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.

Doctors Increasingly Mention Kratom in Patient Notes

By Crystal Lindell

Kratom is a hot topic these days, as states and local governments scramble to enact bans on the sale of kratom or put age limits on who can purchase the controversial herbal supplement.

Kratom is also being talked about more in hospital settings, according to a new study published in JAMA Network Open.

The study looked at how often the word “kratom” was mentioned in clinical notes after an emergency department visit or hospitalization at Mass General Brigham (MGB), a large healthcare system based in Massachusetts. 

Researchers looked at patient records between 2017 and 2024, and found a steady increase in kratom being mentioned, both in the ER and in the hospital – about 15% a year in the case of hospitalizations. 

Mentions of “Kratom” in Patient Notes

JAMA NETWORK OPEN

Researchers did not analyze the context under which kratom was mentioned, only that that word “kratom” was included in the clinical notes. Whether or not kratom caused a health problem for patients was not studied.

But that didn’t stop researchers from sounding the alarm about the growing use of kratom and its potent alkaloid, 7-hydroxymitragynine (7-OH). 

“Clinicians should routinely inquire about kratom use and inform patients of its risks and benefits. While additional research on kratom’s therapeutic potential may be warranted, a focus on the serious adverse effect profile from kratom, 7-hydroxymitragynine, and other kratom alkaloids is urgently needed,” wrote lead author Anika Kopczynski, a clinical researcher at Brigham and Women’s Hospital..

Researchers found that doctors who mentioned kratom in their patient notes were mostly treating white males between the ages of 20 and 49. 

Kratom has been used for centuries in Southeast Asia as a natural stimulant and pain reliever, but its use in the United States is relatively new. Estimates on the number of Americans who have used kratom vary widely, from 1.7 million to as many as 20 million.

“The significant increase of encounters with kratom mentioned in our health care system indicates a need for greater clinical awareness,”  said Kopczynski.

Kratom has not been approved by the FDA for any medical condition, and health officials say it has opioid-like effects that can lead to addiction and overdoses. The evidence supporting those claims is thin however, as most of the overdoses involve other substances. 

While “greater clinical awareness” of kratom and 7-OH is probably a good idea, it’s unclear what advice healthcare providers should give to patients about kratom’s “risks and benefits.”  

Should they tell them kratom is “gas station heroin” – as it is often depicted in the media? 

Or should they say it is “safe and well tolerated” with “no evidence of meaningful abuse potential,” as a recent study found?  

The gap between those two conclusions is likely to confuse both patients and doctors, and lead to less discussion, not more.

Unfortunately, opioid-phobia has turned many patient-doctor appointments into something closer to a visit with a probation officer. And the last thing you want to tell your probation officer about is additional substance use. 

Pain sufferers are rightly worried that anything they say will be used against them, and cited as a reason to reduce or even eliminate opioid prescriptions. Even non-opioid patients have a right to be worried about discussing kratom, because they won’t know how that information will be perceived or used. 

So it’s a little short-sighted to advise clinicians to ask patients about their kratom use, without also noting how uncomfortable patients may be with that line of questioning. 

While I have long called for more research into kratom, the predictable focus on its “serious adverse effect profile” is frustrating. I would argue that research into kratom’s potential benefits is needed just as urgently.

Clearly there’s a need for more education about kratom for medical professionals, but my hope is that some of that education is based on research into actual patient experiences.   

U.S. Overdose Deaths Down Significantly

By Pat Anson

The number of fatal drug overdoses fell sharply in the U.S. in 2024, led by a significant decline in deaths involving illicit fentanyl, according to a new analysis.

Over 79,000 Americans lost their lives to a drug overdose in 2024, compared to 105,000 in 2023, a 24.5% decline in one year. Over 54,000 of the deaths in 2024 involved an opioid of some kind. 

The analysis by KFF further demonstrates the declining role of prescription opioids in the nation’s drug crisis. Prescribed opioids are now involved in about one in seven (13.6%) drug overdoses. 

In 2024, 10,851 Americans died from an overdose involving a natural or semi-synthethic prescription opioid, compared to 47,735 deaths involving synthetic opioids, mostly illicit fentanyl. 

Deaths from prescription opioids peaked at 17,029 in 2017 and have steadily declined.

U.S. Opioid Overdose Deaths 2004-2024

SOURCE: KFF

“Since the opioid epidemic was declared a public health emergency in 2017, it has claimed more than half a million lives. While the epidemic was initially driven by prescription opioids and heroin, it has evolved in recent years, to be dominated by illicit synthetic fentanyl — a substance significantly more potent than morphine,” KFF said. “Provisional CDC data suggest opioid deaths have continued to decline through 2025.”

The KFF analysis also looked at deaths involving alcohol, suicide and firearms.

In 2024, 48,824 American lives were lost to suicide, down slightly from the previous year. Firearms accounted for 57% of those deaths. There were 46,714 “alcohol-induced” deaths in 2024 caused by health conditions attributed to excessive alcohol use, about the same number of fentanyl overdoses.

Those deaths greatly outnumber fatal overdoses involving prescription opioids.

U.S. Deaths in 2024

Source: KFF

As PNN has reported, a recent study ranked alcohol as the 5th most harmful drug In the United States, behind illicit fentanyl, methamphetamine, crack and heroin. Prescription opioids ranked as the 7th most harmful drug in the U.S.

The analysis not only looked at the direct harm to drug users, but the indirect harm to families, communities and society at large caused by excessive drug use.

A panel of experts said the analysis shows how misdirected U.S. drug policy is, which is focused on crime and punitive measures to stop drug use, rather than public health measures to address substance use disorders. Criminalizing drug use may also be making the drug crisis worse, by taking legal drugs away from people who benefit from them.   

“All drugs have benefits to people who use them at least initially, and some may have ongoing benefits. For legal drugs, there may be social benefits like employment in related industries and taxation to fund public services,” wrote lead author Michael Broman, PhD, an Assistant Professor at The Ohio State University College of Social Work.

“Redirecting resources towards harm reduction may reduce social harms by reducing the economic cost of policing and surveilling people who use drugs. Concurrently, PWUD (people who use drugs) could remain contributing members of their families and communities.”

Reflecting on 13 Years of Chronic Pain

By Crystal Lindell

I first developed chronic pain in February 2013. I remember the month because it was Super Bowl weekend and I went to a party to watch the game.

That was the year they had a long blackout delay, so the game ended up running super late. I stayed until the end.

I woke up the next morning with some soreness in my right ribs, and I assumed that I must have just lifted something wrong at some point. It got so bad I went to the ER.

While I had no idea at the time, my life was changed forever that weekend.

I was 29.

Within six months I was celebrating my 30th birthday at my new place: my mom’s house.

I had moved back home, an hour and a half away from my old apartment. I quit my second job, and shifted my full-time job to mostly work-from-home.

I spent the next few years desperately seeking answers, while trying to figure out a medication regimen that actually worked for me.

I also got extremely depressed.

I watched the entire TV series House, hoping to find an episode about a patient with the same symptoms as mine. I never did.

I mostly lingered without a diagnosis.

Eventually, the doctors decided to call it “intercostal neuralgia.” But that basically just meant “rib pain.” And how it had happened or why, they had no clue. They also had no idea how to treat it beyond managing the pain.

My long-term boyfriend – the one I had been with long before I got sick -- cheated on me. We broke up.

I cried a lot. I cried because my heart was broken, but also because my body was broken. I cried because of the physical pain, and I cried because of the emotional pain.

Then, finally, on March 15, 2018, I was diagnosed with hypermobile Ehlers-Danlos Syndrome (hEDS). I remember the date because it was the Ides of March. And the day felt just as ominous to me as I imagine it was for Julius Caesar.

A moment I had long hoped for, one where I finally got some answers, instead turned to extreme grief.  

But that night, I went to a local political event in town and ran into this guy I knew named Chris. A week later we went on a date to see the movie Black Panther, and we have been together ever since.

In fact, we are celebrating our eight-year anniversary this Sunday.

At the time of my hEDS diagnosis, I was so worried that I would never find a man who could love my broken body. But within just a few hours, I was proven wrong.

Lessons Learned

Over the last 13 years of life with chronic pain, I have learned that I was wrong about a lot of things. As it turns out, pain is an extremely strict, rigid teacher. 

I used to believe the government messaging that “all opioids are always bad for you.” But these days I now advocate for patient access to opioid pain medication.

I used to think that if you told a doctor your exact symptoms, that they would be able to find out what was wrong with you and be able to fix it. 

Now I know that if you want to get treated, you have to be your own biggest advocate.

I also honestly believed that I had good health insurance. I truly did think it would cover most of my medical expenses if I ever got sick. 

But after drowning in medical bills for more than a decade, I have come to realize that the only people who like their health insurance are the ones who never need to use it.

I also thought my ex-boyfriend and I could get through anything together. Clearly, that was not the case.

I assumed that my friends would be sympathetic with what I was going through. But in the end, chronic pain left me with a much smaller circle of loved ones. 

I also like to think that chronic pain has made me a more empathetic person. When I meet other people in pain, I do my best to show them empathy and to give them realistic advice that could actually help them.

Today, over a decade since I first woke up with chronic pain, it’s difficult to envision what my life would have been like if I had never gotten sick. 

So many of my life choices have revolved around my pain – from who I live with, to who I love, and to what I do for work.

To be completely honest, I like my life right now. Yes, I wish that I didn’t have to arrange my entire day around my physical pain. But I love what I do, I love the people I spend my days with, and I am content.  

I think that, in a lot of ways, chronic pain forced a contented life onto me. It forced me to evaluate everything I did, to see if it was actually necessary and if it was actually worthy of my time and energy. What was left was only the best parts. 

It is noteworthy that my pain is pretty well managed these days, at least compared to how bad it was in 2013. I still have bad flares, but for the most part, my medications help me get through the day. 

Looking back, there are so many dark nights in my past where I felt like the best choice was to just give up. So many painful hours in bed where I genuinely considered killing myself. 

But now, after 13 years of this life with chronic pain, I am so relieved that I decided to keep living it.

Low Vitamin D Levels Linked to Chronic Low Back Pain

By Pat Anson

Low levels of Vitamin D are a leading cause of disability worldwide and have been associated with fibromyalgia, rheumatoid arthritis, migraines, and musculoskeletal problems. 

A new study in India suggests the “sunshine vitamin” may also play a role in the development of chronic low back pain.

Researchers at a teaching hospital in eastern India took blood samples from 75 adult patients with chronic low back pain and found a remarkably high rate of low vitamin D serum levels – a condition known as hypovitaminosis D.

Over two-thirds of the patients (69.3%) had “deficient” levels of Vitamin D, while the remaining ones had serum levels that were below normal and considered “insufficient.” 

“Notably, none of the participants had sufficient serum vitamin D levels. These findings are in agreement with existing literature reporting a high prevalence of hypovitaminosis D in the Indian population, even in regions with adequate sunlight exposure,” wrote lead author SK Imran Ali, MD, an orthopaedic surgeon at Dr. Bidhan Chandra Roy Hospital in Haldia. 

Ultraviolet rays in sunlight are the principal source of Vitamin D for most people. India usually gets a significant amount of sunshine, especially from October to May, so why would Vitamin D levels be so low?

Vitamin D deficiency rates on the Indian subcontinent range from 50% to as high as 95%, a phenomenon attributed to darker skin pigmentation, poor diets, and increasingly sedentary (indoor) lifestyles with little sun exposure.

While researchers found an association between chronic low back pain and hypovitaminosis D, they did not establish a causal link. Pain severity and disability levels were about equal between the “deficient” and “insufficient” groups, and between men and women.

Researchers did find that patients from lower socioeconomic classes were statistically more likely to have inadequate Vitamin D levels compared to those in the upper class.

“This observation aligns with existing evidence indicating that socioeconomic factors influence nutritional status, sun exposure, dietary quality, and access to healthcare services, all of which may affect vitamin D levels,” researchers found. “Individuals from lower socioeconomic backgrounds may have limited access to vitamin D-rich foods, reduced opportunities for outdoor activity, and decreased healthcare access, thereby increasing the risk of hypovitaminosis D.”  

In addition to sunshine, you can increase your Vitamin D levels by eating oily fish and eggs. Vitamin D has a wide range of positive health effects, such as strengthening bones and teeth, and inhibiting the growth of some cancers. Vitamin D also improves immune function and reduces inflammation.

I Am Being Forced Off Oxycodone in the Name of Opioid Rotation

By Neen Monty

The current myth in opioid science is that buprenorphine is inherently safer than oxycodone.

The truth is far more ordinary: it depends on the individual. Some people do better on buprenorphine. Others do better on oxycodone. There is no universal “safer” opioid for every patient.

I have trialed buprenorphine before. It was profoundly sedating. I could not function on it.

Despite this, I was required to trial it again.

Here’s what happened.

Week One: Hope

The first few days were incredible.

Less pain.

More functional hours.

And I was sleeping until 5am!

I was thrilled to be wrong about buprenorphine. I ignored the severe nausea and the nagging headache because I could go back to the archery range. I started planning a fitness routine. I allowed myself to feel hopeful.

Week Two: Wearing Down

The nausea intensified. Even with ondansetron (Zofran), it was relentless.

The headache persisted. Not dark-room migraine territory, but just constant enough to make thinking difficult.

Panadol. Nurofen. Naproxen. Nothing touched it.

I also realised my mood had shifted. I felt low. Irritable. Short-tempered. Sad. Defeated.

I controlled it. I always do. I don’t take out my moods on others. My children didn’t see it. They saw normal. They did not see the enormous effort it took for me to stay calm and reasonable. 

The crying happened in the one private space I have: the bathroom. The sadness stayed hidden.

Week Three: Something Was Wrong

By week three, I was done.

My pain doctor told me to persevere. I did, as long as I could. At the end of week three, I ripped the buprenorphine patch off and did not apply the next one.

Enough was enough.

Within four days the nausea was gone.

The headache was gone.

I could think again. I could function again.

You never realise how severe something is until it stops.

Why did I tolerate it for so long? Because if I am labelled “non-compliant,” if I am judged not to be trying hard enough, I risk being forcibly tapered off all opioid medication.

And that would be catastrophic for me.

So, I tried.

Positive attitude! Yes, Doctor. I will trial it. With a smile on my face.

But I cannot continue with buprenorphine.

Next: Palexia

Now the rotation moves to another opioid: Palexia (tapentadol).

Doctors have been convinced that these newer opioids are “safer” than oxycodone. There is no high-quality evidence showing they are safer for stable, long-term chronic pain patients. But the safety narrative has been repeated so often, it is treated as fact.

Palexia is now the most commonly prescribed opioid in Australia. It has overtaken oxycodone. This did not happen because Palexia offers improved pain control. Or because it has fewer side effects. Or because it’s safer.

It happened because doctors were encouraged — in some cases pressured — to rotate patients off their “old school” opioids, to “atypical opioids” like Palexia, buprenorphine, and even tramadol.

A patient’s preference is no longer central. Being stable on a dose is no longer enough.

Opioid rotation is being enforced on me for two reasons.

First, because policies and guidelines position buprenorphine and tapentadol as the “safest” opioids. This is not evidence based; it is opinion.

Second, because I am not getting enough pain relief from my current regimen. My 20mg of oxycodone stops working after 6-8 hours, when it should last 12 hours.

The obvious solution is to prescribe it every 8 hours, instead of every 12 hours. That’s what happened in the past and was the standard of care. Because it is well recognised that the 12-hour formula rarely lasts 12 hours. 

But that would put me over the arbitrary daily dose ceiling of 100 MME. Which is also not evidence based. 

What is evidence based is that I was happier, healthier, fitter and more functional on 120 MME, rather than 100 MME.

But my well-being, pain control and function are not the important issues here.

Instead of the simple and obvious solution, the only solution is opioid rotation. The theory being that I have built up tolerance to oxycodone, but I have not built up tolerance to buprenorphine or tapentadol. So those medications will supposedly work better for me.

Except that’s not how it works in the real world.

Pain relief is not the goal here. It’s just not that important. It’s a money-making policy masquerading as “safety.”

Follow the money if you want to understand rapid prescribing shifts. Pharmaceutical policy rarely moves without financial incentive.

But here is the uncomfortable truth: My GP is not corrupt. She is not malicious. She is a very good GP. She is following guidelines.

She does not have time to audit every citation behind every recommendation on every guideline for every condition she treats. She has to trust her medical college, her training, and the documents placed in front of her.

That trust is not deserved. At least when it comes to treating chronic pain.

The current Australian guidelines are built on expert opinion, not randomised controlled trials. Opinion, layered over selective and cherry-picked evidence. Shaped heavily by academic pharmacology and population-level policy concerns. Not patient outcomes, preference, function or stability.

And patients like me pay the price.

A Four-Week Pause

I told my GP I cannot continue buprenorphine.

She immediately began discussing Palexia.

I asked for four weeks. Just four weeks to stabilise. I am only just beginning to feel like myself again. I am only just becoming functional again. I just lost four weeks of my life to the last rotation attempt. I don’t feel ready to tackle the next medication yet.

I need to take a breath. I need to get back to “normal.” Albeit my normal.

This rotation destabilised me. Made me far worse, not better. 

Also, it would make medical sense to start the next medication from a steady baseline, not during biochemical and emotional turbulence.

She agreed. Very readily. I didn’t have to argue my case. I very much appreciate that. She prescribed my usual regimen of oxycodone extended release and immediate release.

So, for four weeks, I remain on oxycodone. For four weeks, I will stabilise. And feel like myself again.

After that, the forced rotation begins again. I have trialed Palexia before, a few years ago. It did not go well. But still, I am being forced to trial it again.

Round and round.

None of this is my choice.

None of this is evidence based.

None of this is for my benefit.

The Systemic Problem

This is not just about me.

Patient choice has been steadily displaced by policy-driven prescribing. Stability is no longer considered sufficient. Long-term patients who are functioning are being told their medication is “unsafe.” Not because of their individual outcomes, but because of population-level risk narratives built on low-quality evidence and relative risk framing.

Meanwhile, newer opioids are positioned as “safer” without robust comparative long-term data in stable chronic pain populations. 

When prescribing patterns shift this dramatically and this quickly, it is reasonable to ask whether evidence alone is driving the change.

Medicine should be individualised. Instead, it is being standardised around risk optics, regulatory anxiety, and market forces.

And patients bear the instability.

Yes, some patients can safely be rotated, with no adverse events. But not all patients.

A large percentage are objectively and substantially worse off. But this does not matter. Patient satisfaction, patient function, pain relief are all secondary concerns. Often not considered at all. Or, if acknowledged, are dismissed as the patient being difficult or non-compliant.

Patients no longer have any agency, any choice, any control, or even a voice.

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.”