Could PEMF Therapy Recharge Your Health?

By Madora Pennington 

I tend to be skeptical of any health treatment that sounds a bit “woo-woo.” After all, I don’t want to waste my resources on something that doesn’t work or might only be placebo.

But after experiencing so much benefit from stimulating my vagus nerve with a neuromodulation device, I wondered what other bioelectric medicine I could benefit from.

Perhaps you have heard of PEMF. It stands for pulsed electromagnetic field therapy. Like a TENS, ultrasound, or vagus nerve stimulator, it seeks to treat the body using electric currents.

Most PEMF devices are a mat for laying on, or sometimes a metal coil that is held or placed on an area of the body. A PEMF sends magnetic energy through the body or part of it.

Similarly, the depression treatment Transcranial Magnetic Stimulation (TMS) uses high intensity magnetic pulses to penetrate the skull to shift the brain out of states like depression, anxiety, or pain.

PEMF technology has been around since at least the 1970s. It’s first FDA approval came in 1979 for the treatment of non-healing bone fractures.

PEMF therapy works because the body responds to external forces. For example, bones get stronger from stress (think tennis or running), which triggers an electrical charge in the body that causes bone remodeling.

The pulsating low magnetic frequency of PEMF has a positive effect on cellular and biophysical systems, beyond just bones. A damaged or unhealthy cell may have its electrical charge disrupted. PEMF treatment increases cellular energy and improves blood flow, accelerating cell regeneration and tissue repair, acting as a sort of battery charger to cells.

Because collagen responds to forces like bones do, PEMF therapy helps tendons, ligaments, and wounds heal. It can also reduce low back pain and pain from osteoarthritis. Sessions on a PEMF can even increase cartilage, the cushioning tissue in joints.

I purchased the Hoolest MiniMax PEMF because I liked their vagus nerve stimulator. This is the only PEMF device I have tried, so I can’t compare it to others.

The Hoolest PEMF aims to be a clinical level device for the home user. Unfortunately, the MiniMax is not inexpensive, and costs thousands of dollars.

The founder of Hoolest says it takes powerful machinery to put energy through the entire body.

“A PEMF can activate and strengthen the entire network of the nervous system at once, while a vagus nerve stimulator takes smaller areas, just one section,” Nick Hool told me.

Hool advises using it frequently. Like exercise, it takes consistent application to get the most benefit.

My PEMF is bulky and noisy, making weird sounds like an MRI, another magnetic technology. Nonetheless, it is deeply soothing and relaxing and quickly became part of my daily routine.

Placing the coil on old injuries feels just wonderful. After some weeks of using it, my tolerance for exercise increased because the PEMF reduced post-exercise aches and soreness. I noticed I was sleeping very deeply. Overall, my mood was consistently optimistic and relaxed.

On Thanksgiving, a few of my guests took turns spending a half hour on my PEMF mat, after I jokingly promised it would cure anything. All said they felt deeply relaxed from it into the next day.

For the chronically ill, stimulating the body with magnetic pulses may be particularly helpful in ways that medications or surgeries are not. The pulsating magnetic frequencies of a PEMF promote homeostasis, the ideal state of balance in the body.

In the aftermath of severe illness or injury, symptoms can linger when the body is not properly regulating inflammatory processes. Immune cells can become inappropriately activated. All of this prevents tissue healing, which can result in chronic pain.

Time spent on a good PEMF device can re-regulate these off-kilter inflammatory and immune responses. This may clear up brain fog and alleviate chronic fatigue.

In the case of chronic pain, a PEMF may improve faulty signals that are transmitting too many pain messages to the brain. A PEMF device can also stimulate deeper branches of the vagus nerve that external stimulators applied to the skin cannot reach.

PEMF devices vary wildly in their specifications and so does their effectiveness. Studies often comment on the lack of uniformity in PEMF devices, which makes studying their results less consistent. Standard PEMF protocols would make studies more reliable.

Most insurers do not cover PEMF therapy, and consider it “experimental, investigational, or uproven,” although some specific FDA-approved uses, such as bone healing, might be exceptions.

Pregnant women and growing children should not use a PEMF. People with implanted devices like pacemakers should not use a PEMF, as it may make them malfunction.

Cannabinoids and Pain Care: A Federal Shift That Needs Guardrails

By Dr. Lynn Webster

On December 18, President Trump signed an executive order directing the Department of Justice to expedite completion of the process moving marijuana from an illegal Schedule I controlled substance to Schedule III, a less restrictive category that allows for medical use.

The order also directs federal health agencies to expand research, explicitly including real-world evidence, to better inform patients and clinicians about medical marijuana and hemp-derived cannabidiol (CBD).

For clinicians who treat chronic pain, the significance is simple. Federal policy is starting to align with clinical reality. Cannabinoids are already widely used for pain and related symptoms, yet clinical guidance and product standards have lagged.

What the Order Gets Right

It squarely names the research gap. The order cites FDA’s review finding scientific support for marijuana’s medical use in specific settings (including pain), and it connects the current rescheduling effort to the Department of Health and Human Service’s 2023 recommendation that marijuana be placed in Schedule III.

Whatever one thinks about cannabis politics, Schedule I status did not prevent use — it contributed to widespread use with limited standardization and weak clinical guidance.

It also highlights a practical safety problem that clinicians recognize immediately: non-disclosure by patients. The order cites survey data that only about 56% of older adults using marijuana have discussed it with a healthcare provider.

This is an avoidable risk in a population where polypharmacy is common, and adverse events can be consequential. Normalizing nonjudgmental conversations about cannabinoid use is low-tech harm reduction.

Another constructive element is that the order explicitly calls for a regulatory framework for hemp-derived cannabinoid products, including guidance on an upper limit of THC per serving and considerations such as per-container limits and CBD:THC ratio requirements.

Where the Risks Remain

Rescheduling is not the finish line. Moving marijuana to Schedule III may improve research, but it does not automatically create FDA-approved medications, standardized dosing, or clinically reliable formulations for the products most patients actually use. If the public interprets Schedule III as “safe and proven,” we may inadvertently widen the gap between perception and evidence.

CBD is the other major vulnerability. The order acknowledges that some commercially available CBD products are inaccurately labeled (for example, isolate vs. broad-spectrum vs. full-spectrum), leaving patients and clinicians without adequate safeguards. Independent testing supports this concern. A JAMA analysis of CBD products sold online found substantial labeling inaccuracies and detectable THC in a meaningful share of samples.

In pain care, that matters. Unintended THC exposure can impair cognition, contribute to sedation and increase fall risk, especially in older adults. It can also trigger unexpected positive drug tests with real-world consequences.

Safety signals also deserve more humility than the marketing suggests. FDA warns that CBD can cause liver injury and affect how other drugs work, potentially leading to serious side effects.

A randomized clinical trial in healthy adults reported liver enzyme elevations in a subset receiving CBD 5 mg/kg/day for 28 days, with some meeting protocol criteria for potential drug-induced liver injury.

The takeaway from this is not “CBD is dangerous.” It is that population-level use without dose clarity, interaction guidance, or monitoring invites harm, especially in older adults, medically complex patients, and in people taking anticoagulants, anti-epileptics, sedatives or other CNS-active medications.

Finally, the order hints at regulatory whiplash around “full-spectrum” products, noting that some could be treated as controlled substances — again, depending on statutory THC thresholds.

Shifting definitions and enforcement create confusion for patients, clinicians and legitimate manufacturers, and can favor market consolidation that raises prices and narrows choice.

A Clinician’s Checklist for Doing This Right

If this federal pivot is going to improve pain care, access must be paired with guardrails including:

1. Product integrity first. Batch testing, contaminant screening, and accurate labeling (including verified CBD and THC per serving, and spectrum classification) for any federally supported access or research model.

2. Pharmacovigilance at scale. If real-world evidence is the strategy, real-world safety reporting must be built in and transparent.

3. Routine medication reconciliation. Clinicians should ask about cannabinoid use the way we ask about supplements — calmly, consistently, and without stigma.

4. Honest messaging. Clear statements about what the evidence supports, what remains uncertain, and what warrants extra caution.

Bottom Line

The executive order is an important acknowledgement that Americans are using cannabinoids for pain while federal research, standards, and safeguards have lagged. If rescheduling accelerates rigorous research and CBD access is paired with product standards and safety monitoring, clinicians and patients could benefit.

But if access expands faster than quality control and pharmacovigilance, we risk repeating a familiar U.S. cycle: adoption first, guardrails later. Cannabinoids give us a chance to do it differently: evidence first, standards always, and patient safety at the center.

Lynn R. Webster, MD, is a physician specializing in pain and addiction medicine, a former president of the American Academy of Pain Medicine, Senior Fellow at the Center for U.S. Policy, and author of “The Painful Truth” and the forthcoming book “Deconstructing Toxic Narratives: Data, Disparities, and a New Path Forward in the Opioid Crisis.”

Lynn has written extensively on drug policy, the opioid crisis, and criminalization of medicine. Webster reports no relevant financial relationships related to cannabis or CBD products. 

Executive Order Rescheduling Cannabis Won’t Help Pain Patients Anytime Soon

By Crystal Lindell

This week, President Donald Trump signed an executive order that aims to reclassify cannabis as a less dangerous drug, but the move stopped short of making it federally legal.

The order directs Attorney General Pam Bondi to complete the process of reclassifying cannabis from an illegal Schedule I controlled substance to a Schedule III drug with lower abuse potential and accepted medical uses, in the same category as codeine and ketamine. President Biden started that process three years ago.

It’s important to note that moving cannabis to Schedule III will not legalize it for recreational use nationwide. And it will be up to the FDA to determine what an “accepted medical use” is for cannabis-based medicines.

The White House specifically mentioned chronic pain as one of the medical conditions that cannabis could help treat, noting that six in 10 people who use medical marijuana in the states where it is legal do so to manage pain.

"We have people begging for me to do this, people that are in great pain for decades," President Trump said. "I'm not gonna be taking it. But a lot of people do want it. A lot of people need it.

"The facts compel the federal government to recognize that marijuana can be legitimate in terms of medical applications when carefully administered. In some cases, this may include the use as a substitute for addictive and potentially lethal opioid painkillers. They cause tremendous problems. [Cannabis] can do it in a much lesser way. It can make people feel much better that are living through tremendous pain and problems." 

In addition to rescheduling, the Trump Administration is trying to expedite medical research so that CBD and hemp-based cannabis products can be legally sold nationwide. Those products are not FDA-approved, putting them in a legal limbo under federal law.

“In short, the current legal landscape leaves American patients and doctors without adequate guidance or product safeguards for CBD,” Trump said in a statement. “It is critical to close the gap between current medical marijuana and CBD use and medical knowledge of risks and benefits, including for specific populations and conditions.”

My hope is that pharmaceutical companies will finally be able to tap into cannabis’ full potential as a medical treatment and develop new drugs. Once they find the best ways to produce it, dose it, conduct clinical trials, and get FDA approval, then cannabis-based drugs could potentially help millions of pain patients. . 

Of course, that process could take years or perhaps even decades, so the odds are that many pain patients will remain reliant on CBD, hemp-based products, and marijuana dispensaries. That’s if cannabis is even legal in their state. 

Plus, whenever we do get pharmaceutical cannabis products, the next barrier will likely be price. Medical and recreational cannabis sold in dispensaries is more expensive than street supply, and I’m sure pharmaceutical companies will mark it up even more. But at least then it could be covered by insurance. 

Looking back, it seems obvious that cannabis should have never been classified as a Schedule I substance to begin with, as there are clearly multiple medical uses for it.

I am old enough to remember a time before any states had even legalized it, when the idea of it even being re-classified federally was a pipe dream.

I remember guys I knew in college in the early 2000s puffing away and going on and on about how one day marijuana would be legal. I would look at them with extreme skepticism. But as it turns out, they were basically right – at least in states like California and Colorado where recreational cannabis is legal. 

The Trump administration still has not made cannabis fully legal, but we are on track to see it happen.

Any time there’s a major change in the U.S. drug policy like this, it is worth noting how arbitrary much of it can be. Very little of it seems based on actual medical reasoning. It’s more about law enforcement and turning substances into villains.  

After all, if the stroke of a pen can move a drug from one controlled substances category to another — suddenly making them legal — perhaps the categories themselves are poorly designed. That logic follows when you see how the federal government handles things like opioids and kratom. You should not accept their reasoning at face value. 

We should all remain skeptical whenever the government tries to say any drug is inherently bad – especially when it tries to enforce such a classification with jail time and fines. Because clearly, their definition of “bad” and a medically-backed definition of “bad” are not the same thing.

‘Stop This Insanity’: Pain Patients Condemn DEA for Cutting Rx Opioid Supply Again

By Pat Anson

Thousands of people have left public comments in the Federal Register, most of them sharply critical of the Drug Enforcement Administration’s plan to reduce the supply of opioids and other Schedule II controlled substances in 2026.

If enacted without any changes, the DEA’s proposal would be the 10th consecutive year the agency has reduced aggregate production quotas (APQs) for manufacturers of opioid pain medication. 

The biggest cut next year would be in the supply of oxycodone – a reduction of 6.24% – a pain medication that is already in short supply, according to the American Society of Health-System Pharmacists.

“When cutting the production of this medication, you are harming millions of innocent victims, whose life has been taken from injury/illness and rely on pain medication daily to survive and have a quality of life,” wrote Charl Revelo. “We are not criminals. We are innocent pain patients.”

Revelo is one of over 5,000 people who left comments in the Federal Register – a hefty turnout, given that the DEA only allowed 15 days for comments, about half the usual comment period for quota proposals. December 15 was the last day public comments were accepted.

Over the past decade, DEA has reduced the supply of oxycodone and hydrocodone by over 70 percent –  citing a decline in “medical usage” and fewer requests from drug manufacturers. 

But “medical usage” does not reflect a decline in medical need. Chronic pain has actually risen in the U.S. and now affects about 60 million people, including 21 million with high-impact pain – pain strong enough to limit daily life and work activity.

Despite the increase in medical need, doctors are not writing as many prescriptions for opioids as they used to, in part because they fear investigations for “overprescribing” by the DEA and other law enforcement agencies. 

“Declining prescribing does not reflect declining need. It reflects restricted access, pharmacy shortages, and policies that have pushed patients off medically necessary treatment. These quota reductions will increase harm, not reduce it,” wrote a poster who preferred to be anonymous. 

“The current atmosphere of fear around prescribing of opioids is very likely to account for the apparent reduction in use. If doctors are afraid to prescribe these medications, that leads to a decrease in prescriptions,” wrote Jonathan Rogers. “This situation has led to chronic pain patients seeking other treatment, including kratom, methadone from clinics that are set up for addiction treatment and not pain management, and adulterated street opioids.”

“Please STOP reducing the amount of opioids. Pain patients are suffering & your actions - continuing to reduce opioid production year after year - is fueling the dangerous black market & putting Americans who are desperate for pain relief at great risk. It’s irresponsible & speaks to your motives,” wrote an anonymous poster.

“Do not reduce the production of opioids. They are a necessary medication to treat patients. The previous reductions, laws, lawsuits by anti-opioid persons, and incarcerations of medical providers is already causing so much suffering and death of pain patients,” said another anonymous poster. 

“This insanity with cutting back and ultimately doing away with opioids is criminal,” wrote Brooke Moon. “Please allow doctors to practice medicine and prescribe what they deem is necessary for the treatment of pain. The suffering of millions of innocent pain patients doesn't need to continue. Please stop this insanity!”

Missed Deadlines

Several posters pointed out the DEA has repeatedly missed a December 1 deadline in the Controlled Substances Act for setting annual production quotas. That puts a strain on drug manufacturers and contributes to shortages. 

“My mother recently died of cancer and was unable to get her pain medication and died in agony. That is on you,” wrote Peter Wilson, who suffers from chronic back pain.

“You need to get your annual quotas for medications before the deadlines expire. You need to do your job and make sure there are adequate quotas of legitimate pain medication for patients who desperately need it. Don't blame this on the pharmaceutical companies whose hands are tied by your inability to come up with reasonable quotas in the allotted time.”

Other posters support a proposal for the DEA to hire a Chief Pharmacy Officer (CPO) and put that person in charge of quota allotments. A CPO would be more familiar with the drug supply system and manufacturing deadlines.

“They should have a CPO because the DEA and DOJ can't seem to stay on track by themselves. They are allowed to miss the deadline, but in a normal person's world, you would be reprimanded for missing the deadline,” said an anonymous poster.

“The DEA definitely needs to hire a Chief Pharmacy Officer to take control of the quota disaster. DEA cites lack of staffing as one of the reasons it can not get the next year's quota in by December 1. Hiring a CPO would assure that the quotas are in by the deadline and that someone knowledgeable would make an informed, reasonable decision on the amounts,” wrote another anonymous poster. 

Even with a shortened public comment period, the production quotas for 2026 will likely not be finalized until after January 1. The last time production quotas were that late was in 2024, when the quotas were not published until January 3. Drug shortages spiked to record levels in the first few months of that year, including opioid pain medications covered under the quota system.

Rural Cancer Survivors More Likely to Have Chronic Pain

By Crystal Lindell

Rural cancer survivors are more likely to have chronic pain after cancer treatment than those who live in urban areas. And as a rural resident myself, I’m not surprised.

The findings are from a new study published in JAMA, led by Hyojin Choi, PhD.

Choi and her colleagues at the University of Vermont looked at over 5,500 U.S. adults with a cancer diagnosis in the last 5 years. The patients were then categorized as rural or urban residents, based on the population of counties where they lived. 

The study found a pretty striking difference between rural and urban cancer patients. Specifically, the prevalence of chronic pain was 43% among rural cancer survivors, compared to 33.5% among urban survivors.

The authors say the results suggest an association between chronic pain and the availability of pain specialists, survivorship resources, and insurance challenges accessing pain care in rural counties.

“Policymakers and health systems should work to close this gap by increasing the availability of pain management resources for rural cancer survivors. Approaches could include innovative payment models for integrative medicine in rural areas or supporting rural clinician access to pain specialists,” Choi wrote.

While the suggestions are well-intentioned, I’m not sure how practical or effective they would be. “Innovative payment models” sounds like they want rural patients to borrow money to pay for their healthcare. That’s not a true solution.

As someone who lives in rural Illinois and who has chronic pain, albeit not from cancer, I have some other thoughts on all this.

First, I want to note that I actually did live in an urban area when I first developed chronic pain in 2013. Within six months though, I made the decision to move in with family members who were living in a rural area, and I’ve been here ever since.

While, at the time, I was hoping to gain some much-needed emotional support by moving in with the family, the decision was largely driven by finances. I could no longer work the long hours and multiple jobs that it took for me to afford living in a more expensive urban area.

So, I suspect that a large part of why urban cancer survivors fare better than rural ones is that the rural cost of living is so much cheaper and thus it attacks people who have less money overall. The study, in fact, found that rural cancer survivors were nearly twice as likely to have household incomes below the federal poverty level than their urban counterparts (12% vs. 6.9%). 

We all know that more money gives access to better treatment. Of course, that doesn’t mean my rural area doesn’t have rich people. We definitely have rich people out here. But the next hurdle is the complete lack of providers near us. 

I personally drive about two hours each way to see my primary care doctor, because I want to get care at a university hospital and that is the closest option. A lot of other people who live near me also make that drive to the same university hospital system for the same reason.

However, even if you have money, and you can get care that far from home, having to drive such a long distance severely limits your healthcare treatments. It means that if you need a treatment that is required weekly, it either massively disrupts your life, or you just end up not doing it.

The easiest and cheapest way to treat pain is to send in a prescription for pain medication. That may not be the best way to address the pain long-term, but alternative treatments like physical therapy and massage are more of a hassle when you have to drive long distances to get them.

It’s also a lot more common to minimize both appointments and even emergency room visits when you know that doing either will require a lengthy drive. I assume that those tendencies also could contribute to post-cancer chronic pain.

My hope is that advances in treatment and technology solutions like virtual appointments will eventually help close the gap between rural and urban patients. Nobody should have to endure chronic pain simply because of where they live, but that is often the case.

I See Doctors All the Time, But They Won’t Treat My Pain

By Neen Monty

I am in complete overwhelm right now. It has been far too much, for far too long.

As I write this, in the last ten days alone, I’ve had seven medical appointments or treatments:

• Two GP visits.

• One neurologist appointment. And the news wasn’t great.

• My fortnightly IVIG infusion.

• A consult with a new pain management doctor. It did not go great.

• The introductory session for the public pain clinic. The first step in a very long process to see the doctor I was referred to.

• A psychologist appointment.

That’s seven appointments in ten days.

This is what being seriously ill looks like. This is what living with a disabling, incurable disease looks like.

I don’t choose for my life to revolve around my disease. The disease chooses. The disease dictates my schedule, my energy, my mobility, my ability to work, and my ability to participate in life.

When you’re very unwell, with a serious, progressive and incurable disease, there is no choice. You don’t get to opt out. You don’t get to think happy thoughts, and everything magically gets better.

You don’t get to postpone or not feel up to it today. You don’t get to decide what you do with your four functional hours a day. Your illness becomes the architect of everything.

People say, “Why don’t you try harder?”

Try what, exactly? Try not being sick? Thanks, that’s really helpful advice.

Instead of empathy, I get blamed.

You should change your diet. You should exercise more. You should get out more. You should try grounding. You should try Bowen therapy. You should read this great book I just read, it’s sooooo motivational!

You should read up on stoicism, it would help you be tougher. You should stop taking all those medications. Pharma makes customers, not cures, you know. Never mind that if I stop taking just one of my medications, I will die.

They are all saying, “You should try being not sick.”

The truth is that they don’t want to hear about it. It’s boring. And you’re exaggerating. You’re malingering. You’re not strong enough. You’re not positive enough. You are not enough.

Not one of these people has taken a moment to even consider what my life is really like. What it’s like to wake up sick and in terrible pain, every single day. Usually at around 3am.

That’s when my day starts. That’s when I start battling the pain. It’s truly a very difficult existence.

But instead of empathy and support, I get belittled. Dismissed. Treated as if pain — the most defining and disabling part of my disease — is somehow optional, psychological, or a personal and moral failing.

Something that I chose. Something I did wrong. Or something I didn’t do right.

Because people like to believe that everything happens for a reason. Spoiler: It doesn’t.

And that bad things don’t happen to good people. Spoiler: They do.

Doctors will treat the disease. But they refuse to treat the pain the disease causes.

And honestly, what’s the point? If you’re not going to treat the pain, how can you call yourself a doctor? How can you pick and choose what you will and won’t treat? And who you will and won’t help?

Pain is not my only disabling symptom. I have significant muscle weakness that is noticeably progressing.

I try to exercise, even though it usually makes things worse before it makes anything better. I hope it’s going to make me stronger long term. I don’t know that, but it’s my best hope. So I take my dogs on a slow jog and walk, and hope for the best. Always looking on the bright side.

Pain? It’s getting worse. No question. That’s disease progression. And maybe opioid tolerance in play.

But every doctor says the same thing: “You cannot have a higher opioid dose. No matter how bad the pain is.”

This isn’t medicine. It’s barbarism. It’s cruelty.

This is politics dressed up as healthcare. Policy made by people who are not doctors or scientists, and not interested in the terrible pain they cause. Yet they call it “evidence-based” and “best practice.”

These are rules made by people who will never experience what they’re inflicting. Because we know when doctors and politicians are in the hospital, they get opioids.

Just not us normal folk. The little people. We don’t matter, apparently.

Every week I talk to medical professionals, trying to understand why it’s like this. I don’t want to argue, I want to learn. Is this clinician bias I am looking at? Or is this what they’re all being taught?

Answer: It’s systemic. Doctors are being taught myths based on lies. And they don’t have time to check the science. If they did, they would be horrified at the patient harm they have caused and the lack of evidence for their decisions. But they’ll never check, so…

They have literally been trained to believe that education is more effective than opioid pain medication. How can any intelligent person believe that? It blows my mind.

They are taught that pain is “psychological” or caused by a “hypersensitive nervous system.” It has nothing to do with tissue damage, inflammation, disease or pathology.

Which is 100% wrong in every case.

We have a generation of clinicians who see pain not as a serious medical symptom, but as a faulty thought pattern. A cognitive glitch. A mindset problem.

Do you know what that belief system does? It erases empathy. Because why feel compassion for someone who is “catastrophising?” Why help someone whose pain is “in the brain,” which they can change themselves?

Why treat the suffering of someone who just needs to understand pain better?

I can always tell the exact moment a clinician realizes my pain is pathological and that their program, book, or brain training technique won’t work on me.

It’s like a curtain drops. Their interest vanishes. Their warmth evaporates. They stop asking questions. They stop seeing me as anything other than a problem.

Only one person in the last fortnight showed actual empathy — the sort of basic human response that should be universal when you have a severe, progressive, incurable, and painful disease. Every human being should be able to say, at the very least, “I’m so sorry you’re dealing with that.”

But only one did. I spoke to two physical therapists and one GP on social media. Asking them questions, hoping to learn. I answered their questions, but they didn’t answer mine. And as soon as they realized I would be of no use to them, they ghosted me.

Only one took the time to say, “I’m so sorry this has happened to you.”

My story is terrible. I have been abandoned, ignored, demonized, stigmatized, misdiagnosed and refused the most basic care. Any normal human being should be horrified by my story and the reality of my life. Of the pain I am forced to endure.

But only one showed me any empathy at all.

Mostly what I get is coldness. Defensiveness. Blank stares. Silence.

Not my problem-ism.

These are the people we rely on. The people who decide whether we get treatment, whether we get relief, whether we get to have any quality of life at all.

My life is not my own. I am not choosing this. No one would.

I’m trying to survive a body that is failing me and a system that refuses to see what pain really is — a physical experience rooted in biology, pathology and disease, that is sometimes influenced by psychological and sociological factors.

Not a mindset. Not a belief. Not a psychological construct.

The hardest part of being sick isn’t the disease. It’s fighting for your life while the system fights against you.

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

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

Medical Assistance in Dying: When Is Enough, Enough?

By Ann Marie Gaudon

Google AI defines the phrase "enough is enough" as a personal judgment that continued effort or tolerance is no longer beneficial or sustainable. When you are trying to fix a problem and you've exhausted all reasonable options, it's a signal that you need to let go and move on. 

If only we knew where moving on is meant to be.

If you’ve been following along, you will know I have lost a few friends to Medical Assistance in Dying (MAiD) here in Canada. I have written about Maggie and Melissa,who both ended their lives after struggling for years to meet MAiD’s requirements, which include having an “irrevocable and grievous medical diagnosis” that could not be cured or treated.

Some people call it “assisted suicide.” I don’t particularly like that term, only because the word “suicide” itself comes with centuries of baggage.

It’s Canadian law that an individual may not have a foreseeable death. However, if they are suffering to an extent that they choose to die, then they can access the MAiD option – what is supposed to be a peaceful, dignified death. 

It’s not as easy as the law sounds. Maggie’s choice took well over two years and only happened because her medical practitioner pushed for it. For Melissa, it never came first or last. My heart ached for her. Just because you are qualified to receive MAiD, doesn’t mean that you’re going to get it – and that frightens me.

Physically, things are not going well for me lately. What if I’m ready to leave this earthly body and no one will help me do it peacefully? 

You might already know that I am an advocate for personal choice in dying. That means a person’s right to choose for themselves only. But how does one even make this decision? When is enough, enough? 

I would think that relief of suffering is the most important factor in the decision to access MAiD. If you are actually dying, MAiD will provide you with a very peaceful and humane death. 

But I don’t think this is fair to a person living with pain who is not dying, but is suffering too much to cope or have any meaningful quality of life. 

I don’t think there should be a difference, however there is. There is a great reluctance for the MAiD doctors to provide assistance in dying to a person in pain. There’s a tendency instead to diagnose them with a mental illness — which then disqualifies them for MAiD.

A lack of support would surely be another factor in the decision for or against MAiD. I am eternally grateful for my inner circle and their support. Even if they hated the idea of MAiD for me (which they would), I would still receive their support if I was very certain I wanted to end my suffering forever. Unconditional love is what it’s all about.

Speaking about loved ones, I now have another one that has changed everything for me: a grandchild. He is nine months old as I write this and a ball of love and sunshine all rolled into one. How could anyone not want to see him grow? Be a part of his life? Be a beloved grandparent? 

I sit here crying as I write this to you. I can’t speak for others, but this grandchild has changed everything about how I feel regarding my own death – that is, if I even have a choice in the matter. Unknowingly, he has taken the priority off of myself as a candidate for MAiD and become the priority.

I think I’m asking a question that there is no answer to, at least cognitively. Perhaps enough is enough when you feel it. Even if you don’t have the language to explain it, maybe it is a feeling? 

Our minds have evolved to be great problem-solving machines, but what if the problem cannot be solved? It’s a conundrum. My chronic pain and illness cannot be solved, and with each passing year I feel physically worse than the year before.

That does not equate, however, to feeling emotionally worse. That is not my case. Perhaps my age has allowed me to give up a lot of the emotional struggle and grab a handful of happiness whenever I can. I can laugh easily and heartily at the healthy moments of life, yet my body is breaking beneath me. What does one do with this scenario?

For one, I am not convinced that although I legally qualify for MAiD, that it would actually be completed. For two, now with a grandchild in the mix, everything has been upended for me. 

What I thought I would do is now what I don’t want to do. The big problem is my body is breaking beneath me. I have acquired a world of coping skills, but they do not work when the pain is severe. 

How long do I suffer because I can’t bear to leave others? There is no answer for this and I damned well know it.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.   

Many Older Americans With Disabilities Resist Being Called ‘Disabled’

By Paula Span, KFF Health News

In her house in Ypsilanti, Michigan, Barbara Meade said, “there are walkers and wheelchairs and oxygen and cannulas all over the place.”

Barbara, 82, has chronic obstructive pulmonary disease, so a portable oxygen tank accompanies her everywhere. Spinal stenosis limits her mobility, necessitating the walkers and wheelchairs and considerable help from her husband, Dennis, who serves as her primary caregiver.

“I know I need hearing aids,” Barbara added. “My hearing is horrible.” She acquired a pair a few years ago but rarely uses them.

Dennis Meade, 86, is more mobile, despite arthritis pain in one knee, but contends with his own hearing problems. Similarly dissatisfied with the hearing aids he once bought, he said, “I just got to the point where I say, ‘Talk louder.’”

But if you ask either of them a question included on a recent University of Michigan survey — “Do you identify as having a disability?” — the Meades answer promptly: No, they don’t.

Disability “means you can’t do things,” Dennis said. “As long as you can work with it and it’s not affecting your life that much, you don’t consider yourself disabled.”

Their daughter Michelle Meade, a rehabilitation psychologist and the director of the Center for Disability Health and Wellness at the university, accompanies her parents to medical appointments and tends to roll her eyes at their reluctance to acknowledge needing support.

Working with other researchers on the recent national poll has shown her how often older adults feel that they are not disabled despite ample evidence to the contrary.

The survey looked at nearly 3,000 Americans aged 50 and older and found that only a minority — fewer than 18% of participants over 65 — saw themselves as having a disability.

Yet their responses to the six questions that the Census Bureau’s American Community Survey uses to track disability rates told a different story.

The survey asks whether respondents have difficulty seeing or hearing, limitations in walking or climbing stairs, difficulty concentrating or remembering, trouble dressing or bathing, difficulty working, or problems leaving the home.

In the university’s survey, about a third of those aged 65 to 74 reported difficulty with one or more of those functions. Among those over 75, the figure was more than 44%.

Moreover, when respondents were asked about several additional health conditions that would require accommodations under the Americans With Disabilities Act, including respiratory problems or speech disorders, the proportion climbed even higher. Half the 65-to-74 group reported disabilities, as did about two-thirds of those over 75.

Yet only a sliver — fewer than 1 in 5 — of older adults had ever received an accommodation from their health care providers to which they are legally entitled under the ADA.

Even among the small minority who identified as disabled, only a quarter had asked for an accommodation (though a third received one, whether they asked or not)

“It’s a familiar story,” said Megan Morris, a rehabilitation researcher at NYU Langone Health and director of the Disability Equity Collaborative. When it comes to the way people describe themselves, “many people still feel like ‘disability’ is a dirty word,” she said.

‘Toughen Up and Battle Through It’

It’s almost an American value to decline to seek help, even when the law requires that it be available, Michelle Meade added. Faced with a disability, she said, “we’re supposed to toughen up and battle through it.”

That may be particularly true among older Americans whose attitudes formed before the landmark ADA became law in 1990, or even before the 50-year-old Individuals With Disabilities Education Act, which guaranteed access to public education.

“It’s going to be hard for that older generation,” Morris said. “Disability was something that was locked away. Younger folks are more open to seeing disability as being part of a community.”

In the University of Michigan survey, for instance, among people over 65 who had two or more disabilities, about half identified as a person with a disability. In the younger cohort, aged 50 to 64, it was 68%.

Why does that matter? “It greatly assists in health care settings if you disclose a disability and know to request an accommodation and support,” said Anjali Forber-Pratt, the research director at the American Association of Health and Disability.

Such accommodations “can make a stressful situation easier,” she added. They include mammography and X-ray machines that allow patients to remain seated, scales that wheelchair users can roll onto, examination tables that rise and lower so that patients don’t have to step onto a footstool and swivel around.

Health care providers may also offer amplification devices for people with hearing loss, as well as magnifiers and large print materials for the visually impaired. Buildings themselves must be accessible. Practices can send a staff member with a wheelchair to help patients traverse long distances.

Even with a disability parking placard, “you hike in, you wait for the elevator, you hike to the office,” said Emmie Poling, 75, a retired teacher in Menlo Park, California.

Because of arthritis and spinal stenosis, “I can’t walk with an upright posture for more than a few minutes” without pain, she said. “I basically live on Tylenol.” Yet when she makes an appointment and the scheduler asks if she will need assistance, Poling replies that she won’t.

“My personal voice says, ‘Come on, you can do it,’” she said.

Identifying as a person with a disability provides other benefits, advocates say. It can mean avoiding isolation and “being part of a community of people who are good problem-solvers, who figure things out and work in partnership to do things better,” Meade said.

Government programs and private organizations like the National Disability Rights Network, the Americans with Disabilities Act National Network, and the National Association of Councils on Developmental Disabilities help connect people with services and support in their communities.

Several studies have found, too, that patients who identify as disabled have less depression and anxiety, higher self-esteem, and a greater sense of “self-efficacy” than disabled people who don’t.

For years, despite a lifetime of surgeries for congenitally dislocated hips, as well as joint replacements and cancer treatment, Glenna Mills, an artist in Oakland, California, told herself that she was not disabled.

“I suffered a lot by denying that I couldn’t walk very far,” she recalled. Although walking caused pain in her knees, hips, and shoulders, “I didn’t want people to see me as someone who couldn’t keep up,” she added.

But about 10 years ago, “I stopped worrying about that,” said Mills, 82. “I was more willing to say, ‘I can’t do that activity. I can’t walk that far.’” She bought a scooter that allowed her to take walks with her husband and dog, and to spend time in museums. “I’m happier now,” she said.

More often, older Americans resist a label that could help improve their care. Even those who do request accommodations may find that enforcement of the ADA remains spotty, in part because patients don’t always report violations.

The Meades, after years of pleading from their children, have made appointments to see an audiologist about new hearing aids.

But Poling intends to struggle on without seeking or accepting assistance. “I know that point will come,” she said. “I’ll attempt to surrender as gracefully as possible, given my personality.”

Until then, she said, “the mental picture that’s acceptable to me is not wanting to look like I’m disabled.”

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

Most Americans Want Federal Government to Ensure Healthcare Coverage

By Crystal Lindell

Two-thirds of Americans (66%) say the federal government has a responsibility to make sure everyone has healthcare coverage. That’s according to a new Pew Research Center survey of over 10,000 U.S. adults conducted last month.

While these views are essentially unchanged over the last year, they are somewhat higher than they were in 2021, when 62% of Americans said the government has a responsibility to make sure everyone is covered by health insurance. 

Pew said the increase is primarily due to more Republicans (42%) supporting the idea. However, they are outnumbered by Republicans and Republican-leaning independents who believe the federal government has no business ensuring healthcare coverage for anyone (59%).

In contrast, a solid majority of Democrats and Democratic-leaning independents (90%) say the government has a responsibility to ensure coverage. 

While there is broad support for healthcare coverage overall, Americans disagree on how that should be achieved.

Over a third (35%) favor a single national government program, while 31% say insurance should be provided through a mix of government and private programs.

About one in four adults (26%) say government coverage should only be provided through Medicare and Medicaid, and 7% believe there should be no government involvement of any kind.

PEW RESEARCH CENTER

Adults in lower-income households are significantly more likely to support federal involvement, regardless of political affiliation. Sixty percent of Republicans with lower incomes favor a government-run program of some kind. That includes 27% who say it should be done through a single national insurance program.

Meanwhile, large majorities of Democrats at all income levels say the federal government is responsible for ensuring everyone has health coverage. 

Among racial groups, 85% of black people favor government-run coverage, followed by Asians (78%), Hispanics (75%) and white people (59%). 

Younger people are more likely to believe the government has a responsibility to provide healthcare coverage. Specifically, 74% of 18-29 year olds said this, followed by 67% of 30-49 year olds; 63% of 50-64 year olds; and 62% of those over 65. 

While a large majority of Americans believe the federal government should play a role in providing insurance to everyone, the political appetite for such a move is not supported in Congress or by the Trump Administration.

This week, the U.S. Senate voted down two competing proposals. One, supported by Democrats, would have extended the Obamacare subsidies without any strings attached. The other proposal, backed by Republicans, would have continued some subsidies, provided the money could not be used for abortion or gender-transition procedures.

The White House, meanwhile, is working on its own plan to give money directly to people so they can buy their own health insurance. But few specifics have been made public.

Barring any last minute breakthroughs, 24 million Americans will face significantly higher insurance premiums on January 1, when federal subsidies for the Affordable Care Act end.

A Doctor’s Appointment Can Feel Like Criminal Court for Pain Patients

By Crystal Lindell

This week I had an appointment where I was worried that I would have to submit to a urine drug test. And if anything went wrong, it could ruin my life.

It wasn’t a criminal court date or a meeting with a probation officer. It was with my doctor.

Every six months, I have to see the doctor who prescribes my opioid pain medication for a check-in. I’m actually very lucky that I only have to see him twice a year, because many patients are required to go in much more frequently.

But those two appointments each year cause me so much stress that I have trouble functioning. There is always the fear that if something doesn’t go according to plan, my opioid prescriptions could be cut off. And when a doctor has that much power over you, it’s rational to worry about how things will go.

So, in the weeks leading up to the appointment, I stress about everything that could go wrong.

Chief among my worries is that I haven’t had health insurance since 2022, so now a lot of my previous medical bills are in collections. Mind you, even when I had insurance, a lot of my medical bills went to a collections agency because, between co-pays and deductibles, the bills were in the thousands of dollars.

I always worry that this be the visit when my doctor finally cuts me off from care because of unpaid bills. Or maybe it will be the front-desk receptionist who confronts me about the overdue bills. What do I do if they refuse to see me as a patient because I am late paying? While it’s a decision that would fully be within their rights, it would ruin my life.

I have good reason to fear this. In 2008, I got an HPV vaccine from a doctor, and the shot came with a $150 co-pay. I had just finished paying thousands of dollars in medical bills for my gall bladder removal surgery, so I was having trouble paying for the vaccine.

And then, out of the blue, I got a letter from that doctor’s office saying that they were cutting off my care because of the unpaid bill. And I was no longer allowed to get care at any of the doctors in that hospital system.

I was shocked and sad, and also thankful that I was moving out of the area soon. But the experience scared me and left me constantly worried that even small unpaid medical bills could result in a doctor abandoning me.

Money isn’t the only stress factor when it comes to these appointments. There is also the chance of a urine drug test going wrong. While my doctor has not ordered one in a while, it’s always a possibility.

Now, you might assume that since I take my medications as prescribed, there should be nothing to worry about when it comes to peeing in a cup. But if anything does go wrong, I could lose access to the medications that I need to function. Like if there’s a false result on the screening, which happens more often than you might think.

So, I stress.

A lot of people assume that drug tests only look for non-prescribed or illicit substances. That what they are really looking for is cocaine and heroin. But the tests go far beyond that, and they are constantly adding substances to check for. While they have never tested for kratom in the past, I have no idea if it will suddenly be added to the screening, and what would happen if I tested positive for it.

The real reason most doctors order drug tests is they want to make sure you are taking your opioid medication as prescribed. If the medication isn’t found in your urine, that means you might be selling or diverting it. 

Again, not a problem for me. But still, the act of being forced to pee in a cup for the sole purpose of policing my compliance with the doctor is always going to feel punitive.

All of these worries are rolling around in my brain when the day of the appointment arrives. I have to wake up earlier than normal to shower and make the drive to the doctor’s office. It’s almost two hours each way because he works at the closest university hospital, and my complex medical needs require more than a local primary care doctor can handle.

My body hates waking up early, and my chronic pain often flares up in rebellion if I don’t get enough sleep. So, I have to ease into functioning while waiting for my pain medication to kick in.

All of this stress is compounded by the fact that on the day of this particular appointment it was snowing, with a mix of rain and sleet hitting the ground in just the right way to make all the roads extremely icy.

I knew this was going to make driving difficult, but I also knew that if I canceled my appointment, I risked not being able to get my next pain medication refill. So I prepared myself for an extremely treacherous drive and planned to leave a full hour early

Before I was set to leave, my fiancé went to the local Casey’s gas station to fill up the car for me. When he came back he sounded like he had been to war: “You can’t drive to your appointment in this weather! People were literally spinning out in the Casey’s parking lot!”

Ugh. Fine. I decided to suck it up and call my doctor’s office to see what my options were because I knew the weather was too bad to drive.

I assumed that I would need to completely reschedule, because he’s usually booked out for months. But when I called, the receptionist said that in the notes my doctor had said that I could do the appointment virtually if needed.

I once heard that wearing different colored socks brings good luck, and thus I have done this many times throughout my life on stressful days. And this time, it actually worked!

I was able to do a very easy telehealth call, from the comfort of my own home! Everything went extremely well. He told me that he had seen the weather, and that I had made the right call to stay off the roads that day. I had spent all that time stressing for nothing. 

But it shouldn’t take a pair of mismatched socks to get compassionate care. Millions of chronic pain patients are constantly stuck navigating these types of appointments because of the war on opioids. Unfortunately, many of them end up living the things that I feared. 

Of course, in six months’ time, I will have to go to his office again, and I’m sure I’ll go through all the same stress before that appointment too. Hopefully by then I’ll have some sort of health insurance, and ideally it will be a clear summer day..

Until then, I’m just happy that my doctor decided to rule in my favor. In an ideal world, a doctor’s appointment shouldn’t feel like a verdict.

Mixed Findings on Effectiveness of Medical Cannabis

By Pat Anson

Some new studies are muddying the water even more on whether medical cannabis is an effective treatment for pain, anxiety, insomnia and other health conditions. 

The first study, a JAMA review of over 120 clinical trials, medical guidelines and meta-analyses (studies of studies), found that there is not enough scientific evidence to support most of the conditions that cannabis is commonly used to treat.

Over one in four (27%) adults in the United State and Canada have used cannabis for medical purposes. And over 10% of people in the U.S. have used products containing cannabidiol (CBD) for therapeutic purposes.

But researchers say that widespread use is driven more by perceptions, anecdotes and promotion than it is by scientific evidence.

"While many people turn to cannabis seeking relief, our review highlights significant gaps between public perception and scientific evidence regarding its effectiveness for most medical conditions," says lead author Michael Hsu, MD, a psychiatrist and health researcher at UCLA Health. “Patients deserve honest conversations about what the science does and doesn't tell us about medical cannabis.”

Hsu and his colleagues found that FDA-approved cannabis-based medications, such as dronabinol and nabilone, are effective for HIV/AIDS-related appetite loss, chemotherapy-induced nausea, and pediatric seizure disorders such as Dravet syndrome and Lennox-Gastaut syndrome.

But for most other conditions, the evidence remains either inconclusive or lacking. Over half of medical cannabis users take it for chronic pain, but current medical guidelines recommend against cannabis as a first-line treatment for either chronic or short-term acute pain.

The researchers also highlighted the potential health risks of cannabis. High-potency cannabis containing over 10% THC has been linked to higher rates of psychotic symptoms and anxiety disorder. Daily use of cannabis, particularly of inhaled or high-potency products, is also associated with higher rates of coronary heart disease, heart attack and stroke compared to non-daily use.

About 29% of people who use medical cannabis also met the criteria for cannabis use disorder.

The review emphasizes that doctors should screen patients for cardiovascular disease and psychotic disorders, and evaluate them for potential drug interactions, before recommending THC-containing products for medical purposes.

Medical Cannabis Reduces Opioid Use

But another study, published in JAMA Internal Medicine, suggests that medical cannabis is an effective treatment for chronic pain because it reduces the use of prescription opioids.

Researchers at Albert Einstein College of Medicine and Montefiore Health System evaluated 204 adults in New York State’s Medical Cannabis Program who were prescribed opioids for chronic pain between 2018 and 2023.  

At the start of the study, most participants reported high levels of pain (an average of 6.6 on the zero to 10 pain scale) and were taking an average daily dose of 73.3 morphine milligram equivalents (MME). By the end of the 18-month study, the average daily dose fell to 57 MME, a 22% reduction.

“Our findings indicate that medical cannabis, when dispensed through a pharmacist-supervised system, can relieve chronic pain while also meaningfully reducing patients’ reliance on prescription opioids,” said lead author Deepika Slawek, MD, an associate professor of medicine at Einstein, and an internal medicine and addiction medicine specialist at Montefiore. 

The reduced use of opioids suggests that chronic pain sufferers can be slowly weaned off opioids with medical cannabis. For example, participants who received a 30-day supply of medical cannabis reduced their opioid use by an average of 3.5 MME compared to non-users.

“Those changes may seem small, but gradual reductions in opioid use are safer and more sustainable for people managing chronic pain than stopping suddenly,” said Slawek.

Since the study occurred during a time period when opioid prescribing overall fell by nearly 50% in the United States, we asked Dr. Slawek if that could have influenced the findings. She said researchers adjusted their modeling data to account for that as best they could.

“The only way that we will be able to get definitive answers on whether medical cannabis reduces opioid use is to conduct randomized trials, which are very difficult to do in the U.S. specific to cannabis,” Slawek told PNN in an email. “We believe that by using causal inference modeling in this study, we were able to add the highest quality evidence possible that cannabis may reduce opioid use in patients with chronic pain.” 

The scientific data for medical cannabis is improving. According to an analysis by the National Organization for the Reform of Marijuana Laws (NORML), the number of cannabis research studies grew for the fifth consecutive year, with over 4,000 scientific papers involving cannabis published so far in 2025.

“Despite the perception that marijuana has yet to be subject to adequate scientific scrutiny, scientists’ interest in studying cannabis has increased exponentially in the past decade, as has our understanding of the plant, its active constituents, their mechanisms of action, and their effects on both the user and upon society,” said NORML Deputy Director Paul Armentano. 

“It is time for politicians and others to stop assessing cannabis through the lens of ‘what we don’t know’ and instead start engaging in evidence-based discussions about marijuana and marijuana reform policies that are indicative of all that we do know.”

According to NORML’s analysis, over 37,000 scientific papers about cannabis have been published since 2015. That means over 70% percent of all peer-reviewed scientific papers about cannabis have been published in the past ten years alone.    

The studies are growing and so is the anecdotal evidence. A recent survey of 1,669 medical cannabis users in the UK found that nearly 89% of those with chronic pain reported somewhat improved or significantly improved quality of life.

Is the Vagus Getting On Your Nerves?

By Madora Pennington 

After writing about a nerve stimulation implant approved by the FDA to treat rheumatoid arthritis by targeting the vagus nerve, I just had to try neuromodulation myself.

While my condition is a genetic disorder, not autoimmune, there is a lot going wrong with me. Could a vagus nerve stimulator help me?

Neuromodulation devices send electrical pulses to nerves to alter their activity. These signals can inhibit pain, seizures or tremors. They can also stimulate neural impulses when they are deficient or absent, inducing positive changes in the body.

Luckily, many manufacturers are making non-invasive vagus nerve simulators that are available without a prescription, so I did not have to get anything surgically implanted. The devices send energy through the skin at points on the neck or ear, where the vagus nerve isn’t deep inside the body.

The vagus nerve is the longest nerve we have – originating inside the skull and traveling down through the neck, chest and abdomen. It interacts with many organs and the immune system, and carries important information back to the brain.

Signs that your vagus nerve may be underperforming include:

• digestive problems

• difficulty swallowing

• dizziness or lightheadedness

• fainting

• slow recovery from illness or injury

• anxiety

• depression

• poor emotional regulation

• chronic fatigue or low energy

• migraines

• insomnia

I have Ehlers-Danlos Syndrome (EDS), an inherited collagen defect. EDS is considered a “high-burden” disease as it causes many debilitating symptoms that can be near impossible to alleviate.

The hallmark of EDS is unstable joints that bend backwards, but most of us who have it have many of the problems listed above. Could this be a sign of the vagus nerve not functioning correctly?

To find out for myself, I evaluated a number of devices. The good news is that most companies that sell vagus nerve stimulators offer a trial period during which the purchase can be returned for a refund, so you can see if it works for you.

I bought the Hoolest VeRelief Prime, a handheld device that sells for $199, because it does not run through a phone app. I spend more time than I want looking at my phone already, plus I did not want to be stuck paying for an app just to use an expensive item that I already purchased. 

I also liked how compact the VeRelief Prime is. There are no wires or extraneous parts, no screens, just buttons.

Founder Nick Hool told me his interest in calming the nervous system started when he developed severe performance anxiety as a high school golfer. 

“People told me just relax, breathe, do positive affirmations, go for a walk, all the stuff that is suggested for bad anxiety,” he said. “Those are good daily practices for general well-being, but they don't work on someone who's having a nervous system breakdown. You can't think your way out of a paralyzing fight or flight response."

I have to say, I agree. Various relaxation techniques can be soothing, as long as I don't need too much soothing.

In working on his PhD in biomedical engineering, Hool researched and tried vagus nerve stimulators on himself and learned they don’t usually work right away. 

“You don't feel immediately better after one session,” said Hool, who recommends using a stimulator daily for at least six weeks to strengthen the vagus nerve and get results. Less frequent use will then maintain the improvements.

I, however, felt better immediately, and was in a calmer and brighter mood. The reduced stress and improved resilience continued to build as I used the device over weeks and then months.

Shortly after I got the VeRelief device, I took a cross-country trip. I'm not a great traveler, even though I want to be. Time changes, different beds, jet lag, lugging my luggage, and sensory overload all can be pretty aggravating. On top of that, sitting still on a plane for hours irritates my back. I usually come home miserable.

As I flew back on a late-night, crowded, delayed plane that hadn’t been cleaned, after a week of exhausting tourist activities, I was, much to my surprise, just fine. I discreetly took out my little device and held it against my neck when I began to feel discomfort.

Since then, I don't hesitate to bring the stimulator with me when I know I will encounter a troublesome environment, such as pain triggers, bright fluorescent lights, and difficult people. If other people ask, I tell them it's to prevent migraines. 

The device is small and silent. No one seems to mind. I even use it during psychotherapy. It seems to help me process uncomfortable topics quickly.

DEA Missed Deadline for Opioid Production Quotas. Will It Worsen Shortages?

By Pat Anson

In recent years, hundreds of physicians have been prosecuted by the U.S. Justice Department for violations of the Controlled Substances Act (CSA).

In many cases, the doctors were accused of prescribing opioid pain medication without “a legitimate medical purpose” – a vague term in the CSA that was meant to prevent drug abuse, but in practice put the DOJ in charge of deciding whether healthcare decisions involving controlled substances are legal. 

The CSA is rigidly enforced when federal prosecutors believe opioids are prescribed excessively. But when it comes to enforcing another provision in the CSA, the DOJ and Drug Enforcement Administration have routinely ignored deadlines for setting aggregate production quotas (APQs) for opioids and other Schedule I and II controlled substances:

“On or before December 1 of each year, upon application therefor by a registered manufacturer, the Attorney General shall fix a manufacturing quota for the basic classes of controlled substances in schedules I and II.”

The December 1 deadline is important because it gives the pharmaceutical industry a small window to prepare for the coming year by acquiring raw materials for drugs, setting manufacturing schedules, and distributing medications to hospitals and pharmacies – a process that can take as long as six months. . 

But Attorney General Pam Bondi and acting DEA Administrator Terry Cole didn't publish their proposed quotas for 2026 in the Federal Register until November 28, which call for a 6% cut in the supply of oxycodone.

Allowing for a shortened public comment period that ends December 15, and time to review thousands of comments and make changes in the quota allotments, that means the final APQs for next year will likely not be ready until after January 1.

The last time production quotas were that late was in 2024, when the final APQs were not published until January 3. Drug shortages spiked to record levels in the first few months of that year, including many medications that are covered under the quota system. 

Missing the deadline again this year threatens to worsen chronic shortages of oxycodone, hydrocodone, fentanyl, hydromorphone, morphine and amphetamine-based stimulants that are vital to millions of patients who live with pain or attention deficit disorder (ADHD).

The DOJ and DEA did not respond to multiple requests from PNN to explain why the CSA deadline was missed again.

This is not a new problem. Late quotas and drug shortages have persisted for years, as the DOJ and DEA have focused on going after doctors who prescribe opioids – at times using “flimsy evidence” – rather than ensuring that essential medications are available on time. 

That mindset of being a law enforcement agency first – with maintaining the drug supply an afterthought – may have cost some patients their lives. 

“We talk a lot about opioid misuse, but almost never about the quiet suffering caused when essential pain medicines simply aren't available,” says Lynn Webster, MD, a pain management expert and former president of the American Academy of Pain Medicine. “Chronic delay and rigidity in quota decisions make patients with serious illness feel like collateral damage in a war on drugs that has lost sight of its humanitarian obligations.

“Quotas were meant to curb diversion, not to create a permanent state of scarcity for people in pain. By keeping quotas tight and decisions late, the DEA has turned an already fragile supply chain into a game of musical chairs where patients lose their seats.”

Late Quotas Worsened Drug Shortages

As far back as 2015, the General Accountability Office (GAO) warned in an audit report that the DEA “has not effectively administered the quota process.” Although a decade old, many of the problems cited by the GAO still exist today.

“Each year, manufacturers apply to DEA for quota needed to make their drugs. DEA, however, has not responded to them within the time frames required by its regulations for any year from 2001 through 2014,” the GAO said.

“Manufacturers who reported quota-related shortages cited late quota decisions as causing or exacerbating shortages of their drugs.”

The report found that drugs containing Schedule II controlled substances accounted for over half the shortages between 2001 and 2013. Several manufacturers complained to the FDA the shortages were caused by the DEA’s mishandling of the quota system.

But the DEA denied any responsibility for the shortages, while blaming the missed deadlines on  “inadequate staffing” and an “increasing workload” in its Quota Unit.

“DEA is confident that its administration of the quota process did not affect a shortage during the period of review because drug product shortages are not limited to products that contain Schedule II controlled. substances,” Joseph Rannazzisi, then-DEA Deputy Assistant Administrator, wrote in the agency’s response to the GAO report.

Rannazzisi would later emerge as a “whistleblower” on 60 Minutes, who blamed the opioid crisis on lax policies at the FDA that favored that drug industry.

The relationship between DEA and FDA, at least in 2015, was not one of trust. The FDA advised the DEA about medical demand for Schedule II drugs and any shortages that may exist, but the DEA didn’t always listen.

“DEA and FDA are not able to effectively collaborate due to fundamental disagreement over whether any given shortage exists. DEA has made it clear it does not trust FDA’s information, as it does not consider many of the shortages that FDA verifies to be legitimate,” the GAO said. “They do not believe FDA appropriately validates or investigates the shortages.” 

The GAO concluded that problems in DEA’s Quota Unit run deeper than any petty rivalries with the FDA. 

“Our work shows that DEA’s lack of internal controls, such as controls to ensure data reliability, performance measures, and monitoring of performance, may hinder the agency’s ability to ensure an adequate and uninterrupted supply of controlled substances,” the 2015 report found. “This approach to the management of an important process is untenable and poses a risk to public health.”

New Deadline

The GAO’s critique came at a time when the DEA’s deadline for final APQs was October 1 – a deadline the agency consistently failed to meet. 

To buy itself more time to work on quotas, the DEA lobbied Congress to change the annual deadline to December 1 in the 2018 Support Act, a bill intended to reduce opioid diversion. The DEA also reduced the amount of inventory drug manufacturers are allowed to keep of controlled substances, and agreed to base its quotas on dosages, not the raw supply of drugs.

How has that worked out? Poorly.

The DEA has not only been unable to meet the December 1 deadline, but the smaller inventories have worsened the ability of drug manufacturers to respond to late quotas and emerging drug shortages. 

The pharmaceutical industry warned the DEA that reducing inventories would only worsen shortages and do little to prevent diversion.

“We believe that risks associated with this proposal, including the increased likelihood for drug shortages and market outages, greatly outweigh the negligible benefit this provision will provide,” Larry Cote, an attorney representing a drug manufacturer, wrote to the agency in 2019.

“Given the timing of procurement quota issuance, it will become more imperative to carry increased levels of inventory at year end in order to ensure continued drug supply, as opposed to decreased levels.”

The DEA ignored those warnings and reduced inventories anyway. As a result, analgesic medications needed for surgery and post-op care, such as injectable fentanyl and hydromorphone, have been on the FDA shortage list for years, in part due to low inventories. The two drugs are rarely diverted.

‘Vulnerable to Supply Shocks’

Two pharmacists recently criticized the DEA for its “outdated system” for APQs.

“The current one-size-fits-all system for setting APQs is ineffective and Congress recognized this back in 2018, passing the SUPPORT Act to modernize the APQ setting process and require quota allocations based on dosage form. Yet seven years later, the DEA has failed to implement this law, leaving manufacturers constrained, patients underserved, and the nation vulnerable to supply shocks,” Soumi Saha, PharmD, and Justin Schneider, PharmD, wrote in a recent op/ed published in the Pharmacy Times.   

Saha and Schneider believe many of the quota problems could be addressed if the DEA were to hire a Chief Pharmacy Officer who is familiar with the drug supply system and is put in charge of the quota system.

“It is time to elevate the agency’s clinical responsibility by establishing a Chief Pharmacy Officer (CPO) within the DEA - a role dedicated to ensuring that patient access is not an afterthought, but a core priority,” they said. “A strong CPO would not only modernize quota systems but also bring agility, accountability and patient advocacy to the heart of DEA decision-making.”

To be clear, the DEA is not solely at fault for persistent shortages of opioids and other controlled substances. A 2021 opioid litigation settlement with three drug distributors essentially rationed the supply of opioids at many pharmacies and made pharmacists even more wary of filling new prescriptions. 

In a 2023 PNN survey of over 2,800 patients, 90% said they experienced delays or problems getting their opioid prescriptions filled, mostly because their pharmacy was out of stock. Nearly one in five were unable to get their pain medication, even after contacting multiple pharmacies.

Some generic drug manufacturers have stopped making opioids because of low profit margins and because of concerns they could be targeted by plaintiff law firms in opioid lawsuits that could cost them billions of dollars. 

Bad weather and a heavy reliance on foreign drug manufacturers have also made the supply chain less reliable and contributed to shortages.  

But the DEA’s chronic failure to meet quota deadlines – a problem dating back decades – and its slow-walking of efforts at reforming the quota system, have made a fragile drug supply chain even more vulnerable to disruptions. And it is patients who pay the ultimate price for the DEA’s negligence.

“When DEA repeatedly misses its own deadlines for setting opioid production quotas, that uncertainty reverberates all the way to the bedside,” says Dr. Webster. “Manufacturers pull back, pharmacies ration, and it's the patients – people with cancer, sickle cell disease, or severe chronic pain – who are left wondering if their next prescription will even be filled.” 

Should the DEA hire a Chief Pharmacy Officer? Should deciding what is or isn’t “a legitimate medical purpose” be left to the DEA and DOJ? Only a few days are left to comment on the DEA’s proposed APQs for 2026. You can leave a public comment by clicking here.

A War on Drugs That Bombs Boats, Pardons Narco-State President, and Prosecutes Doctors

By Dr. Lynn Webster

On September 1, 2025, a U.S. warplane blew apart a small speedboat in the Caribbean, killing all eleven people on board. President Trump released the video like a trailer for a new season of a drug war TV series, boasting that the vessel was loaded with narcotics and crewed by Venezuelan “narco-terrorists.”

The strike was the opening salvo in a new campaign of air attacks on suspected drug boats in the Caribbean and eastern Pacific — Operation Southern Spear — that has killed at least 87, all on the strength of the administration’s unproven claims about who was on board and what cargo they were carrying.

On December 1, the same administration quietly did something very different. It issued a “full and complete pardon” to former Honduran president Juan Orlando Hernández, who was convicted in a U.S. federal court of helping move more than 400 tons of cocaine into the United States and running Honduras as what prosecutors called a “narco-state.”

Hernández was serving a 45-year sentence when the pardon came through. The White House justified the move by claiming the trial was “politicized” under the prior administration and that Hernández was the victim of overzealous prosecutors relying on compromised witnesses.

So, in the space of a few months, we have a government that claims the authority to kill alleged drug traffickers on the high seas without a trial, while freeing a former head of state that U.S. courts found to be deeply enmeshed in the cocaine trade.

At the same time, ordinary physicians inside the United States continue to be charged as “drug dealers in white coats” for prescribing opioid analgesics to patients in pain—often amid clinical uncertainty and shifting standards of care.

Drug Control by Spectacle

Together, the boat killings, the Hernández pardon, and the prosecution of well-intended physicians reveal something fundamental about the modern American war on drugs: It is less a coherent public-health strategy than a flexible political script.

Consider Hernández. For years, he was treated as a reliable U.S. ally, an eager partner in migration control and anti-drug cooperation. Only after he left office did the Justice Department present evidence that his government functioned as a protection racket for traffickers, with bribes flowing in and cocaine flowing north.

A New York jury convicted him; a federal judge imposed a 45-year sentence; and families ravaged by the cocaine trade were told this was a landmark in the fight against high-level corruption.

Yet, with the stroke of a pen, that message has been reversed. The pardon has been widely read in Honduras as an intervention on behalf of Hernández’s political allies, and it signals that even the most spectacular narcotics conviction is negotiable if the defendant is useful to Washington.

Now, set that alongside the first boat killing and the broader air campaign that followed. Under Operation Southern Spear, U.S. forces have been authorized to strike suspected drug-running vessels in international waters, killing dozens of people so far in the Caribbean and Eastern Pacific.

Human-rights experts call this an extrajudicial killing regime. They cite the fact that there has been little transparency and no meaningful process to distinguish a trafficker from, say, an unlucky fisherman who happened to be in the wrong place at the wrong time.

This is drug control by spectacle. It projects toughness and reassures a domestic audience that someone is paying the price for drug trafficking. But it does little to reduce supply, and it risks deepening resentment in countries that already bear the brunt of the U.S.’s drug policy.

Physicians Targeted

Meanwhile, inside the United States, the same punitive mindset has migrated into medicine. Under the Controlled Substances Act, doctors commit a crime if they “knowingly or intentionally” distribute or dispense controlled substances in an unauthorized way.

In our amicus brief in Ruan v. United States, my co-authors and I explained how prosecutors have increasingly treated alleged deviations from the “standard of care” as proof that a prescription lacked a “legitimate medical purpose in the usual course of professional practice.” This effectively turned malpractice or medical guideline disputes into drug-trafficking charges, and eroded the requirement that the government prove a guilty mind.

In the Ruan ruling, the Supreme Court unanimously held that the government must show that a prescriber knew their conduct was improper and illegal.

Yet for many clinicians, the message from years of aggressive prosecutions is that prescribing opioids to patients with complex pain conditions can be a fast track to a felony indictment. Physicians have watched colleagues led from their offices in handcuffs, their careers and reputations destroyed, sometimes on the basis of retrospective judgments about “red flags” rather than evidence of deliberate criminality.

Put crudely, our system has developed three very different responses to people labeled “drug traffickers.”

If you are a poor person on a boat in the Caribbean, you may be killed without a trial.

If you are a former president whose government helped move hundreds of tons of cocaine, you may be pardoned.

If you are a physician treating complex pain patients in a fragmented, under-resourced health system, you may be prosecuted as a drug dealer if your prescribing patterns later look suspicious on a spreadsheet.

That is not a rational drug policy. It is a hierarchy of whose lives are expendable, whose conduct is negotiable, and whose mistakes are treated as crimes.

None of this is to deny that real traffickers wield violence and that some clinicians have abused their prescribing privileges. But when we glorify lethal force at sea, quietly forgive a leader of what U.S. prosecutors themselves called a narco-state, and simultaneously treat legitimate clinical judgment as suspect, we are no longer talking about a war on drugs.

We are talking about a war on certain kinds of people: the poor, the foreign, the sick, and medical professionals all serve as convenient scapegoats.

If we are serious about reducing overdose deaths and drug-related harm, we need to abandon the theatrics. That means three things.

First, we must subject military operations to rigorous legal and human-rights scrutiny.

Second, we must acknowledge that pardoning a convicted narco-president while bombing alleged couriers does not “send a message” of resolve. It sends a message of incoherence — and of a system more invested in performance than in justice or saving lives.

Third, once and for all, we must end the use of criminal law to second-guess good-faith medical practice.

Lynn Webster is a physician specializing in pain and addiction medicine, a former president of the American Academy of Pain Medicine, Senior Fellow at the Center for U.S. Policy, and author of “The Painful Truth” and the forthcoming book “Deconstructing Toxic Narratives – Data, Disparities, and a New Path Forward in the Opioid Crisis.” He has written extensively on drug policy, the opioid crisis, and the criminalization of medicine.  

Feline Good: A Sense of Purpose Helps Me Manage Chronic Illness

By Crystal Lindell

Every morning, at around 5 a.m., my very fat orange cat Goose starts his daily routine: Screaming at the top of his lungs in an effort to wake up me and my partner.

He’s hungry and he doesn’t care if we’re asleep – it’s time for cat breakfast.

Trust me when I tell you that we have tried a number of workarounds to help avoid this daily cat alarm clock.

We have attempted to ignore his screams. We have tried feeding him a bigger meal later at night before bed. And we have left dry food out overnight.

We even gave him a late-night catnip snack in hopes that it would help him sleep later into the morning.

Goose doesn’t give a shit about any of that. He still gets up at 5 a.m. every single morning so that we can feed him.

Turns out, though, this daily ordeal may actually be helping me manage my chronic pain from Ehler-Danlos syndrome.

GOOSE AND CRYSTAL

New research from Cigna shows that having a strong sense of purpose can help offset the effects of chronic disease. And every single morning, Goose makes sure that I know that my purpose is to take care of him.

Cigna researchers found that while adults with chronic conditions usually have much lower vitality scores than those who are not sick, the same does not hold true when they also have a strong sense of purpose. 

Adults with chronic conditions and a strong sense of purpose actually have a significantly higher vitality score — nearly matching the scores of people without health issues. Cigna defines vitality as the ability to pursue life with health, strength and energy. 

People with a strong sense of purpose are significantly more likely to have vitality than those who do not (89% vs. 61%). They are also five times more likely to say they feel energized (63% vs. 13%) and nearly three times as likely to look forward to each new day (86% vs. 31%).

Notably, having a strong sense of purpose is linked to greater ownership of physical health — 84% of adults with strong purpose say they feel in control of their health vs. 55% of those without strong purpose. People with a strong purpose are also more likely to get regular exercise, sleep better, and to see their doctors for regular checkups. They also have less anxiety and depression.

“Having a sense of purpose gives people energy and helps them feel happier and healthier,” says Stuart Lustig, MD, National Medical Executive for Behavioral Health at Cigna. “When you know what matters to you, you’re more likely to bounce back from tough times, build strong friendships, and take care of yourself, which impacts your overall physical health.”

It can be easy to shrink into yourself when you’re dealing with chronic health problems, especially when it comes to chronic pain. And truth be told, one of the reasons I resisted my fiancé’s pleas to get a cat in the first place is that I was worried I wouldn’t be able to take care of the cat on bad pain days. 

But as fate would have it, having Goose actually helps me get through the bad pain days —  especially when he is waking me from a deep sleep by screaming for breakfast. In fact, Goose and his cat sisters give my life meaning and make me feel needed every morning, even on the days when I don’t feel like I have much to give.

Of course, you don’t have to get a cat to have a sense of purpose. You don’t even need to have a constant level of activity. Small, gentle acts of generosity can go a long way. 

There are many things in my own life beyond my cats that help me see the world outside of myself and my chronic pain. I also care for my elderly grandma, babysit my niece, volunteer at a local animal shelter, and cook for my family on a regular basis. I also write these columns, which gives me a very direct connection between my pain and my purpose. 

Finding purpose can happen in a million small ways, throughout the days and years. As the old saying goes, it’s better to give than to receive.  And ultimately, when you give, you do, in fact, receive.