Patients Are Becoming Less Open to AI in Healthcare

By Crystal Lindell

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

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

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

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

Participants said they use AI for a variety reasons:

• 62% use AI to help understand symptoms

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Can Hypnosis Therapy Treat Chronic Pain?

By Pat Anson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Dr. Lynn Webster

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

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

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

What We Know About GLP-1s and Pain

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

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

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

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

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

What We Know About GLP-1s and Addiction

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

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

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

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

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

The Risks We Can’t Minimize

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

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

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

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

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

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

A Measured Path Forward

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

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

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

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

The Fear Mongering Over Tiger Woods’ Hydrocodone

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In another Reddit thread, a user writes:

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

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

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

CDC Study Warns Against Consuming Kava-Kratom Drinks

By Pat Anson

For the second time in a week, the CDC has released a study warning of “serious medical outcomes” for people who consume kratom, a controversial supplement used by millions of Americans as a stimulant and pain reliever.

This time, the study focuses on the co-use of kratom with kava, a plant in the pepper family used to make a coffee-like drink that promotes relaxation and improves mood. 

Consumption of kava declined after the FDA warned in 2002 that it could cause severe liver injury. But consumption began rising about a decade ago, as drinks containing both kava and kratom rose in popularity among young people.

“These commercial products are commonly marketed as healthy alternatives to alcohol, sold near college campuses, and increasingly being combined with kratom, a psychoactive botanical with opioid-like effects, raising safety concerns,” wrote lead author Christopher Holstege, MD, Professor of Emergency Medicine and Pediatrics at the University of Virginia School of Medicine.

Holstege and his colleagues reported in the CDC’s Morbidity and Mortality Weekly Report (MMWR) that kava-related calls to U.S. poison control centers rose 383% from 2011 to 2025 (from 57 cases to 203). About a third of the kava calls in 2025 also involved kratom. 

“These data indicate a resurgence of overall kava exposure reports to poison centers, as well as an increase in kratom-related kava reports, which has coincided with higher rates of serious clinical outcomes. The findings in this report suggest the need for enhanced surveillance for, clinical awareness of, and public education regarding commercial products containing kava,” Holstege said.

Nearly half (43%) of the kava-related calls involve other substances, including ethanol (alcohol) and benziodiazepines. While most adverse effects were minor, such as nausea and dizziness, about a third resulted in hospitalizations or serious outcomes. Eight kava-related deaths were reported during the study period.

Last week the same group of researchers warned in another MMWR report that kratom-related calls to U.S. poison control centers rose by 1,200% over the past decade. While that appears to be a startling increase, it’s a misleading number that represents only a tiny fraction (0.28%) of the estimated 5 million kratom users.

A MMWR report in 2016 was used by the DEA to justify its efforts to have the kratom alkaloids 7-hydroxymitragynine (7-OH) and mitragynine listed as Schedule One controlled substances, a move that would have effectively banned kratom. That report was also based on calls to poison control centers.

The DEA dropped its proposal after a public outcry. A top federal health official in the first Trump administration later admitted the scheduling request was based on “embarrassingly poor evidence & data” from the FDA and could result in “substantial risk to public health” if kratom were made illegal.

The growing controversy over potent forms of 7-OH recently revived efforts by the FDA to have the DEA list 7-OH as a controlled substance, but not natural leaf kratom. The DEA has yet to act on that request. 

A controversial drink that contains kava and natural leaf kratom is Feel Free Classic, made by Oklahoma-based Botanic Gardens. Media stories claimed the drink is addictive, has “opioid-like effects” and is “hooking young people.”  

A class action lawsuit was filed against Botanic Gardens that alleged it used misleading advertisements to promote Feel Free as a healthy alternative to alcohol. The company settled the case for $8.75 million, and agreed to put stronger safety warnings on Feel Free bottles and limit sales to people 21 and older. 

In 2023, the FDA seized nearly 250,000 bottles of Feel Free, alleging the drink was an adulterated substance with inadequate safety information. Over a year later, the FDA quietly dropped the case.

A small short-term clinical study funded by Botanic Gardens found that Feel Free was “generally safe, with only mild to moderate AEs (adverse events) reported, which were all transient in nature.”

When You Have Chronic Pain, Every Day Is April Fool’s Day

By Crystal Lindell

When you’re a chronic pain patient, every single day can feel like you’re the butt of an April Fool’s Day joke: 

Think your doctor will actually help you? April Fool! 

Think your insurance will cover your medical bills? April Fool! 

Think you’ll be able to get your opioid prescription filled? April Fool! 

It’s never funny when you have these experiences, but they happen all too often.

When you first start enduring chronic pain, you’re hopeful that the medical system will provide answers and solutions. But as you work your way through the system, it eventually becomes clear that many of the things you probably thought were true just… aren’t. 

Think you’ll be able to get an appointment with a specialist in the next 12 months? April Fool!

Think your doctor will continue searching for answers after all your blood work came back “normal”? April Fool!

Think your prescriptions will be affordable? April Fool!

Of course, it’s not just the medical system. Many pain sufferers quickly find out that it’s also April Fool’s Day in the non-medical areas of their life, too. 

Think your job will provide accommodations? April Fool! 

Think your friends will treat you the same after you develop chronic pain? April Fool! 

Think you’ll be able to qualify for disability? April Fool!

Not to mention just trying to exist day to day. 

Think you’ll be able to shower every day? April Fool!

Think you’ll be able to keep your house clean? April Fool!

Think you’ll still be able to work as much as you did before? April Fool!

But the thing about people living chronic pain is that we are fast learners. We’re also resilient – because we don’t have any other choice. That means even when it becomes clear that life with chronic pain is just one cruel joke after another, we still keep going. 

So when you think about it, we’re the ones who really have the last laugh after all. 

Collagen Supplements Help Reduce Joint Pain

By Heba Ghazal

Collagen supplements have become one of the bestselling products in the wellness industry, promising everything from smoother skin to stronger joints. But do they actually work?

A major new review of the evidence – pulling together data from 113 clinical trials – suggests that, for some health outcomes, the answer is probably yes. But as ever with nutrition science, the full picture is more complicated.

Collagen is a protein the body makes naturally. It gives skin its structure and elasticity, supports bones and muscles, helps wounds heal and plays a role in protecting organs. The problem is that production slows as we age, which is why so many people turn to supplements to top it up.

Not all collagen is the same, though. The collagen found naturally in food may be less well absorbed than the smaller forms used in most supplements. These hydrolysed forms – where the protein has been broken down into shorter chains called peptides – are thought to pass more readily into the bloodstream and making it easier for the body to transport these fragments to tissues where they may have biological effects, potentially supporting skin, joint and muscle health.

The new review examined research published up to March 2025, drawing on 16 systematic reviews that between them included nearly 8,000 participants. The overall picture was cautiously positive.

Collagen supplementation was linked to moderate improvements in muscle health and reduced pain in people with osteoarthritis. There were also improvements in skin elasticity and hydration – though these benefits built up gradually, suggesting that taking collagen consistently over a longer period matters more than a short-term burst.

Some of the findings were less clearcut. Results for skin elasticity and hydration shifted depending on when the studies were conducted, with newer research showing lower improvements in elasticity but greater improvements in hydration. That inconsistency is worth noting – it suggests the science is still settling.

The quality of the research itself is also worth scrutinising. The studies used a wide variety of methods, doses and ways of measuring outcomes, which makes direct comparisons difficult.

Fifteen out of the 16 reviews included were rated as low or critically low quality – not necessarily because the supplements don’t work, but because of methodological problems such as studies not being registered in advance and poor reporting on potential biases. Many trials were also short and included few participants, which limits what we can reliably conclude about long-term effects.

Not All Collagen Is Equal

Part of the problem is that collagen supplements vary enormously. Some are derived from animals, such as cows, pigs and chickens, and others come from marine sources, including fish, jellyfish and shellfish. There are even so-called “vegan” collagen alternatives. Some studies used oral supplements, while others tested collagen dressings applied to the skin.

The way collagen is processed also affects the size and composition of the peptides in the final product, which in turn influences how it behaves and is absorbed in the body. Lumping all these different products together in a single analysis risks obscuring as much as it reveals.

Individual differences matter too. Factors such as sun exposure, smoking, sleep quality, environment and hormone levels all affect how skin ages and how it might respond to supplementation. If studies fail to account for these variables, it becomes very difficult to know whether any observed changes are genuinely due to the collagen or simply reflect differences in participants’ lifestyles.

This review adds to a growing body of evidence suggesting collagen supplements are not simply expensive placebos. There appear to be real, if modest, benefits – particularly for skin hydration, joint pain and muscle health.

The research base still has significant gaps. Without more rigorous, standardised studies, it remains genuinely difficult to say what is driving those benefits, or who is most likely to see them. Studies need to clearly specify the type of collagen used, the dose, how it was delivered and the characteristics of the people taking it.

Heba Ghazal, PhD, is a Senior Lecturer in Pharmacy at Kingston University in London.

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

Iran War Creates ‘Perfect Storm’ for Drug Shortages

By Pat Anson

The Iran war has disrupted the global supply chain so much that it could worsen shortages and raise prices of painkillers and other commonly used medications, according to experts. 

In addition to supplying much of the world with oil and natural gas, the Middle East serves as a crucial transportation hub for pharmaceutical companies. Ships and planes are being rerouted to avoid the region, which creates delays and higher shipping costs. 

“If the instability really persists, you’ll probably see lead times, transportation costs that can impact direct items that we need for our medicines, including the key starting materials into active pharmaceutical ingredients,” Gerren McHam, vice president of external affairs at the API Innovation Center, told The Hill.  

Even before the war, the UK was dealing with shortages of aspirin and co-codomal, a combination of paracetamol and codeine. Other drugs in short supply include those used to treat arthritis, diabetes, epilepsy and cancer.

The UK is reportedly “a few weeks away” from running out of some generic medicines. Like the United States, the UK relies heavily on generic pharmaceuticals produced in India.

“It’s the perfect storm. We have the conflict in the Gulf that caused the strait of Hormuz to shut down, and India is known as the pharmacy of the world. They produce a lot of the generic drugs and APIs (active pharmaceutical ingredients). With the geopolitical situation, it’s harder and harder to get those out,” said David Weeks, director of supply chain risk management at Moody’s. 

Before the war, Canada was also dealing with shortages of drugs used to treat pain and arthritis, according to a new report from the Canadian Arthritis Patient Alliance (CAPA). 

CAPA interviewed arthritis sufferers and their caregivers, who reported “profound disruptions to their physical and mental well-being” due to shortages of pain relievers such as Percocet, hydromorphone, Tylenol 3 and acetaminophen, as well as anti-inflammatory drugs and biologics used to treat arthritis. 

Patients and caregivers said they often had to make multiple trips to pharmacies before finding one that had their medications in stock.

“What happens to people who don’t have someone to support them through this? Would they just be waiting in the pharmacy while in immense pain - I would hate for my mom to be stuck in a situation like this on her own,” one caregiver told CAPA.

One bright spot is that shortages of oxycodone and acetaminophen with codeine that began last summer in Canada have largely ended. The drugs are now “generally available in pharmacies,” according to Health Canada.

The Iran war so far has had little immediate impact on pain patients in the U.S. – who have already been dealing with persistent shortages of opioid medication for several years. 

The American Society of Health-System Pharmacists (ASHP) continues to report shortages of oxycodone-acetaminophen tablets, oxycodone immediate release tablets, hydrocodone-acetaminophen tablets and morphine immediate release tablets; as well as injectable opioids used in surgery and emergency medicine. 

A new study published in JAMA Health Forum highlights how vulnerable the U.S. pharmaceutical industry is to global supply chain disruptions. 

Researchers at Yale University looked at stimulant shortages in 2022 and 2023, when many  patients with attention-deficit/hyperactivity disorder (ADHD) had difficulty filling their prescriptions. 

Although the limited supply was often blamed on increased demand and tight DEA production quotas, researchers say the more likely cause was a “historically unprecedented” decrease in US imports of amphetamine and other chemicals used to make stimulants. The shortfall in imports led to sudden production cutbacks by several stimulant manufacturers.

“Supply chain disruptions can occur in many places in the supply chain. However, descriptive evidence indicates that the most recent ADHD drug shortage may be associated with a disruption in the sourcing of raw ingredients from abroad,” researchers reported..

“More broadly, this economic evaluation reframes the discussion of ADHD medication shortages beyond DEA quotas, highlighting the vulnerability of US pharmaceutical manufacturing to international supply chain disruptions.” 

TENS Helps Reduce Symptoms of Fibromyalgia

By Pat Anson

In the first clinical study of its kind, researchers at the University of Iowa found that transcutaneous electrical nerve stimulation (TENS) significantly reduces pain and fatigue in patients with fibromyalgia, when combined with physical therapy.

Fibromyalgia is a poorly understood and difficult-to-treat disorder that causes widespread body pain, fatigue, insomnia, and brain fog. 

The study involved 384 people with fibromyalgia, and was conducted at 28 outpatient physical therapy clinics in the Midwest. Participants were broken into two groups, with half receiving physical therapy (PT) with TENS or physical therapy alone. TENS units send mild electric currents into sore muscles and tissues to temporarily relieve pain. 

TENS electrodes were placed on the upper and lower backs of patients, and delivered a mixed frequency signal at an intensity as strong as the participant could tolerate. Patients were asked to use TENS for two hours a day for six months. The treatments could be split into short periods or done all at once. 

The study findings, published in JAMA Network Open, show patients in the TENS/PT group had significant improvement in their movement-based pain and fatigue after 60 days, while those who only received physical therapy had no change in their pain. The improvements in the TENS/PT group were dose-dependent, with people using TENS daily having the best outcomes. 

After 60 days, patients in the physical therapy group were also given TENS units, and all the participants continued in the study for another four months.  

“When we gave the PT-only patients the TENS unit and they started using it, we also saw the same improvements as the PT with TENS patients,” said lead author Kathleen Sluka, PhD, a Professor of Physical Therapy and Rehabilitation Science at University of Iowa.

The improvements in fatigue were notable, because reduced fatigue makes people more willing and able to have physical therapy.

“We were excited to see that patients also had less fatigue,” Sluka added. “Right now, there are no good treatments for fatigue. So, the fact that we had anything that touched the fatigue was pretty powerful.” 

After six months, 81% of participants found TENS helpful and over half (55%) were still using TENS daily.

Researchers say it’s important for people to realize that the benefit of TENS comes from using it as a part of a total treatment plan.  

“Using TENS on its own will not give the same benefits,” said first author Dana Dailey, PhD, an Assistant Research Scientist at the University of Iowa.  “All the study participants were also using pain medications and receiving physical therapy, yet TENS still provided additional relief.” 

Until recently, the only three medications were FDA-approved for fibromyalgia: duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella). Many patients consider the drugs ineffective or have too many side effects.

Last year, the FDA approved Tonmya, a fourth drug for the treatment of fibromyalgia in adults. Tonmya is a new formulation of an old drug: cyclobenzaprine hydrochloride (Flexeril), a muscle relaxant that was originally developed as an antidepressant. 

Losing My Religion: How Chronic Pain Took My Faith

By Crystal Lindell

Next week is Holy Week, but I won’t be spending any of it in church.

It hasn’t always been that way. Before I developed chronic pain in 2013, I was quite devout.

In fact, in the years right before my health issues, I was even working as a paid youth leader for a Methodist Church.

I taught teens every Sunday; regularly gave sermons to the entire church; and led annual out-of-state mission trips. I was a regular at Bible Study; on the board of a local youth ministry organization; and spent multiple nights a week at church functions.

I read the Bible and prayed every night.

At the time, I assumed nothing could shake my faith in God. I really thought that I’d be part of The Church until I died.

And back then, I would have spent almost every night leading up to Easter at some sort of church service or event.

Not this year though. In fact, not for many years.

When I developed chronic pain, I became too sick to continue working as a youth leader, so I had to quit that role. And then I had to move in with my mom an hour and half away, so I also had to find a new church.

And I did try. I attended multiple churches in multiple denominations. But being in pain all the time made getting to Sunday morning services more trouble than it was worth.

Eventually, church faded from something I did to something I used to do.

I really did grapple with the loss though.

Looking back, two things really stopped me from ever fully going back to church..

The first was that I had felt very let down by the lack of support I received when I developed health problems. There were almost no accommodations made for me at church, and I was honestly a little bitter that they were so quick to accept my resignation from my role as youth leader.

Maybe this is a selfish thing to confess, but the Church as a community felt like it had failed me. I had invested so much into the Church – but when I needed something back, I felt ignored.

It was not just the Church as a community that I could no longer abide. My faith in God Himself was also badly damaged.

And to be honest, one of the things I kept coming back to was my jealousy of Jesus dying on the cross.

My whole life I heard about His great, suffering sacrifice. It was always relayed to me as the worst possible thing anyone could ever go through. Carrying the cross, nails through his hands (or wrists depending on your historical reference), and a literal crown of thorns.

Because Jesus died in pain, we got to live.

But then I developed chronic pain. And suddenly, Jesus being in pain for a day before his death seemed enviable.

My pain had lingered for months, and eventually years. I wasn’t lucky enough to find relief through death. Instead, my body insisted on persisting despite the pain, forcing me to live in Hell while I was still on Earth.  

All of the reverence that pastors had tried to convey via the story of Jesus’ incredible suffering before his death on the cross now fell flat.

Instead of finding something worthy of worship, I was just envious.

After that, the whole idea of faith came crumbling down. I really hit a wall. A lot of people do and ask: How could a loving God allow so much suffering in the world? 

If He existed, He suddenly felt cruel to me. But then, maybe the answer was simple: He didn’t exist. 

To those who don’t have chronic pain, perhaps my reasons for eventually leaving the church and my faith sound self-centered or childish. But chronic pain changes your perspective of the world, whether you want it to or not.

It has shown me the reality of the human condition. And through sheer force of will I have used that new perspective to write about my experiences. I do it so that others, even in their worst moments, know that they are not alone.

Whatever doesn’t kill you can expand your understanding of your fellow human beings. If you are open to it, it can offer you a glimpse of a broader spectrum of what life on this cold planet is actually like.

Yes, I lost my faith, and my church. But I gained new understanding and more empathy. And maybe one day faith will find me again.

Calls About Kratom to U.S. Poison Control Centers Surge

By Pat Anson

In what could be part of a new federal effort to ban kratom nationwide, the CDC has released a new study pointing to an exponential increase in kratom-related calls to U.S. poison control centers over the past decade.

There was a 1,200% increase in kratom-related reports to the National Poison Data System, from 258 in 2015 to 3,434 in 2025, including a “marked surge” last year. 

There was a similar 1,200% increase in kratom-related reports that resulted in adverse events and hospitalizations, from 43 cases in 2015 to 538 in 2025.

Over that 11-year period, there were a total of 233 kratom-related deaths. Most of the deaths and hospitalizations involved other drugs, such as alcohol, opioids, cannabis, stimulants and benzodiazepines. 

About half of the exposure reports were considered “intentional misuse” or suspected suicide attempts, researchers reported in the CDC’s Morbidity and Mortality Weekly Report (MMWR).

“Kratom-related adverse effects are increasing in number and complexity in the United States. Increasing use, the availability of high-potency kratom, and frequent multiple-substance exposure reports contribute to hospitalizations from physical as well as psychiatric causes,” wrote lead author Christopher Holstege, MD, Professor of Emergency Medicine and Pediatrics at the University of Virginia School of Medicine.

Last summer, the FDA said it would seek to have the kratom alkaloid 7-hydroxymitragynine (7-OH) – but not whole leaf kratom – classified as an illegal Schedule One controlled substance. 

7-OH occurs naturally in kratom in trace amounts, but some kratom vendors are selling concentrated versions of 7-OH that boost its potency as a pain reliever and mood enhancer. The surge in poison control cases in 2025 is mainly attributed to the growing use of 7-OH products. 

“As FDA moves to regulate 7-hydroxymitragynine but not whole-leaf kratom products, surveillance should distinguish product types to assess risks. Building this evidence base is essential to promoting safe kratom use, identifying high-risk combinations of substances, and guiding public health action to prevent future health effects in this rapidly evolving drug landscape,” said Holstege. 

Misleading Numbers

It’s important to note that the surge in kratom-related calls to poison control centers has more to do with kratom’s growing popularity in the United States. 

Kratom comes from the leaves of a tree in Southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. Kratom’s use began growing in the U.S during the 2010’s, as restrictions were placed on opioid analgesics and pain patients sought other ways to get relief. 

According to the MMWR, about 5 million Americans have used kratom, although some estimates are as high as 20 million..

Even using the conservative estimate, the 14,449 kratom-related calls to poison centers over the 11-year period represents only a tiny fraction (0.28%) of the estimated 5 million kratom users.

Critics say calls to poison control centers are “notoriously unreliable” and an imperfect way to measure the risks associated with a substance, since most calls involve minor symptoms such as upset stomachs or dizziness.

The number of calls can also be misleading. For example, a study of poison control data from 2000 to 2017 found there were more calls about exposure to nutmeg than there were about kratom.  

Nevertheless, the poison control data is often used by federal health officials and law enforcement agencies to seek changes in the legal status of a substance.  In 2016, the DEA and FDA cited another MMRW study to justify their efforts to have 7-OH and the alkaloid mitragynine listed as Schedule One controlled substances, in the same category as heroin. Such a move would have effectively banned kratom.

“Evidence from poison control centers in the United States also shows that there is an increase in the number of individuals abusing kratom, which contains the main active alkaloids mitragynine and 7-hydroxymitragynine. As such, there has been a steady increase in the reporting of kratom exposures by poison control centers,” the DEA said in 2016, citing the earlier MMRW study.

The DEA dropped its proposal to schedule mitragynine and 7-hydroxymitragynine after a public outcry, saying a ban on kratom would have “significant risk of immediate adverse public health consequences.” 

A top federal health official later admitted the FDA and the DEA based their scheduling request on “embarrassingly poor evidence & data.”

The growing controversy over 7-OH has revived efforts to restrict or ban sales of kratom and 7-OH at the state and local level. It may only be a matter of time before the DEA joins that movement, by renewing its effort to schedule 7-OH, mitragynine, and perhaps kratom itself.

How Chronic Pain Makes Childcare Difficult

By Crystal Lindell

I can’t pick up my 21-month-old niece anymore.

Every time I give in to temptation and lift her, I hurt my back and have to take 2-3 days of rest to recover, lest I risk throwing out my back again. And that’s even if I’m just quickly lifting her out of the playpen.

It’s heartbreaking, and it’s just one small way that chronic pain makes it so difficult to care for her.

I’m not a mom, but I have loved and cared for many small children over the years, so I know first-hand just how difficult chronic pain makes childcare. Unfortunately, it’s a burden that is not often acknowledged.

The prevailing attitude tends to be that if you love a child, you should be able to push through any physical pain that you might have to care for them.

Even the companies that make things like cribs and high-chairs seem oblivious to the physical toll that caring for young children can take. As one of my friends, who herself has four children, recently told me: “Imagine lifting weights while bending over a railing and standing on your tip toes.”

No physical trainer in the world would suggest such a move. But if you want to get a baby out of a crib, and you’re even slightly below average height, it’s what you’ll have to do.

These days, my mom and I watch my niece 3-4 days a week because her parents are on overnight work schedules.

Over the last few weeks I had to stop picking her up at all. It’s not just sad because it’s the end of an era, but it’s also logistically difficult to deal with.

Anytime I need her lifted, I have to call for help and put that task on someone else. And toddlers actually need to be lifted all the time! It basically makes it impossible to watch her by myself for long periods.  

It’s just one of the ways having chronic pain impacts my ability to care for her.

Young children are, understandably, very needy. They need breakfast regardless of whether or not you’re dealing with a pain flare. They don’t care if you’re not getting enough sleep. And they want to play outside even if you’re feeling miserable.

Beyond the day-to-day, there’s also the wear and tear that caring for children does to your body. I’m pretty sure that lifting her up so often over the past few months is partly why I reached a place where my back could no longer handle it. 

Even caregivers who are healthy are likely damaging their joints by constantly picking up and holding a toddler.  

Thankfully, I live with other family members who are able to care for my niece when my body won’t allow it. But there are countless single caregivers out there who don’t have another adult around to help out when their body rebels.

It’s why community support is so important when it comes to raising children. My biggest piece of advice to all new parents is, if at all possible, to live within walking distance of someone you trust enough to watch your child.  

The physical toll of caregiving is one of the many reasons pain patients need access to pain medications. They make it possible for us work, do household chores, and help our families.

Some days, a low-dose hydrocodone is the only reason I’m able to physically endure caring for my niece. A lot of people still think people only want opioids so that they can avoid responsibility, but pain patients know the truth: We take them so that we can function.

Sadly though, even opioids can’t give me back the ability to pick up my niece again. My back just won’t allow it. But thankfully, she’s always happy to stand on a chair to give me a great big hug.

Pain and Shame: Workers With Chronic Pain Often Feel Pressured to Perform

By Beth Schinoff and Elana Feldman

Your back pain gets worse as you sit through a long meeting. Your wrist pain flares when you’re typing furiously to meet a tight deadline. During a busy shift at the grocery store, you feel a migraine coming on.

If that sounds familiar, you’ve got plenty of company. About 1 in 4 U.S. adults suffer from chronic pain. The share who say they are in chronic pain either on most days or every day in the past three months is growing: It jumped by nearly 4 percentage points to 23% of U.S. adults in 2023, up from 19% in 2019.

Chronic pain is not only hard on workers trying to do their jobs, but it also takes a toll on employers and the economy as a whole by costing an estimated US$722 billion in lost productivity each year.

As management scholars who study how people feel at work, we wanted to understand why chronic pain so often makes it impossible for employees to do their work – and even to keep their jobs.

Pushing Through the Pain

With this in mind, we teamed up with two other management researchers, Kimberly Rocheville of Creighton University and Njoke Thomas of Boston College, to conduct a study that Academy of Management Journal published online in January 2026 and will include in an upcoming print edition.

We interviewed 66 people between 2019 and 2021. All of them said that they were in chronic pain – meaning pain that lasts for at least three months. They were all U.S. workers and at least 18 years old. They lived all over the country, in relatively more urban than rural areas. Our sample was 78% women because women tend to experience more chronic pain than men and tend to be more open to talking about their pain.

This professionally diverse group included lawyers, grocery store workers, teachers, police officers and health care professionals. They experienced many different kinds of pain, such as back pain, migraines, arthritis and fibromyalgia.

We found that this wide array of workers and white-collar professionals pushed through their pain because they felt pressure to have what we call an “ideal worker body”: a body that is healthy and strong enough to do anything their job requires.

Regardless of what job they had, people described a surprisingly similar pressure to perform despite their pain. From warehouse workers to lawyers, people felt they had no choice but to walk without a limp, lift heavy things and sit still during meetings.

Many of these people felt compelled to be ideal workers who put work before everything else in their lives. Previous research has found that these expectations can harm their mental health. We found that it can harm your physical health too.

Hiding Their Pain

Because they were in chronic pain, all of the participants in our study said their body wasn’t healthy and strong enough to do everything their job required when it required them to do it.

Even though they were more than intellectually capable of doing their work, they felt ashamed that their bodies fell short. This led them to hide their pain. They took the stairs, instead of the elevator, to seem more like their co-workers who felt fine. They avoided managing their pain in ways their colleagues could see, such as by applying ice to areas of their body that were in pain.

Ironically, trying to make it seem like their bodies were ideal worsened pain for all 66 of the people we interviewed. Most of them eventually reached a point where their pain became so intolerable that they could not function at or outside of work.

Some of them ultimately had to leave their jobs and found other ones that were more compatible with their chronic pain symptoms. In a few cases, they exited the workforce entirely.

This is not unusual. Chronic pain is the leading reason for workers becoming eligible for long-term disability benefits.

Breaking the Cycle

A few of the people we interviewed told us that they managed to escape the damaging cycle of shame and pain.

Why were they able to break free?

First, they found doctors who told them their pain was real. Getting a clear diagnosis and having a medical professional recognize their physical limitations helped them understand that they could never look healthy and strong as expected, no matter how hard they tried.

This released them from the pressure of trying to do so.

Second, most of these people had employers who cared more about what they did – the work itself – and less about how their body looked and moved, even if this meant finding a new job or even changing their profession. As a result, they felt free to ask colleagues for help, stretch during meetings, use dictation software instead of typing, or keep the camera off during Zoom calls so they could lie down when their backs were aching.

They also came up with creative ways of working that were more efficient and better for their bodies. For example, an ultrasound technician told us that she learned to scan patients using both her arms instead of constantly using the same arm. A deli worker said she started using a cart to move heavy meats around the store.

Although we focused on how pressure to be strong and healthy can hurt workers with chronic pain, we believe our findings could matter to everyone – no matter their size, strength, age or employment status.

After all, it’s possible to feel social pressure to conceal aches and pain when you’re in public settings of any kind. And failing to move around when needed or take care of your body in other ways can make you vulnerable to more pain.

Beth Schinoff, PhD, is an Assistant Professor of Management in the Alfred Lerner College of Business and Economics at the University of Delaware.

Elana Feldman, PhD, is an Associate Professor of Management in the Manning School of Business at UMass Lowell and a former Visiting Scholar at Harvard Business School.

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

Pain Patients Ridicule FDA Plans for Opioid Disposal Systems

By Pat Anson

Should the FDA require pharmacies to provide in-home opioid disposal systems to patients, so they can safely dispose of their unused pain medication?

That’s the question being asked by the FDA in the Federal Register as it seeks public comment on the agency’s latest effort to combat opioid abuse. Although opioid prescriptions have already been reduced significantly – by 50% or more since 2011 – the FDA claims many pain patients still have excess opioids that can easily fall into the wrong hands.

“Having unused opioids laying around at home can be a significant risk to those struggling with opioids and can be a gateway for opioid-naïve family members,” said FDA Commissioner Marty Makary, MD. “We need to develop creative ways to address opioid misuse and abuse.”

Do patients really have opioids “laying around at home” that they don’t need? Given how far opioid prescriptions have fallen and how difficult they are to obtain, some find the idea laughable.

“Ridiculous, waste of money. I'm pretty sure there aren't any leftover pain medications that need disposal because they're not being prescribed to people who truly need them. This is like one of the most ridiculous wastes of money I have ever seen,” wrote April Stetka in her comment on the FDA proposal.

“I live with chronic pain. I am scrambling all the time to get enough medication to alleviate my pain,” said Isaac Arnett Jr. “The idea that people getting prescribed opioids for pain have extras sitting around is laughable.”

“This new proposed regulation is asinine, inhumane, morally corrupt, and continues to push a narrative full of xenophobia and stigma against people who require opioid analgesics. No one in their right mind would throw away life saving medications that are impossible to acquire in proper pain treating doses, if at all,” said Rodney Hipsher

“What are you going to do? Are you going to go into everyone’s house and go through their cabinets, looking for opioids?” asked Catherine Harris. “This is just one more step in treating surgical and chronic pain patients as toddlers, unable to monitor their own use and their own opioids. You have absolutely no right. This whole practice has been barbaric and the federal government and everybody involved should be ashamed at how far these policies have gone.” 

The FDA already requires pharmacies to provide prepaid envelopes to patients to mail back their unwanted opioids. Many pharmacies also have kiosks where unneeded medication can be dropped off, and the DEA regularly has drug “take back” days in local communities. As a last resort, the FDA even recommends flushing some excess opioids down the toilet.

Despite these efforts, the FDA claims that opioid analgesics remain the most common class of prescription drug that is misused, with about 8 million people reporting past-year misuse.

The term “misuse” is misleading, however, because it includes anyone not rigidly following their doctor’s orders. That can include someone taking less medication than what’s prescribed, or someone who stops taking a drug because it doesn’t work, has unwelcome side effects, or simply because they don’t need it anymore. 

Opioids are so difficult to obtain for some patients that they’ve resorted to hoarding excess pills because they’re uncertain if or when they’ll be able to get them in the future. In a PNN survey, nearly a third (32%) of pain patients admitted hoarding opioid medication — patients unlikely to need or want an in-home disposal system.

The odds of any excess opioids falling into the wrong hands are also low. According to the DEA, the estimated diversion rates for hydrocodone (0.53%) and oxycodone (0.69%) are both well under one percent.

Do Disposal Systems Work?

The FDA is vague about how opioid disposal systems should work, only that they be able to “inactivate, sequester, and/or absorb the opioid analgesic” so that it can be safely disposed in household trash.

At least nine commercial drug disposal systems already exist, but because the systems are not regulated and there are no industry standards to follow, there is limited information on their effectiveness or safety. The FDA says there have been reports to poison control centers of children accidentally being exposed to the disposal systems and of patients misunderstanding what the systems are for and ingesting their contents. 

The agency provides no estimate of a possible cost of in-home disposal systems or who should pay for it. But even if they were purchased by opioid manufacturers or pharmacies, you can bet those costs would eventually trickle down to insurers and/or patients. 

An in-home disposal system that is relatively inexpensive is DisposeRx. For $28.99, patients can get a lockable storage kit and packets containing a chemical powder that, when mixed with water, will bind to a medication and make it unusable.

A woman with two teenagers who cares for her elderly sick parents spoke highly of DisposeRx. She worries about her teens having access to her parents’ medications, and tries to get rid of them as soon as possible.

“I would save up my parents’ old meds on the counter until I had time to take them into a kiosk. There have been times where the kiosk is full or out of service and then I have to take everything back home where it goes on the counter again. This actually increases risk,” wrote Lara Popovich. “Now, as soon as I have an Rx my parents no longer need, I use DisposeRx powder and get rid of it immediately.”

People interested in leaving their own comments in the Federal Register have until April 6. You can learn more about the FDA proposal and submit a comment by clicking here.

Why Chronic Pain Often Leads to Depression

By Jianfeng Feng, Trevor Robbins and Xiao Xiao

Chronic pain has long been known to be associated with depression.

Among adults with chronic pain, around 40% exhibit clinical symptoms of depression. But why is it that only some people with chronic pain develop depression?

Researchers have long been wondering why this happens – and what goes on in the brain. If we can answer this question, we may be able to prevent depression from developing.

Our recent article, published in Science, suggests the answer to this question does indeed lie in the brain.

To conduct our study, we analysed neuroimaging brain scans from 14,462 participants from the UK Biobank cohort. We compared the following groups of participants: people with chronic pain for at least seven years who did not have symptoms of depression, and people with chronic pain who also developed depressive symptoms.

For the latter, the depressive symptoms were present either for the entire seven-year period, or they developed after two years or four years. This enabled an analysis of the development of depression associated with chronic pain, using brain imaging.

These neuroimaging analyses revealed something surprising was taking place in the brain – specifically in a structure called the hippocampus. The hippocampus has important functions in learning and memory.

In the participants who reported chronic pain without depressive symptoms, they showed modest increases in hippocampal volume and improved memory performance. This is consistent with the brain attempting to cope with the stress of the pain.

In contrast, people experiencing both chronic pain and depression exhibited reduced hippocampal volume and impaired cognitive performance. Further analyses of these scans suggested these changes developed progressively over time. This indicates that the hippocampus may initially adapt to persistent pain, but it gradually becomes vulnerable when pain continues over long periods.

Importantly, similar patterns were observed across multiple categories of chronic pain – including back, stomach, knee and hip pain, as well as headaches. This suggests that the findings were not specific to a single type of chronic pain condition.

We then studied how these brain changes unfolded in people with chronic pain by using rodent animal models. This research found that in animals there was a similar sequence of changes in the volume of the hippocampus, accompanied by increased neural activity. Moderate improvements in cognitive functioning occurred initially, but this was then followed by anxiety-like behaviour, which later transitioned to depressive-like symptoms and poorer memory.

The hippocampus has long been known to be involved in emotional memories and is highly susceptible to chronic stress. The hippocampus’s plasticity (the ability to form new nerve cells) is known to be involved in coping with chronic stress.

Chronic stress has also been implicated in exacerbating apoptosis (nerve cell death) and suppressing adult neurogenesis – the process of producing new nerve cells in the hippocampus.

We found that a region of the hippocampus known as the dentate gyrus – one of the few areas where new brain cells continue to form in adulthood – emerged as the critical regulatory hub and the pivot for the transition from chronic pain to depression.

Early in the pain process, newly generated neurons in the dentate gyrus showed increased activity – suggesting the brain initially mounts a protective response to persistent pain. Over time, however, immune cells, known as microglia, became abnormally activated and disrupted normal neural signalling in the hippocampus.

This abnormal microglial activation appeared to mark the tipping point at which the brain’s initially protective response to pain began to fail.

Importantly, an antibiotic treatment, minocycline, suppressed abnormal microglial activation and reduced depression-like behaviour in the animal models. This treatment also preserved the structure of the hippocampus and cognitive function.

Treating Pain and Depression

Our findings suggest that a treatment such as minocycline could help prevent depression in people living with persistent pain — particularly if treatment is introduced early.

Of course, other psychosocial, socio-economic and genetic factors play a role in the perception of pain. Therefore, it’s likely that in some people these factors will exacerbate chronic stress and the experience of pain.

However, there are other evidence-based ways to reduce the risk of depression. In another collaborative study between Fudan University and the University of Cambridge, it was shown that seven healthy lifestyle factors, including good sleep, exercise and diet, could reduce the risk of depression by 57%. Importantly, these lifestyle factors were also associated with increased hippocampal volume, consistent with our new study.

Mindfulness training may be another strategy. This focuses on being present in the moment and minimising distraction from competing thoughts and memories. The practice is shown to improve working memory and increase hippocampal density.

A recent review showed that mindfulness meditation experts have increased brain grey matter, including the hippocampus. Mindfulness meditation training was also shown to lead to increased hippocampal volume.

Mindfulness practice has also been found to be beneficial for improving quality of life – not only when coping with chronic pain – and for reducing symptoms of stress and depression.

Our discovery has answered an important question that has long puzzled researchers. We showed the key role the brain’s hippocampus plays in why some chronic pain sufferers develop depression. This discovery also points to potential treatments that may prevent depression in people with chronic pain.

The brain’s coping mechanisms that we discovered may also apply more generally to other conditions where the brain has to cope with chronic stress – such as in psychological trauma.

Jianfeng Feng, PhD, is a Professor of Science and Technology for Brain-Inspired Intelligence at Fudan University.

Trevor Robbins, PhD, is a Professor of Neuroscience at the University of Cambridge.

Xiao Xiao, PhD, is an Associate Professor of Science and Technology for Brain-Inspired Intelligence at Fudan University

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