3 New Year’s Resolutions on Behalf of Pain Patients

By Crystal Lindell

It’s now 2026, which means I’ve spent too many decades making mostly failed New Year’s resolutions for myself. So this year, I’m not going to bother.

Instead, I have some New Year’s resolutions for other people. Specifically, they’re for people with power, like doctors and healthcare policy makers.

After all, it really seems like they need to make some policy changes, given the current state of things for people in pain. Perhaps they are just waiting for someone to tell them what those changes should be. 

Below is a look at three of my 2026 New Year’s resolutions on behalf of pain patients..

Resolution # 1: Fully Legalize 7-OH and Develop New Edibles

There’s so many conflicting local regulations when it comes to kratom and 7-OH, despite the fact that neither one is as harmful as health officials and lawmakers often claim.

For those unfamiliar, 7-OH is short for 7-hydroxymitragynine, an alkaloid that occurs naturally in kratom in trace amounts. Some kratom vendors now sell concentrated versions of 7-OH to boost its potency as a pain reliever and mood enhancer.

A lot of pain patients find both 7-OH and kratom to be effective at treating chronic pain. And while I am glad that both are still legal in most places in the United States, I would really like to see them fully legalized across the country, as municipalities and states realize just how beneficial these products can be.

I also would really like to see 7-OH vendors come out with some new edible formats, like chocolates, gummies and even seltzer.

I think 7-OH in particular has the potential to help a lot of people who have been denied adequate pain treatment. However, many of them may not be comfortable figuring out where to buy and correctly dose a 7-OH chewable tablet, especially if they are among one of the largest demographic of pain patients: the elderly.  

I think of my grandma trying to get 7-OH tablets at a local smoke shop, or having to figure out how to order them online. Both options are bad. 

Ideally, regular grocery stores and local pharmacies would have a display of low-dose 7-OH chocolates available over-the-counter for pain patients like her.

Resolution # 2: Stop Prescribing Gabapentin and Tramadol for Pain

This would be such a relatively easy change for doctors to make, and there’s so much science to back it up.

In October of 2025, PNN covered a study showing that tramadol is often not effective for chronic pain. And PNN has long been covering how ineffective gabapentin is for most pain conditions.  

However, despite the evidence, doctors still regularly prescribe gabapentin and tramadol for chronic pain. 

It doesn’t have to be that way. Doctors have alternatives that actually work, most notably low-dose hydrocodone. Yes, there are more regulations around that medication, making it more difficult to prescribe. But actually giving pain patients real options shouldn’t be so difficult.  

So, I would like doctors and other healthcare professionals to make it their goal to stop prescribing ineffective medications. Instead, offer pain treatments that actually work. Your patients will thank you.

Resolution # 3: Implement Medicare for All

Yes, I know this one is kind of unrealistic. But that’s what New Year’s magic is all about —  putting whimsical ideas out into the universe with the hope of seeing them come to fruition. 

After all, it can’t happen if we never ask for it.

Unfortunately, as the year starts off, we are actually heading in the opposite direction, with many Americans seeing their health insurance premiums soar or even deciding not to buy coverage. 

But I’m hoping that may be the catalyst we need for the public to start demanding real change. Right now, millions of people are losing their health insurance because the Trump administration ended federal subsidies for coverage under the Affordable Care Act. 

It’s an awful and unnecessary situation that our policy leaders have the power to fix, if only they worked together on the issue.

Every human should have the right to healthcare, and Medicare for All would go a long way to making that happen.

I know a lot of these resolutions probably won’t come to fruition in 2026, but I do think they could realistically happen before we start the next decade. And all of them have the potential to vastly improve the lives of millions of people living with chronic pain.

Happy New Year everyone. May your 2026 be filled with low-pain days, too much joy, and lots of love.

Hip Pain Has Many Causes and Most Don’t Require Surgery

By Charlotte Ganderton and Joshua Heerey

You can feel hip pain at any stage of life, including childhood, young adulthood and the middle years.

This can come as a surprise; since many people associate hip pain with old age. It can strike fear into the hearts of those in their 40s or 50s, who may suddenly wonder if old age – or even a hip replacement – may be on the horizon much sooner than expected.

The good news is only a minority of people with hip pain will have something medically concerning or actually need surgery. Surgery should only be considered after doing a comprehensive rehabilitation exercise program.

There are lots of complex underlying reasons for hip pain, and there may be plenty you can do before you start jumping to conclusions about needing surgery.

Causes of Hip Pain

In young boys and men, a condition known as femoroacetabular impingement syndrome is a common cause of hip pain. This is particularly true for those who play sports (such as soccer) where you need to change direction quickly and often.

This condition is caused by a bigger hip ball (also known as the femoral head) or the hip socket (the acetabulum). This may cause pain at the front or side of the hip. The pain may get worse during movements that involve the knee coming towards the chest (such as a squat) or trending across the middle of the body (such as sitting cross-legged).

In young girls and women, hip dysplasia is particularly common. This happens when the hip socket does not fully cover the ball of the joint. The hip can move too much, and may cause pain at the front, side or back of the hip.

However, excessive hip movement can also be caused when the connective tissue (such as the ligaments and hip capsule) get too elastic or stretchy.

Some people – such as performing artists, yogis and swimmers – may thrive on having more mobility for their artistry and sporting pursuits, but they need to be strong enough to control their excessive motion. Because people with increased mobility are at risk of injury, it is important to maintain hip muscle strength to support the hip joint.

In middle-aged adults and older people, the most common causes of hip pain are osteoarthritis and gluteal tendinopathy.

People with osteoarthritis often experience hip pain and stiffness, and may find it hard to reach down and put on shoes and socks.

People with gluteal tendinopathy might experience pain on the outside of their hip and have problems with lying on their side, climbing stairs or standing on one leg.

My Hip Hurts. How Worried Should I Be?

Well, it’s fundamentally about quality of life.

Does your hip pain make it hard to do social or community activities, perform daily tasks, or stay active? If so, then yes – you’re right to be concerned about your hip pain.

However, most hip conditions can be well managed with non-surgical treatments, such as exercises or stretches prescribed by a physiotherapist, doctor or other health-care professional. You may find you’re soon back to taking those long strolls in the park.

Whether your hip is too stiff or too mobile, start by seeking a thorough clinical examination from a trained and registered doctor or healthcare professional (such as a physiotherapist).

They may ask you to get some scans to help diagnose the cause of your hip pain. In most cases, an X-ray is used to understand the shape of the bones that form the hip joint and check for osteoarthritis.

In some people, an MRI is ordered to get a more detailed understanding of the different components of the hip joint. However, it is important to remember something might show up on an MRI even in people without pain.

Treatment for Hip Pain

Hip pain can often be managed with or without surgery.

If you do end up needing surgery, it’s worth knowing there are lots of different types of surgical treatments. The most common are hip arthroscopy (keyhole surgery) and hip replacement. For many people, though, non-surgical treatments are effective.

These might include adjusting how you exercise or do sport; learning about how to manage symptoms; and muscle strengthening exercises.

In most cases, it’s recommended to try non-surgical treatments for at least three months to see if they help reduce pain and improve hip function before considering surgery.

Whatever you do, stay active. And remember strong bum muscles are important to maintaining healthy hips, so try to find ways to keep your glutes strong.

Charlotte Ganderton, PhD, is a Senior Lecturer in Physiotherapy at RMIT University in Australia. She has received numerous awards for her research and has published papers and presented at national conferences in the musculoskeletal management of the hip and shoulder. 

Joshua Heerey, PhD, is a Physiotherapist and Research Fellow at La Trobe University in Australia. He has published numerous articles examining the diagnosis and treatment of intra-articular hip conditions and is a current member of the International Hip-Related Pain Research Network and Young Athlete’s Hip Research Collaboration.

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

The 5 Most Popular PNN Stories of 2025

By Crystal Lindell

Looking back at 2025, there was a lot of news to cover when it came to chronic pain and illness. Access to opioids was again a major concern for our readers, but there was also a lot of interest in the potentially harmful effects of gabapentin.

Below is a look at the top 5 most widely read articles that PNN published in 2025.

We truly appreciate every time you read, comment and share our articles. And we can’t wait to bring you more great coverage in 2026! 

1) Over 15 Million Americans Prescribed Gabapentin Despite Warnings

In September, we covered an analysis by CDC researchers that showed that the use of gabapentin (Neurontin) continued to soar in the United States — usually for chronic pain and other health conditions the drug is not approved to treat. 

Gabapentin is the fifth most prescribed drug in the United States, with prescriptions nearly tripling since 2010, according to findings published in the Annals of Internal Medicine. The number of patients prescribed gabapentin reached 15.5 million in 2024, up from 5.8 million in 2010.

Read the full article here.  

2) Cannabis Use by Older Adults Linked to ‘Younger Brains’ and Improved Cognition

In August, we covered a study that showed that cannabis use by older adults slowed the aging of their brains and may even improve cognitive function.  

An international research team analyzed health data on more than 25,000 adults in the UK, looking at the relationship between cannabis use, aging, and cognitive function. They found that cannabis users had brain characteristics “typically associated with younger brains” and “enhanced cognitive abilities.” 

Read the full article here. 

3) 6 Things to Try If Your Doctor Won’t Prescribe Opioid Pain Medication

A lot of pain patients find that their doctors are reluctant to prescribe opioids. So in February, I shared six things to try if your physician tells you to go home and take ibuprofen.

The first tip is not to give up. Tell your doctor what poorly treated pain is doing to your life – that you’re unable to work or that you may have to go to the emergency room. Tell the truth and don’t exaggerate, and you just might get them to change their mind.

Another option is to try kratom and/or cannabis. They don’t work for everyone, but many patients say they provide some level of pain relief.  

Read the full article here. 

4) DEA Plans Further Cuts in Oxycodone Supply

In November, we covered the DEA’s plan to cut the supply of oxycodone by more than 6% in 2026, along with marginal reductions in the supply of hydrocodone, morphine and other Schedule II opioids. 

From year-to-year, the cuts may not appear significant. But over the past decade, there has been an historic decline in the nation’s opioid supply. If its current plan is adopted, DEA will have cut the supply of hydrocodone and oxycodone by over 70% since 2014.

The DEA says the “medical usage” of prescription opioids is declining, when in fact the “medical need” for them is actually increasing.

Read the full article here. 

5) Study Links Gabapentin to Increased Dementia Risk 

In July, we covered how gabapentin (Neurontin) may significantly increase the risk of dementia and cognitive impairment, even for middle-aged patients who only took the nerve medication for six months.

That was according to research published in the Regional Anesthesia & Pain Medicine journal, which looked at health records for more than 26,000 U.S. patients with chronic low back pain.

Researchers found that patients with six months or more of gabapentin use had a 29% higher risk of developing dementia and an 85% higher risk of developing mild cognitive impairment 

Read the full article here.

We hope you enjoyed reading PNN in 2025 and that you found our stories informative and helpful. We look forward to continuing our coverage of chronic pain and other health issues in 2026. 

Unlike many other online news outlets, we don’t hide behind a paywall or charge for subscriptions. PNN depends on reader donations to continue publishing, so please consider making a donation today.

Happy New Year everyone!

The Basic Protocol for Treating Adhesive Arachnoiditis

By Dr. Forest Tennant

When Arachnoiditis Hope was formed eight years ago, we had enough experience under our belt to know that treatment of adhesive arachnoiditis (AA) required 3 medical components: 

1. Suppression of inflammation

2. Regeneration of the cauda equina and arachnoid membrane

3. Relief of pain 

Our recommended basic protocol has evolved over the past eight years, based on our review of about 2,000 AA cases. This treatment protocol has been consistently successful in treating most AA cases.  

The basic protocol represents our best approach to stop deterioration. Once established, we recommend additional measures in an attempt to permanently reduce pain and neurologic impairments.

The starting treatment protocol:   

Relief of Pain

Choose a short-acting opioid for pain flares and exacerbations.

Options include less potent opioids, such as tramadol, codeine, buprenorphine, and hydrocodone or oxycodone with acetaminophen 

More potent opioids include oxycodone (plain), morphine, fentanyl and hydromorphone

Suppression of Inflammation and Autoimmunity

• Methylprednisolone 4 mg or dexamethasone 0.5 or 0.75 mg two or three days a week

• Ketorolac 10 mg with meals 2 days a week or a 15 to 60 mg injection one day a week

There are alternatives to corticosteroids and ketorolac, but they do not appear as consistent or effective.

Regeneration of Cauda Equina and Arachnoid Membrane

Dehydroepiandrosterone (DHEA) 200 mg in AM and PM

Additional Measures

Supportive Diet, Vitamins and Minerals: The basic protocol is supported by a daily protein, low carbohydrate, sugar-restrictive, anti-inflammatory diet (daily fruits and vegetables), plus vitamins C, B-12, D and the minerals, magnesium and selenium.

Spinal Fluid Flow Exercises: Rocking in a chair or gentle bouncing on an indoor trampoline are recommended.

Advanced Treatment: After a person is stabilized on the basic protocol, some additional measures that are designed to permanently reduce pain and symptoms can be added. These include peptide/hormone administration, Epstein-Barr virus eradication, adhesion dissolution, electromagnetic therapy, and central pain therapy.

As we approach the end of 2025 we hope you have received some benefit from our efforts to help those suffering with adhesive arachnoiditis and related conditions.  We will likely start a new bulletin series in 2026.  You may wish to print or download and save some of our bulletins from 2025.

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

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

A Pained Life: What's in a Name?

By Carol Levy

First, we were called “handicapped." It was a wholesale term to paint all those with physical, emotional or intellectual limitations. One inability meant total inability. Often, it was used as an exclusionary term, to mean someone was “less than.”

Eventually, it was realized that handicapped was a demeaning term. So, they changed it to “disabled.” That too was belittling — a word that tended to make us seem less than whole.

Then came physically (or emotionally or intellectually) “challenged.” That sounds better. After all, being challenged just means you have to try harder to meet goals and objectives.

But even that term carries a subtle meaning: we can overcome challenges if we just “try harder” or “do better.” It suggests we are too lazy, too much of a malingerer, and don't want to even try.

There has to be something better. In thinking about this, I had an “Aha!” moment: I am not disabled, I am “unable.”

That seems more appropriate. After all, being unable in one sense does not mean unable in all. "I am unable to answer the phone right now. Please call back later.".

Because of my trigeminal neuralgia, I can't use my eyes for more than 15 -20 minutes without severe pain. I can't tolerate wind or even a slight breeze against the affected side of my face.

But the rest of me is able and willing. It only makes me unable to do things that require the use of my eyes. I am still able to do things that are physically demanding. I can walk, talk, think, exercise, and thankfully take care of myself. That is far from being disabled. 

Others among us may be unable to lift things, clean a room, or even walk. But we can still think, talk, read, and interact with others, even if only on the phone or online.  We are “unable” in part, but able in many other ways.

But, at the end of the day, does the term used to describe those with inabilities really matter? Most healthy people don’t even consider the label, it’s just a way of quickly describing someone.

Quick descriptions, though, lead to stereotypes and misunderstandings. Take, for example, someone parking in a “handicapped” parking spot.

They may have the placard or license plate that gives them permission to park in these spaces, but when they exit their car and start to walk away, another person may object. They’ll start yelling, “You're not handicapped! How dare you park there and take the space away from someone who actually needs it!”

I have had this happen to me. But it’s too hard to explain what trigeminal neuralgia is, and how the wind or even a breeze could set off a pain flare.

Instead, I say, “I do not need to have a cane or wheelchair to be disabled. I may have a heart condition or emphysema or any number of other disorders that make it difficult for me to park farther away from the entrance.”

Looking abashed, if you're lucky, the person walks away.

It would be nice and so much easier, if I could respond by saying “You're right. I am not handicapped in the way you expect me to be. I am unable physically in a way that may be invisible to you, but necessitates my using this spot.”

I keep my fingers crossed, hoping it’s a teachable moment, that this person will understand that “unable” in one sense does not mean unable in all. Maybe, if we're all really lucky, she’ll be able to pass it on.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 40 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.  

On a Scale of 1 to 10…

By Julie Titone

Pain is the most common reason that people see a primary care doctor. If you have chronic pain – the kind that’s stuck around for three months or more – chances are you’ve seen lots of specialists, too. 

You may dread their standard question as much as I do: “On a scale of 1 to 10, how much pain do you feel, with 10 being the worst pain possible?”

I hesitate to answer. If I say 6, will I feel like a whiner? If I say 5, will my pain be taken seriously? 

How would I know if I felt the worst possible pain? 

Are you asking me how much it hurts when I stand or when I sit?

There is value in trying to quantify pain, and many have tried to improve upon the 10-point scale. But pain can never be captured by numeric language or, for that matter, by the English language. Good doctors are less interested in numbers than in how the pain is affecting someone’s life.

This subject is on my mind because of the responses to my column, “Arachnoiditis: My Not-So-Rare Disease.” 

Readers who share my diagnosis of adhesive arachnoiditis told me they appreciated my effort to spread the word about this chronic inflammatory disease. But a few chided me for downplaying how painful arachnoiditis can become. 

Here is what I wrote: “Patients experience lower body numbness and stinging pain that, at its worst, is likened to hot water dripping down the legs. The disease can lead to paralysis and bladder dysfunction.”

I debated which words to use in that paragraph. A litany of misery might cause folks to stop reading, so I kept the descriptive list short. 

Now, in recognition of those who suffer, I will expand upon the kinds of pain reported by arachnoiditis patients:

• Burning, stabbing, shocking, zapping

• Buzzing, icy hot, insects crawling under the skin. 

• Deep aching/boring in the spine. 

• Pain radiating down the back of the legs. 

• Vice-like pressure. Cramping. 

• Pain that increases upon standing or sitting. 

• Sudden flares triggered by movement. 

• Widespread burning in the lower body. 

• Pelvic, abdominal and bladder-related pain. 

• Unrelenting, throbbing, exhausting pain.

As one woman wrote in an online discussion: “How much can a body take?” 

Some patients would answer that question with suicide.

What makes this all doubly sad is that arachnoiditis often begins when people seek relief, via injections or surgery, from another source of pain.

So far, my own arachnoiditis is not debilitating. I get modest relief from medicines, movement and massage. Distraction helps. If you need advice on the best ice packs and seat cushions, I’m your gal.

Chronic pain plagues an estimated 20 to 30 percent of people in the world at any given time. The cliché goes that misery loves company. I don’t love it, but that massive company could work in my favor someday.

Researchers have 2 billion reasons to investigate pain treatment and prevention. As the secrets of neural pathways are unlocked, the knowledge is bound to benefit those of us with arachnoiditis.

Julie Titone is a former newspaper journalist who also worked in academic and library communications. She is retired and lives in Everett, Washington. Julie’s website is julietitone.weebly.com.

This column first appeared in Julie’s Substack blog and is republished with permission. 

Congress Went Home for Holidays, Leaving Millions to Face Rising Healthcare Costs

By Robert Applebaum

Dec. 15, 2025 – the deadline for enrolling in a marketplace plan through the Affordable Care Act for 2026 – came and went without an agreement on the federal subsidies that kept ACA plans more affordable for many Americans. 

Despite a last-ditch attempt in the House to extend ACA subsidies, with Congress adjourning for the year on Dec. 19, it’s looking almost certain that Americans relying on ACA subsidies will face a steep increase in health care costs in 2026.

As a gerontologist who studies the U.S. health care system, I’m aware that disagreements about health care in America have a long history. The main bone of contention is whether providing health care is the responsibility of the government, or of individuals or their employers.

The ACA, passed in 2010 as the country’s first major piece of health legislation since the passage of Medicare and Medicaid in 1965, represents one more chapter in that long-standing debate. That debate explains why the health law has fueled so much political divisiveness – including a standoff that spurred a record-breaking 43-day-long government shutdown, which began on Oct. 1, 2025.

In my view, regardless of how Congress resolves, or doesn’t resolve, the current dispute over ACA subsidies, a durable U.S. health care policy will remain out of reach until lawmakers address the core question of who should shoulder the cost of health care.

The ACA’s Roots

In the years before the ACA’s passage, some 49 million Americans – 15% of the population – lacked health insurance. This number had been rising in the wake of the 2008 recession. That’s because the majority of Americans ages 18 to 64 with health insurance receive their health benefits through their employer. In the 2008 downturn, people who lost their jobs basically lost their health care coverage.

For those who believed government had a primary role in providing health insurance for its citizens, the growing number of people lacking coverage hit a crisis point that required an intervention. Those who place responsibility on individuals and employers saw the ACA as perversion of the government’s purpose. The political parties could find no common ground – and this challenge continues.

The major goal of the ACA was to reduce the number of uninsured Americans by about 30 million people, or to about 3% of the U.S. population. It got about halfway there: Today, about 26 million Americans, or 8%, are uninsured, though this number fluctuates based on changes in the economy and federal and state policy.

Health Insurance for All?

The ACA implemented an array of strategies to accomplish this goal. Some were popular, such as allowing parents to keep their kids on their family insurance until age 26. Some were unpopular, such as the mandate that everyone must have insurance.

But two strategies in particular had the biggest impact on the number of uninsured. One was expanding the Medicaid program to include workers whose income was below 138% of the poverty line. The other was providing subsidies to people with low and moderate incomes that could help them buy health insurance through the ACA marketplace, a state or federal health exchange through which consumers could choose health insurance plans.

Medicaid expansion was controversial from the start. Originally, the ACA mandated it for all states, but the Supreme Court eventually ruled that it was up to each state, not the federal government, to decide whether to do so. As of December 2025, 40 states and the District of Columbia have implemented Medicaid expansion, insuring about 20 million Americans.

Meanwhile, the marketplace subsidies, which were designed to help people who were working but could not access an employer-based health plan, were not especially contentious early on. Everyone receiving a subsidy was required to contribute to their insurance plan’s monthly premium. People earning US$18,000 or less annually, which in 2010 was 115% of the income threshold set by the federal government as poverty level, contributed 2.1% of their plan’s cost, and those earning $60,240, which was 400% of the federal poverty level, contributed 10%. People making more than that were not eligible for subsidies at all.

In 2021, legislation passed by the Biden administration to stave off the economic impact of the COVID-19 pandemic increased the subsidy that people could receive. The law eliminated premiums entirely for the lowest income people and reduced the cost for those earning more. And, unlike before, people making more than 400% of the federal poverty level – about 10% of marketplace enrollees – could also get a subsidy.

These pandemic-era subsidies are set to expire at the end of 2025.

Cost vs Coverage

If the COVID-19-era subsidies expire, health care costs would increase substantially for most consumers, as ACA subsidies return to their original levels. So someone making $45,000 annually will now need to pay $360 a month for health insurance, increasing their payment by 74%, or $153 monthly. What’s more, these changes come on top of price hikes to insurance plans themselves, which are estimated to increase by about 18% in 2026.

With these two factors combined, many ACA marketplace users could see their health insurance cost rise more than 100%. Some proponents of extending COVID-19-era subsidies contend that the rollback will result in an estimated 6 million to 7 million people leaving the ACA marketplace and that some 5 million of these Americans could become uninsured in 2026.

Policies in the tax and spending package signed into law by President Donald Trump in July 2025 are amplifying the challenge of keeping Americans insured. The Congressional Budget Office projects that the Medicaid cuts alone, stipulated in the package, may result in more than 7 million people becoming uninsured. Combined with other policy changes outlined in the law and the rollback of the ACA subsidies, that number could hit 16 million by 2034 – essentially wiping out the majority of gains in health insurance coverage that the ACA achieved since 2010.

Subsidy Downsides

These enhanced ACA subsidies are so divisive now in part because they have dramatically driven up the federal government’s health care bill. Between 2021 and 2024, the number of people receiving subsidies doubled – resulting in many more people having health insurance, but also increasing federal ACA expenditures.

In 2025, almost 22 million Americans who purchased a marketplace plan received a federal subsidy to help with the costs, up from 9.2 million in 2020 – a 137% increase.

Those who oppose the extension counter that the subsidies cost the government too much and fund high earners who don’t need government support – and that temporary emergencies, even ones as serious as a pandemic, should not result in permanent changes.

Another critique is that employers are using the ACA to reduce their responsibility for employee coverage. Under the ACA, employers with more than 50 employees must provide health insurance, but for companies with fewer employers, that requirement is optional.

In 2010, 92% of employers with 25 to 49 workers offered health insurance, but by 2025, that proportion had dropped to 64%, suggesting that companies of this size are allowing the ACA to cover their employees.

Dueling Solutions

The U.S. has the most expensive health care system in the world by far. The projected increase in the number of uninsured people over the next 10 years could result in even higher costs, as fewer people get preventive care and delayed health care interventions, ultimately leading to more complex medical care

Federal policy clearly shapes health insurance coverage, but state-level policies play a role too. Nationally, about 8% of people under age 65 were uninsured in 2023, yet that rate varied widely – from 3% in Massachusetts to 18.6% in Texas. States under Republican leadership on average have a higher percentage of uninsured people than do those under Democratic leadership, mirroring the political differences driving the national debate over who is responsible for shouldering the costs of health care.

With dueling ideologies come dueling solutions. For those who believe that the government is responsible for the health of its citizens, expanding health insurance coverage and financing this expansion through taxes presents a clear approach. For those who say the burden should fall on individuals, reliance on the free market drives the fix – on the premise that competition between health insurers and providers offers a more effective way to solve the cost challenges than a government intervention.

Without finding resolution on this core issue, the U.S. will likely still be embroiled in this same debate for years, if not decades, to come.

Robert Applebaum, PhD,  is a Senior Research Scholar in the Department of Sociology and Gerontology at Miami University. He is also Director of the Ohio Long-Term Care Research Project and Senior Research Scholar at the Scripps Gerontology Center.

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

My Christmas Wishes for Pain Patients

By Crystal Lindell

With Christmas spirit in the air, and the hope of the New Year close behind, it seems only appropriate to make some holiday wishes for all my fellow pain patients.

Here are my wishes for people in pain:

More low-pain days than not. Easy opioid prescription refills. Clothes that don’t hurt to wear. Supportive family that always believes you and never judges you.

The ability to use a cane, the possibility of not needing it, and the wisdom to know the difference.

I wish for you a sweet pet to cuddle up in your lap whenever you can’t get off the couch. Money that comes in more than it goes out. And steady weather, so that the barometric pressure doesn’t increase your pain.

I wish that every book you read to get through a pain flare takes you to a new world where your pain isn’t as bad.

I wish for you a doctor who takes you seriously and prescribes you medications that actually work. Health insurance that actually covers all of your medical expenses. And a pharmacist who actually believes you.

I wish you more strength that you need to keep going when the pain is really trying to make you stop. And the ability to keep hope alive even when you’d rather be dead.

If you’re seeking answers and a diagnosis, I hope you find both. 

If you’re seeking a romantic partner, I hope they find you. 

If you’re just seeking a good TV show to watch on bad pain days, I hope you find one with lots of seasons. Hopefully, it’s on one of the streaming services you already subscribe to!

May your naps always rejuvenate you, your medications always kick in quickly, and your shoes always be comfortable.

But most of all, my wish for you is that your pain goes away. I really do.

Sadly, like my body, my wishes don’t always work so well. They only rarely come true. 

So, if your pain refuses to leave, I wish only that you know that this world needs you in it, and that it’s vitally important that you keep going. There are still so many things left for you to see and do and accomplish. 

Merry Christmas dear pain patient, and hopefully a very happy New Year – or at least a survivable year ahead.

Review Finds THC More Effective Than CBD for Chronic Pain

By Pat Anson

An updated systematic review found that cannabis products with relatively high levels of THC (tetrahydrocannabinol) may provide small improvements in chronic pain; while those containing high levels of CBD (cannabidiol) and little or no THC had minimal effect on pain.

Researchers at the Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University reviewed 25 short-term cannabis studies involving over 2,300 patients with chronic pain. Their findings are published in the Annals of Internal Medicine. 

CBD-based gummies, tablets, oils and other products have long been marketed for various health issues, but researchers say they demonstrated almost no improvement in managing pain. 

“This may be surprising to people,” said lead author Roger Chou, MD, in a press release. “Conventional wisdom was that CBD was promising because it doesn’t have euphoric effects like THC and it was thought to have medicinal properties. But, at least in our analysis, it didn’t have an effect on pain.” 

Chou, who was lead author of the controversial 2016 CDC opioid guideline and its 2022 update, said the small improvement in pain was on the order of a half point to a point on the zero-to-10 pain scale. While providing modest pain relief, THC-based products also had a higher risk of side effects, such as dizziness, sedation and nausea.   

There are several caveats to the review which make it unhelpful, at best, in determining whether THC or CBD are effective pain relievers. 

One, many of the clinical trials were deemed to be biased or of low quality. They mostly involved patients with chronic neuropathic pain, which means they don’t necessarily apply to patients with other types of pain.

Second, most of the studies involved pharmaceutical-grade cannabis-based medicines, such as dronabinol and nabilone, which are approved for nausea, vomiting and as an appetite stimulant. None of them are approved for pain relief.  

Third, those pharmaceutical medicines are based on synthetic THC, not plant-derived THC or CBD. So basically, the researchers studied products that most cannabis consumers don’t use, which makes the overall findings misleading.

“This raises critical questions about generalizability: Can findings from standardized formulations inform real-world use of diverse, cannabis-derived, state-regulated products?” asks Ziva Cooper, PhD, from the UCLA Center for Cannabis and Cannabinoids, in an editorial also published in the Annals of Internal Medicine.   

Copper says the review demonstrates the need for better evidence and less reliance on clinical trials. The inclusion of observational studies and patient reviews of products obtained in dispensaries would better capture real-time evidence of current cannabis use and outcomes. 

“There are opportunities for novel approaches to understand cannabis-related health effects. Rigorous randomized controlled trials (RCTs) are the gold standard for determining the safety and efficacy of cannabis and cannabinoids for therapeutic end points,” Cooper wrote. 

“Yet, these studies are resource-intensive, challenging due to federal regulations, and slow to adapt to a rapidly evolving marketplace and patient behavior. Expanding the scope of study designs to consider complementary strategies is urgently needed.”

Chou says the wide variety of cannabis products on the market makes drawing conclusions about their effectiveness difficult.

“It’s complicated because cannabis products are complicated,” he said. “It’s not like taking a standardized dose of ibuprofen, for example. Cannabis is derived from a plant and has multiple chemicals in addition to THC and CBD that may have additional properties depending on where it’s grown, how it’s cultivated and ultimately prepared for sale.”  

Better cannabis research is one of the reasons the Trump Administration is moving to complete the process of reclassifying cannabis from a Schedule I controlled substance to a Schedule III drug with accepted medical uses.

Because cannabis has long been illegal under federal law, it has stifled research into its health benefits, leaving patients and doctors in the dark on its potential uses. This review does nothing to shine a light on the issue.  

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 Plead with DEA Not to Cut 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 public comments, about half the usual comment period for quota proposals. December 15 was the last day 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, which is often treated with opioids.

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.”