University of Wisconsin-Madison studied the budget impact of four different strategies used at primary care clinics to comply with the guideline, which strongly encouraged doctors to reduce opioid prescribing. 

The strategies primarily relied on prescriber education, evaluations and auditing to see if the clinics were successful in reducing the use of opioids. Whether patient safety and pain relief improved were not part of the study.

The cost per clinic for implementing the strategies ranged from $4,416 to $8,358, with prescriber education being the cheapest approach. However, while education alone cost less upfront, the clinics that used it had the largest increases in downstream expenses, such as greater use of urine drug tests (UDTs), treatment agreements, and depression screening. That made it the most costly approach overall.       

The 2016 guideline recommended that doctors limit daily opioid doses to no more than 90 morphine milligram equivalents (MMEs), conduct regular drug testing of patients, and have patients sign “pain contracts” promising to follow their doctor’s treatment plan.

The CDC’s recommendations were not only costly and burdensome to providers, according to researchers, but resulted in “no significant decrease” in MME for patients on long-term opioid therapy. Patients on opioid therapy for less than 3 months saw their doses decline by 6%. 

“In summary, from 2016 to 2022, no evidence emerged showing that UDTs were effective in improving long-term outcomes such as decreased overdoses or better pain management,” wrote lead author Andrew Quanbeck, PhD, an Associate Professor in the University of Wisconsin's Department of Family Medicine and Community Health.

“Over time, treatment agreements and UDTs have emerged as low-value care that imposes significant costs for primary care physicians and patients. Results suggest that health systems have an opportunity to shift focus from costly surveillance tools to inexpensive, holistic screening for pain, function, and quality of life and careful initiation of opioids for new patients.”  

The study, published in the Annals of Family Medicine, is one of the few to analyze the long-term impact of the original CDC guideline.  

It’s important to note that the CDC updated its guideline in 2022 to give more “flexibility” to doctors prescribing opioids. However, many of the agency’s 2016 recommendations were so stringently adopted by states, healthcare systems, insurers, and even law enforcement agencies that they remain unchanged – even though there were many reports of patients being harmed by them.

“It is clear that the CDC Guideline has harmed many patients,” the American Medical Association wrote in a 2020 letter to the CDC. “In many cases, health insurance plans and pharmacy benefit managers have used the 2016 CDC Guidelines to justify inappropriate one-size-fits-all restrictions on opioid analgesics while also maintaining restricted access to other therapies for pain.”

The Food and Drug Administration also warned the CDC guideline was causing “serious harm” to patients, including forced tapers, uncontrolled pain, psychological distress and suicide.    

In a 2022 PNN survey of over 2,500 patients and providers, nearly 85% said the CDC should not have created guidelines for opioid prescribing and pain treatment. Over 93% said the guidelines made the quality of pain care in the United States worse.

Can Rheumatoid Arthritis Be Prevented?

By Kevin Deane

More than 18 million people worldwide suffer from rheumatoid arthritis, including nearly 1.5 million Americans.

Rheumatoid arthritis is an autoimmune, inflammatory form of arthritis, meaning a person’s immune system attacks their joints, causing substantial inflammation. This inflammation can cause pain, stiffness and swelling in the joints, and in many cases, patients report fatigue and a flu-like feeling.

If left untreated, rheumatoid arthritis can lead to damage of the joints. But even when treated, this condition can lead to significant disability. In highly active disease or advanced stages, patient may have difficulty performing daily tasks, such as preparing food, caring for children and getting dressed.

Up to now, this condition has been treated once patients have already developed symptoms. But a growing body of evidence suggests this disease can be identified earlier – and maybe even ultimately prevented.

I’m a physician specializing in rheumatoid arthritis and a researcher who has conducted a clinical trial on treatments for this condition. I believe this research is moving us toward being able to identify people who are at risk for rheumatoid arthritis before the disease fully develops, and to finding treatments that will delay or prevent it altogether. 

My hope is that this could lead to changes in how we manage rheumatoid arthritis in the next several years.

Finding RA Before Symptoms Start

Currently, when someone visits their health care provider because they are experiencing joint pain or other symptoms of an immune attack, health care providers can make a diagnosis by examining the joints for swelling. The health care provider will also run tests to find blood markers called autoantibodies, which help in confirming the diagnosis. 

While not all people with rheumatoid arthritis will have abnormal blood markers, the two autoantibodies that are seen in up to 80% of people with rheumatoid arthritis are rheumatoid factor and anti-cyclic citrullinated peptide.

But multiple studies have now confirmed that rheumatoid arthritis has a preclinical stage of development. This is a time about three to five years or longer, prior to the onset of swollen joints when markers like rheumatoid factor and anti-cyclic citrullinated peptide are detectable in the blood. 

The presence of these markers indicates that autoimmunity is occurring, yet the body and organs are still functioning well, and a person who is at risk of getting rheumatoid arthritis may not feel sick yet.

Now that researchers have identified this preclinical stage, health care providers can use markers such as autoantibodies and symptoms like prolonged early morning joint stiffness to identify people who are at risk for rheumatoid arthritis but do not yet have joint inflammation.

At this point, predicting future rheumatoid arthritis is still in the research stage, although the field is working toward established ways to test for risk for rheumatoid arthritis as a routine part of health care. This is akin to how cardiovascular disease risk is assessed through measuring cholesterol levels.

Stopping or Delaying RA 

Because of advances in the ability to predict who may get rheumatoid arthritis in the future, researchers are now working on identifying treatments that can delay or prevent the full-blown condition from developing.

In particular, trials have been performed in people who tested positive for anti-cyclic citrullinated peptide, or who have other risk factors for rheumatoid arthritis. These risk factors include joint pain and subclinical joint inflammation, which is when an imaging study, like magnetic resonance imaging, sees joint inflammation that can’t be seen by a clinician examining the joints.

To date, almost all of these trials have used immune drugs that are commonly used to treat full-blown rheumatoid arthritis, such as methotrexate, hydroxychloroquine and rituximab. Researchers have been testing whether a short course of any of these drugs could lead to a lasting reset of the immune system and prevent rheumatoid arthritis from developing.

While there is not yet an approved drug for rheumatoid arthritis prevention, these studies offer hope that researchers are on track to find the right drug – as well as the right dosage and duration of that drug.

Preclinical Stage of RA

Some challenges remain to be addressed before preventive treatments become the norm in clinical care.

First, researchers need to better understand the biology of the preclinical stage of disease. Until recently, most studies have focused on patients with full-blown arthritis and generally ignored people at risk for developing the disease.

But now, researchers can use blood markers like anti-cyclic citrullinated peptide antibodies to identify those who are at risk much more easily. And a growing number of studies of people with this marker are informing how scientists understand the biology of rheumatoid arthritis development.

In particular, it is now apparent that the preclinical stage is marked by multiple circulating immune system abnormalities in cells, autoantibodies and inflammation. The hope is that researchers will find interventions that effectively target the immune system abnormalities driving the development of rheumatoid arthritis before the patient’s joints begin to swell.

Researchers are also finding that the abnormalities in the immune system during the preclinical stage may be coming from sites in the body other than the joints. An emerging idea called the mucosal origins hypothesis posits that the early autoimmunity of rheumatoid arthritis is caused by inflammation at mucosal surfaces of the body, such as the gums, the lungs and the gut. According to this theory, the joints are involved only later as the disease progresses.

More research is needed, but the mucosal origins hypothesis may help explain why periodontal disease, emphysema or other forms of lung disease and exposure to tobacco or forest fire smoke are risk factors for rheumatoid arthritis. It would also explain why certain bacteria have been associated with the disease. Future trials targeting interventions to a mucosal process could help researchers better understand the nature of this disease.

But while biomarkers like the anti-cyclic citrullinated peptide antibodies are strongly predictive for future rheumatoid arthritis, one difficulty remains: Some people who test positive for them never develop the full-blown disease.

Studies have shown that about 20% to 30% of people who are positive for anti-cyclic citrullinated peptide antibodies develop rheumatoid arthritis within two to five years, although the presence of combinations of risk factors can identify people who have a greater than 50% risk for developing the condition within one year.

This makes it difficult to find participants for clinical trials for rheumatoid arthritis prevention. If you can’t predict who will get the disease, it’s hard to know whether you’re preventing it.

So far, researchers have tried to recruit people who have already come to their health care provider with early joint symptoms of rheumatoid arthritis but still no swollen joints. That has worked well, but there are likely far more people at risk for rheumatoid arthritis who have not yet sought care.

Since health care providers are not yet testing everyone for blood markers for rheumatoid arthritis, researchers will need larger, international networks that can test for risk factors like autoantibodies to identify candidates for participation in prevention trials.

More needs to be done, but it’s exciting to see the field advancing toward the point where prevention may be part of routine clinical care for rheumatoid arthritis.

Kevin Deane, MD, is a Professor of Medicine and Rheumatology at the University of Colorado Anschutz Medical Campus.

He is the lead investigator on a U.S. trial called “StopRA” which seeks to identify people at-risk for future rheumatoid arthritis through a blood test, and then investigates whether treating them with a drug can delay or prevent future disease. You can learn more about this study by visiting their website or calling (303) 724-8330.

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

7-OH Is a Breakthrough for Pain Relief and Should Remain Legal

By Crystal Lindell 

This week, Missouri took a step towards banning most 7-OH products, joining a long list of governmental bodies considering similar things. 

If you’re unfamiliar, 7-OH is an alkaloid that occurs naturally in kratom, the full name of which is 7-hydroxymitragynine. When concentrated, it has opioid-like effects that can relieve pain and boost energy levels. 

The interesting part is that 7-OH doesn’t cause respiratory depression the way opioids do, which means it is not deadly the way opioids can be. 

Unfortunately, multiple governmental bodies are attempting to ban it. While the FDA would like to ban it nationwide, states like Florida, Ohio and Kentucky have already banned it, while health officials in California are taking it off store shelves.

The Missouri Senate is considering a bill that would also effectively ban 7-OH. The proposed law would prohibit the sale of all kratom products to people under the age of 21 and specifically limit the 7-OH content in products to 2%.

Since many contain about 50% 7-OH or even more, that would essentially prohibit the sale of all 7-OH products. Violators could face felony charges if the bill becomes law.

The Missouri Independent reported that during a committee hearing on the bill, State Sen. Maggie Nurrenbern (D) of Kansas City said several families submitted statements calling 7-OH products “highly addictive, unregulated drugs” that have impacted their loved ones and children.

“I don’t know if there’s any more pressing issue before us than making sure that kids don’t have access to these drugs,” Nurrenbern told the committee. “As well as making sure that we’re not doing further damage to our community right now that’s already grappling with so much in terms of addiction and mental health.” 

A Painkiller That Actually Works

It’s disheartening to see 7-OH framed this way, when I know just how much value it has for the lives of the millions of people suffering from chronic pain. 

For years, we’ve been told that the reason opioid prescriptions had to be greatly restricted was because of overdose deaths. But now that we finally have something that actually treats pain without directly causing OD deaths, officials are still trying to claim it is doing “damage” to the community. 

What about the damage caused by chronic pain?

My life is littered with hellish stories about people I know who couldn’t get pain meds when they needed them. In fact, comment sections on PNN’s social media are often overflowing with the same type of stories.

Readers tell us many doctors dismiss their pain, refuse to prescribe opioid medication, and leave patients to suffer. Some pharmacists also refuse to fill opioid prescriptions and get irate when pushed. 

I have even seen numerous patients lamenting that they have lost the will to live because their severe pain is untreated. I have been there myself. Before I found my current doctor — who prescribes me enough pain medication to function — I still remember talking to my mom about how, if I do kill myself, I want her to understand that death would be a mercy for me.

But now there is an over the counter substance that actually treats pain, and I just have to call it what it feels like to me as a patient: a miracle.

In fact, I would argue that  7-OH is likely the closest we will come in my lifetime to seeing something like hydrocodone being sold OTC – something I have long advocated for.

In a humane society, everyone should have access to effective pain treatment, especially in a country without universal healthcare or insurance coverage.  

I was talking to my fiancé about a surgery he had a few years ago, where the operating surgeon initially refused to give him opioid medication for post-operative pain. The doctor claimed that his other patients had only needed ibuprofen — after he took a scalpel and sliced open their arms to repair a nerve. 

While my partner was still coming out of anesthesia, I had to argue with his surgeon to make sure he was sent home with at least a handful of Norco. 

I had made the mistake in the past of not doing this after my partner’s nose surgery, and then I was left to watch him suffer on the couch for three days while he lamented that every time he tried to breathe, it felt like death.

If either situation happened today, we could save ourselves from so much stress and agony because he could just take 7-OH post-op. Yes, 7-OH is that good of a painkiller.

If doctors were smart they would be jumping all over 7-OH. Finally, something that actually relieves pain and doesn’t kill their patients.  It’s what we have all been looking for! 

But no, doctors are not recommending 7-OH. In fact, most have never heard of it, while state and local governments either ban it or threaten to do so. 

Yes, there are some downsides. The main one is how expensive it is. One 7-OH chewable tablet, which has 4 servings, will run you around $10. 

It can also be difficult to figure out which brand works best for you, in large part because there’s so little regulation of kratom or 7-OH, making it difficult to know what each brand puts into their tablets and how much is in there.

My circle of people really like using the brand 7Stax, but you can also browse through the r/7_hydroxymitragynine subreddit for additional recommendations and user experiences. 

You should know that 7-OH can cause dependence and withdrawal symptoms if you abruptly stop taking it. As someone who has used opioids for over a decade to manage pain, I am an expert on tapering down medications to avoid withdrawal. Newcomers may have some trial and error time before they figure out what’s best for their own bodies.

There’s also not much research on how 7-OH interacts with other drugs or health conditions, not to mention the lack of information about long-term side effects.

That is largely why I am still hesitant to recommend it to elderly relatives, as their health tends to be more fragile. Although, paradoxically, they also tend to be much more likely to have chronic pain.  

With everything going on in the news, it does seem like the fight to make 7-OH illegal has taken a backseat to other issues.  

What I would say is that if you have been hesitant to try 7-OH because you don’t want to waste money on another supplement that probably won’t work, then I can vouch for the fact that it does work on my pain. 

I’m not a doctor, just a patient who also has a lot of loved ones with chronic pain. And I can tell you that everyone I know who tries 7-OH finds it to be effective.  

If you are among those who have already found 7-OH to be effective, I encourage you to be proactive by reaching out to your local government officials to tell them how important it is for you. I would also encourage you to make yourself available to local reporters when possible, so that they can offer more balanced coverage of what 7-OH is and what it does. 

While 7-OH is a breakthrough, it will only stay that way if it remains legal. We all have to fight to keep it that way. 

From Reefer Madness to Schedule III: What I Learned About Marijuana

By Carol Levy

I was a child of the late 60's and early 70's. I gave daisies to policemen as I walked by them. My friends called me a “hippie dippy.”

In a way, I was. I protested against the Vietnam war. I sat in the park with friends and sang folk songs. One of the boys wore love beads. I wore a headband.

I never did try any of the psychotropic drugs that were easily obtained at that time. Illegal, yes, but very available. Marijuana seemed to be the one most easily gotten.

Since my trigeminal neuralgia pain started in 1976, doctors prescribed me with most of the opioids that were available, including tincture of opium, morphine, oxycodone, fentanyl, codeine, Demerol, Darvon, and even methadone.

I had the same reaction to all of them. I felt groggy, cotton-headed, and dry-mouthed – and they didn't help my pain at all. 

Google “How do opioids make you feel?” and you’ll get answers like, “Opioids make you feel calm, relaxed, and euphoric by blocking pain signals and activating pleasure centers in the brain."

None of which I found to be true.

The stories about marijuana made me nervous. My friends said it makes you high and gives you the munchies. 

Google “How does marijuana make you feel?” and you’ll be told it causes “feelings of euphoria, deep relaxation, intensified sensory experiences, and altered time perception.”

All of which I was afraid was true!

I like to be tied to reality. My fear was that marijuana would make me feel as though reality had left me, as the “Reefer Madness” movie said it would. This was a drug I would never try.

But then medical marijuana became legal in my state of Pennsylvania. Despite the pain and no benefit from any opioid, I wasn't sure I wanted to try it. 

To be honest, as much as none of the opioids scared me, marijuana did. I wasn't sure how it would make me feel.

Most of us know the quiet desperation of poorly treated pain: “I'll try anything to stop the pain.” That is how I felt about marijuana. Fearful or not, maybe, just maybe, it will help. And, I had reason to believe it might.

Despite marijuana being an illegal Schedule I controlled substance with “high abuse potential and no accepted medical use,” limited research was permitted under strict FDA and DEA regulations. Marijuana may soon be rescheduled as a legal Schedule III substance, although its future use in medicine is still an open question.

Over the years, I have seen research that showed marijuana helped those with anaesthesia dolorosa (phantom pain), which is the pain and numbness many amputees feel after a limb is removed. I have anaesthesia dolorosa on one side of my face, a side effect of surgery. 

If marijuana helped them, would it help me?

I signed up for Pennsylvania’s medical marijuana program. The next step was to find a doctor, authorized by the state, to certify that I met the requirements for certification, which meant having one or more of the disorders on a list of allowable health conditions. Once I was certified, I was free to go to a dispensary and buy medical marijuana.

It may sound incredible today, but when I got my first prescription for opium – way back when – the pharmacist immediately filled it for me. The same was true for all the other opioid prescriptions I was given. If I had questions, the pharmacist could answer them.

I expected the same would be true for marijuana.

The dispensary had security, that was not a surprise. I had to show my state certification card to get inside the building. Then I sat in a waiting room, filled with others waiting their turn. 

After a few minutes, someone came out of the office, and called my name. We went to a room with a counter and 5 or 6 stations where you would select the marijuana you would buy. 

I knew nothing about how marijuana worked, what kind I should try, or how much I needed. There was no prescription setting the dose or how often I should take it. No doctor told me what to get or the CBD and THC combination I should try. The salespeople could not answer my questions about dosage, effects, or how long it would stay in my system. 

I am glad so many of us are now able to try marijuana, a drug that carries fewer consequences than some of the higher-level opioids I used to get. 

But I hate that no one can tell me the important points: how much, how often, etc. When I first tried marijuana, it didn't help. The two pain doctors I saw told me I wasn’t taking enough. But they couldn't tell me how much is “enough.”

Marijuana is a wonderful addition, finally, to the list of drugs we are allowed to have. I am happy I have the option. But I am very unhappy that it is still not seen as a medical medication. It’s more of a “what the heck, give it a try” substance.

Maybe marijuana can be another tool that doctors have in their arsenal for chronic pain. Maybe getting it off Schedule I and putting it into Schedule III will let the research start in earnest, and it will then become a real medication your doctor can prescribe with specific instructions on the type, combination, and dosage. 

I look forward to the day you can get marijuana from a pharmacist, instead of an untrained salesperson in a dispensary

Fed Vaccine Policies Ignore Covid’s Long-Term Harm

By Stephanie Armour, KFF Health News

Possible risk of autism in children. Dormant cancer cells awakening. Accelerating aging of the brain.

Federal officials in May 2023 declared an end to the national covid pandemic. But more than two years later, a growing body of research continues to reveal information about the virus and its ability to cause harm long after initial infections resolve, even in some cases when symptoms were mild.

The discoveries raise fresh concerns about the Trump administration’s covid policies, researchers say. While some studies show covid vaccine offer protective benefits against longer-term health effects, the Department of Health and Human Services has drastically limited recommendations about who should get the shot. The administration also halted Biden-era contracts aimed at developing more protective covid vaccines.

The federal government is curtailing such efforts just as researchers call for more funding and, in some cases, long-term monitoring of people previously infected.

“People forget, but the legacy of covid is going to be long, and we are going to be learning about the chronic effects of the virus for some time to come,” said Michael Osterholm, an epidemiologist who directs the University of Minnesota’s Center for Infectious Disease Research and Policy.

The Trump administration said that the covid vaccine remains available and that individuals are encouraged to talk with their health providers about what is best for them. The covid vaccine and others on the schedule of the Centers for Disease Control and Prevention remain covered by insurance so that individuals don’t need to pay out-of-pocket, officials said.

“Updating CDC guidance and expanding shared clinical decision-making restores informed consent, centers parents and clinicians, and discourages ‘one size fits all’ policies,” said HHS spokesperson Emily Hilliard.

Although covid has become less deadly, because of population immunization and mutations making the virus less severe, researchers say the politicization around the infection is obscuring what science is increasingly confirming: covid’s potential to cause unexpected, possibly chronic health issues. That in turn, these scientists say, drives the need for more, rather than less, research, because over the long term, covid could have significant economic and societal implications, such as higher health care costs and more demands on social programs and caregivers.

The annual average burden of the disease’s long-term health effects is estimated at $1 trillion globally and $9,000 per patient in the U.S., according to a report published in November in the journal NPJ Primary Care Respiratory Medicine. In this country, the annual lost earnings are estimated to be about $170 billion.

One study estimates that the flu resulted in $16 billion in direct health costs and $13 billion in productivity losses in the 2023-2024 season, according to a Dec. 30 report in medRxiv, an online platform that publishes work not yet certified by peer review.

Covid’s Growing Reach

Much has been learned about covid since the virus emerged in 2019, unleashing a pandemic that the World Health Organization reports has killed more than 7 million people. By the spring of 2020, the term “long covid” had been coined to describe chronic health problems that can persist post-infection.

More recent studies show that infection by the virus that causes covid, SARS-CoV-2, can result in heightened health risks months to more than a year later.

For example, researchers following children born to mothers who contracted the virus while pregnant have discovered they may have an increased risk for autism, delayed speech and motor development, or other neurodevelopmental challenges.

Another study found babies exposed to covid in utero experienced accelerated weight gain in their first year, a possible harbinger of metabolic issues that could later carry an increased risk for cardiovascular disease.

These studies suggest avoiding severe covid in pregnancy may reduce risk not just during pregnancy but for future generations. That may be another good reason to get vaccinated when pregnant.

“There are other body symptoms apart from the developing fetal brain that also may be impacted,” said Andrea Edlow, an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School who was involved in both studies. “We definitely need more research.”

Epidemiologists point to some specific, emerging challenges.

A U.K. study in The New England Journal of Medicine found people who fully recovered from mild covid infections experienced a cognitive deficit equal to a three-point drop in IQ. Among the more than 100,000 participants, deficits were greater in people who had persistent symptoms and reached the equivalent of a nine-point IQ drop for individuals admitted to intensive care.

Ziyad Al-Aly, a clinical epidemiologist who has studied longer-term health effects from covid, did the math. He estimated covid may have increased the number of adults in the U.S. with an IQ of less than 70 from 4.7 million to 7.5 million — a jump of 2.8 million adults dealing with “a level of cognitive impairment that requires significant societal support,” he wrote.

“People get covid-19, some people do fine and bounce back, but there are people who start experiencing problems with memory, cognition, and fuzzy brain,” he said. “Even people with mild symptoms. They might not even be aware.”

Diane Yormark, 67, of Boca Raton, Florida, can relate. She got covid in 2022 and 2023. The second infection left her with brain fog and fatigue.

“I felt like if you had a little bit too much wine the night before and you’re out of it,” said Yormark, a retired copywriter, who said the worst of her symptoms lasted for about three months after the infection. “Some of the fog has lifted. But do I feel like myself? Not like I was.”

Data from more than a dozen studies suggests covid vaccines can help reduce risk of severe infection as well as longer-lasting health effects, although researchers say more study is needed.

But vaccination rates remain low in the U.S., with only about 17% of the adult population reporting that they got the updated 2025-2026 shot as of Jan. 16, based on CDC data.

Trump administration officials led by Health and Human Services Secretary Robert F. Kennedy Jr. have reduced access to covid vaccines despite the lack of any new, substantiated evidence of harm. Though the shots were a hallmark achievement of the first Trump administration, which led the effort for their development, Kennedy has said without evidence that they are “the deadliest vaccine ever made.”

In May he said on X that the CDC would stop recommending covid shots for healthy children and pregnant women, citing a lack of clinical data. The Food and Drug Administration has since issued new guidelines limiting the vaccine to people 65 or older and individuals 6 months or older with at least one risk factor, though many states continue to make them more widely available.

The Trump administration also halted almost $500 million in funding for mRNA-based vaccines. Administration officials and a number of Republicans question the safety of the Nobel Prize-winning technology — heralded for the potential to treat many diseases beyond covid — even though clinical trials with tens of thousands of volunteers were performed before the covid mRNA vaccines were made available to the public.

And numerous studies, including new research in 2025, show covid vaccine benefits include a reduction in the severity of disease, although the protective effects wane over time.

‘We Don’t Know What Will Happen to People’

Researchers say more and broader support is important because much remains unknown about covid and its impact on the body.

The growing awareness that, even in mild covid cases, the possibility exists for longer-term, often undetected organ damage also warrants more examination, researchers say. A study published this month in eBioMedicine found people with neurocognitive issues such as changes in smell or headaches after infection had significant levels of a protein linked to Alzheimer’s in their blood plasma. EBioMedicine is a peer-reviewed, open-access journal published by The Lancet.

In the brain, the virus leads to an immune response that triggers inflammation, can damage brain cells, and can even shrink brain volume, according to research on imaging studies that was published in March 2022 in the journal Nature.

An Australian study of advanced brain images found significant alterations even among people who had already recovered from mild infections — a possible explanation for cognitive deficits that may persist for years. Lead study author Kiran Thapaliya said the research suggests the virus “may leave a silent, lasting effect on brain health.”

Al-Alay agreed.

“We don’t know what will happen to people 10 years down the road,” he said. “Inflammation of the brain is not a good thing. It’s absolutely not a good thing.”

That inflammatory response has also been linked to blood clots, arrhythmias, and higher risk of cardiovascular issues, even following a mild infection.

A University of Southern California study published in October 2024 in the journal Arteriosclerosis, Thrombosis, and Vascular Biology found the risk for a major cardiac event remains elevated nearly three years after covid infection. The findings held even for people who were not hospitalized.

“We were surprised to see the effects that far out” regardless of individual heart disease history, said James R. Hilser, the study’s lead author and a postdoctoral fellow at the UCLA David Geffen School of Medicine.

Covid can also reactivate cancer cells and trigger a relapse, according to research published in July in the journal Nature. Researchers found that the chance of dying from cancer among cancer survivors was higher among people who’d had covid, especially in the year after being infected. There was nearly a twofold increase in cancer mortality in those who tested positive compared with those who tested negative.

The potential of the covid virus to affect future generations is yielding new findings as well. Australian researchers looked at male mice and found that those who had been infected with and then recovered from covid experienced changes to their sperm that altered their offspring’s behavior, causing them to exhibit more anxiety.

Meanwhile, many people are now living — and struggling — with the virus’ after-effects.

Dee Farrand, 57, of Marana, Arizona, could once run five miles and was excelling at her job in sales. She recovered from a covid infection in May 2021.

Two months later, her heart began to beat irregularly. Farrand underwent a battery of tests at a hospital. Ultimately, the condition became so severe she had to go on supplemental oxygen for two years.

Her cognitive abilities declined so severely she couldn’t read, because she’d forget the first sentence after reading the second. She also had to leave herself reminders that she is allergic to shrimp or that she likes avocados. She said she lost her job and returned to her previous occupation as a social worker.

“I was the person who is like the Energizer bunny and all of a sudden I’d get so tired getting dressed that I had to go back to bed,” Farrand said.

While she is better, covid has left a mark. She said she’s not yet able to run the five miles she used to do without any problems.

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

Gabapentin ‘Free for All’ in Addiction Treatment

By Pat Anson

The nerve drug gabapentin is increasingly being prescribed to patients undergoing treatment for substance use disorder (SUD), according to two new studies that highlight how the drug is being abused and used to treat health conditions it was never intended to treat.

The first study, published in the journal Drug and Alcohol Dependence, looked at over 200,000 urine drug test results from patients undergoing SUD treatment in all 50 U.S. states.   

Over the past decade, gabapentin (Neurontin) prescribing nearly doubled, from 3.9% of patients undergoing addiction treatment in 2016 to 7.6% in 2023. In addition, nearly one in ten patients being treated for SUD tested positive for gabapentin, even though they didn’t have a prescription for it.    

“A lot of that use is off label, and in the context of substance use, we're seeing it being prescribed to manage withdrawals, or for insomnia, pain, and anxiety. It’s just sort of a free-for-all in how it's prescribed,” says lead author Matthew Ellis, PhD, an Assistant Professor of Psychiatry at Washington University School of Medicine. 

“I think one of the big findings was that the positivity rate for those without a prescription for gabapentin was twice as big as those prescribed gabapentin.”

Gabapentin was originally developed as an anti-convulsant. It was first approved by the FDA as a treatment for epilepsy and later for neuropathic pain caused by shingles. But it is also routinely prescribed off-label for migraine, fibromyalgia, bipolar disorder, cancer pain, postoperative pain, and many other conditions.

Its off-label use as a pain reliever grew after the CDC recommended gabapentin in 2016 as an alternative to opioid analgesics. By 2024, gabapentin was prescribed to 15.5 million Americans, making it the fifth most prescribed drug in the U.S. 

Due to the nature of the study, Ellis says it’s difficult to know if patients were prescribed gabapentin before entering SUD treatment or if they started taking it after treatment started to help manage symptoms of withdrawal. Gabapentin prescribing increased to all patients, whether they were being treated for alcohol, cannabis, stimulant, sedative or opioid abuse.

Another possibility is that patients take gabapentin to heighten the effects of addiction treatment drugs like buprenorphine (Suboxone) or methadone. Gabapentin is prized as a street drug because it helps increase the euphoria or “high” that comes from psychoactive substances. 

“I don't want to give gabapentin a bad name at all. I think there's definitely potential for it. I think my biggest issue is that there's just so little evidence base for its use in substance use treatment settings,” Ellis told PNN. 

“And to have so many people using it outside of a prescription, it just may be a call to recognize that, one, there may be untreated comorbid conditions that people are self managing, or two, we need to do a lot better about building an evidence base to see what exactly is or could be the benefit of gabapentin in substance use treatment.”

One positive trend uncovered by the study is that the use of gabapentin without a prescription has declined in drug treatment settings, from 15.2% of patients to 9.9%. 

The second study, published in the same journal, also found that gabapentin prescribing has significantly increased over the past decade, but that its “nontherapeutic” use (another term for misuse) appears to be declining. 

Despite the decrease in misuse, FDA researchers found that the number of cases reported to U.S. poison control centers involving gabapentin greatly exceeded those for pregabalin (Lyrica) and the anti-anxiety drug diazepam. Most of the gabapentin cases involved other substances, particularly opioids. 

Injectable Gel May Be Long Term Solution to Chronic Low Back Pain

By Pat Anson

An experimental hydrogel continues to show promise as a long-term treatment for chronic low back pain caused by degenerative disc disease.

Findings from a feasibility study, recently published in the the journal Pain Physician, show that 60 patients with low back pain had significant improvements in physical function, low back pain, and low leg pain a year after Hydrafil gel was injected into their damaged discs.

The gel is heated to liquify it before being injected into cracks and tears in discs. It hardens as it cools, restoring the discs’ structural integrity. The procedure takes about 30 minutes and can be performed as an outpatient procedure under local anesthesia. 

Unlike other cement-like material injected into damaged discs to restore stability, the gel remains flexible and mimics the biomechanical properties of the natural disc, preserving spinal motion. 

Most patients showed significant improvement in their pain and disability scores within one month, and the results were maintained 12 months later. 

“These peer-reviewed results represent an important milestone in the development of the first nucleus augmentation technology for degenerative disc disease,” said Douglas Beall, MD, Chief of Radiology Services at Clinical Radiology of Oklahoma and a medical advisor to ReGelTec, which developed the Hydrafil system. 

“The improvements in pain and function observed at one year, along with an acceptable safety profile, support the continued evaluation of the HYDRAFIL System in the ongoing pivotal study designed to support FDA approval of the device for patients who currently have limited minimally invasive treatment options.”

Five of the 60 patients had increased back and leg pain or numbness, due to the gel partially migrating beyond the injection site. The migrated gel was later removed.

This promotional video by ReGelTec demonstrates how the Hydrafil system works:

ReGelTec is currently recruiting 225 patients in the U.S. and Canada for a new study to assess the Hydrafil system, an important step towards getting FDA approval. 

Hydrafil received the FDA’s breakthrough device designation in 2020, which allows for an expedited review of an experimental product when there is evidence it is more effective than current options.  

Degenerative disc disease is one of the leading causes of chronic low back pain. Healthy discs cushion the spine’s vertebrae, supporting movement and flexibility. But with aging and activity, discs can wear out and cause the bones of the spine to rub together and pinch nerves, causing pain and numbness. By age 60, most people have at least some disc degeneration in their spines.

Current treatments for degenerative discs include physical therapy, anti-inflammatory medication, and analgesics. When those are insufficient, epidural steroid injections and surgical options such as a disc removal or spinal fusion may be considered.

New Medicaid Policy Won't Pay for Costly Sickle Cell Therapies Unless They Work

By Phil Galewitz, KFF Health News

Serenity Cole enjoyed Christmas last month relaxing with her family near her St. Louis home, making crafts and visiting friends.

It was a contrast to how Cole, 18, spent part of the 2024 holiday season. She was in the hospital — a frequent occurrence with sickle cell disease, a genetic condition that damages oxygen-carrying red blood cells and for years caused debilitating pain in her arms and legs. Flare-ups often would force her to cancel plans or miss school.

“With sickle cell it hurts every day,” she said. “It might be more tolerable some days, but it’s a constant thing.”

In May, Cole completed a several-months-long gene therapy treatment that helps reprogram the body’s stem cells to produce healthy red blood cells.

She was one of the first Medicaid enrollees nationally to benefit from a new payment model in which the federal government negotiates the cost of a cell or gene therapy with pharmaceutical companies on behalf of state Medicaid programs — and then holds them accountable for the treatment’s success.

Under the agreement, participating states will receive “discounts and rebates” from the drugmakers if the treatments don’t work as promised, according to the Centers for Medicare & Medicaid Services.

SERENITY COLE

That’s a stark difference from how Medicaid and other health plans typically pay for drugs and therapies — the bill usually gets paid regardless of the treatments’ benefits for patients. But CMS has not disclosed the full terms of the contract, including how much the drug companies will repay if the therapy doesn’t work.

The treatment Cole received offers a potential cure for many of the 100,000 primarily Black Americans with sickle cell disease, which is estimated to shorten lifespans by more than two decades. But the treatment’s cost presents a steep financial challenge for Medicaid, the joint state-federal government insurer for people with low incomes or disabilities. Medicaid covers roughly half of Americans with the condition.

There are two gene therapies approved by the Food and Drug Administration on the market, one costing $2.2 million per patient and the other $3.1 million, with neither cost including the expense of the long hospital stay.

The CMS program is one of the rare health initiatives started under President Joe Biden and continued during the Trump administration. The Biden administration signed the deal with the two manufacturers, Vertex Pharmaceuticals and Bluebird Bio, in December 2024, opening the door for states to join voluntarily.

“This model is a game changer,” Mehmet Oz, the CMS administrator, said in a July statement announcing that 33 states, Washington, D.C., and Puerto Rico had signed onto the initiative.

Asked for further details on the contracts, Catherine Howden, a CMS spokesperson, said in a statement that the terms of the agreements are “confidential and have only been disclosed to state Medicaid agencies.”

“Tackling the high cost of drugs in the United States is a priority of the current administration,” the statement said.

Citing confidentiality, two state Medicaid directors and the two manufacturers declined to reveal the financial terms of agreements.

‘A Worthy Experiment’

The gene therapies, approved in December 2023 for people 12 or older with sickle cell disease, offer a chance to live without pain and complications, which can include strokes and organ damage, and avoid hospitalizations, emergency room visits, and other costly care. The Biden administration estimated that sickle cell care already costs the health system almost $3 billion a year.

With many more expensive gene therapies on the horizon, the cost of the sickle cell therapies presages financial challenges for Medicaid. Hundreds of cell and gene therapies are in clinical trials, and dozens could get federal approval in the next few years.

If the sickle cell payment model works, it will probably lead to similar arrangements for other pricey therapies, particularly for those that treat rare diseases, said Sarah Emond, president and CEO of the Institute for Clinical and Economic Review, an independent research institute that evaluates new medical treatments. “This is a worthy experiment,” she said.

Setting up payment for drugs based on outcomes makes sense when dealing with high treatment costs and uncertainty about their long-term benefits, Emond said.

“The juice has to be worth the squeeze,” she said.

Clinical trials for the gene therapies included fewer than 100 patients and followed them for only two years, leaving some state Medicaid officials eager for reassurance they were getting a good deal.

“What we care about is whether services actually improve health,” said Djinge Lindsay, chief medical officer for the Maryland Department of Health, which runs the state’s Medicaid program. Maryland is expected to begin accepting patients for the new sickle cell program this month.

Medicaid is already required to cover almost all FDA-approved drugs and therapies, but states have leeway to limit access by restricting which patients are eligible, setting up a lengthy prior authorization process, or requiring enrollees to first undergo other treatments.

While the gene therapy treatments are limited to certain hospitals around the country, state Medicaid officials say the federal model means more enrollees will have access to the therapies without other restrictions.

The manufacturers also pay for fertility preservation such as freezing reproductive cells, which could be damaged by chemotherapy during the treatment. Typically, Medicaid doesn’t cover that cost, said Margaret Scott, a principal with the consulting firm Avalere Health.

Emond said pharmaceutical companies were interested in the federal deal because it could lead to quicker acceptance of the therapy by Medicaid, compared with signing individual contracts with each state.

States are attracted to the federal program because it offers help monitoring patients in addition to negotiating the cost, she said. Despite some secrecy around the new model, Emond said she expects a federally funded evaluation will track the number of patients in the program and their results, allowing states to seek rebates if the treatment is not working.

The program could run for as long as 11 years, according to CMS.

“This therapy can benefit many sickle cell patients,” said Edward Donnell Ivy, chief medical officer for the Sickle Cell Disease Association of America.

He said the federal model will help more patients access the treatment, though he noted utilization will depend in part on the limited number of hospitals that offer the multimonth therapy.

Hope for Sickle Cell Patients

Before gene therapy, the only potential cure for sickle cell patients was a bone marrow transplant — an option available only to those who could find a suitable donor, about 25% of patients, Ivy said. For others, lifelong management includes medications to reduce the disease’s effects and manage pain, as well as blood transfusions.

About 30 of Missouri’s 1,000 Medicaid enrollees with sickle cell disease will get the therapy in the first three years, said Josh Moore, director of the state’s Medicaid program. So far, fewer than 10 enrollees have received it since the state began offering it in 2025, he said.

Less than a year into the federal program, Moore said it’s too early to tell its rate of success — defined as an absence of painful episodes that lead to a hospital visit. But he hopes it will be close to the 90% rate seen over the course of a couple of years in clinical trials.

Moore said the federal program based on how well the treatment works was preferred over cutting fees for a new and promising therapy, which would put the manufacturers’ ability to develop new drugs at risk. “We want to be good stewards of taxpayer dollars,” he said.

He declined to comment on how much the state may save from the arrangement or disclose other details, such as how much the drug companies might have to pay back, citing confidentiality of the contracts.

Lately Cole, who underwent gene therapy at St. Louis Children’s Hospital, has been able to focus on her hobbies — playing video games, drawing, and painting – and earning her high school diploma.

She said she was glad to get the treatment. The worst part was the chemotherapy, she said, which left her unable to talk or eat — and entailed getting stuck with needles.

She said that her condition is “way better” and that she has had no pain episodes leading to a hospital stay since completing the therapy last spring. “I’m just grateful I was able to get it.”

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