People in Pain Need Healthy People to Fight for Them

By Neen Monty,

I haven’t written much lately, because I am sick.

I am not lazy, I do not lack commitment. Or motivation. Or determination.

That is an unfair characterization, an unfair criticism. One that is not uncommon for people who live with chronic pain or a chronic illness.

We are judged to be lazy, exaggerating, malingering, drug seeking. None of it is true.

I am sick. And I am disabled. But I am not just a “chronic pain patient,” as many like to reduce me to. “Chronic pain” is not my identity. It’s not who I am.

However, pain does dictate what I can and cannot do. Every decision I make is influenced and decided by my pain levels. Or rather, how much pain medication I am allowed to utilize.

If I did not have pain, I would still be disabled and sick every day. I never feel “good” in the way that healthy people feel good. I am always fatigued, weak and in pain. And I sure as heck do not choose that. No one would.

We, people like me, need allies. We need people to help us. Because we are too unwell to put 40 hours a week into advocacy and awareness raising. We don’t have that kind of time and energy.

We need people who are healthy to fight for us.

Because helping people who live with painful, progressive, incurable disease should be a given. Helping people who have experienced severe physical trauma and injuries should be a given. People should feel empathy for the ill and infirm. For the injured and traumatized.

Societies are judged on how they treat their weakest members. By this standard, our society is not doing well.

To help, you first have to understand, listen, and believe. You must trust that what we are saying is true.

You cannot be that doctor who “knows better.” The one who makes snap judgements about the woman who walks into the exam room limping, dressed in old clothes, and unkempt. Clearly a hysterical woman with psychological issues.

It’s doctors like that who misjudged me, leaving my serious and rare neurological disease undiagnosed. Because of those four neurologists who judged me, I now must live with constant and severe neuropathic pain every second for the rest of my life.

The insult to injury is that no doctor wants to prescribe opioid pain medication to allow me to manage that pain. To make the pain bearable. To make my life functional.

Had the first neurologist, or even the second one, done their job and diagnosed my disease over ten years ago, I would have had a chance at remission or even reversing the damage. Now? Not much hope of that. I’ll be lucky if the disease is slowed down a tad.

Judgement vs. Empathy

People who have no pain cannot understand what it is like to live with constant, severe pain.

But everyone can show empathy and compassion and kindness -- if they choose to.

I don’t receive a lot of empathy, compassion or kindness. I receive a lot of judgement. I receive a lot of trolling.  I have even been stalked.

Recently, when I had a crisis due to pain and forced opioid tapers, several very kind, empathetic and compassionate people reached out to me. Most were physiotherapists, also known as physical therapists. I cannot tell you how much their support and kindness meant to me. I will never forget.

These are some of the best people I have ever had the privilege to meet or chat with. Some don’t agree with my opioid use, and my opioid advocacy. But they still reached out to help me. I am so very grateful for that.

Many people still don’t believe my various illnesses are real. As I said, I went undiagnosed for over a decade because four neurologists decided I was just a hysterical woman.

Turned out I have a very serious disease. It took neurologist number five, and ten years, to get that diagnoses.

That should never happen, but it’s very common. Women are very often ignored, dismissed, accused of exaggerating or being hysterical.

I used to be a gym junkie, nutrition nazi, a super fit person. I did not bring any of this on myself though poor choices. Though people do love to tell me I did.

All I’m asking for is a better quality of life. And less pain.

I advocate strongly for people like me to have access to whatever pain treatments work. I am not pro-opioid. I am pro pain relief.

When I was in crisis, I also received messages from two doctors. One told me opioids do not work for pain, and that I should be ashamed of myself for promoting them. The other told me if doctors are not prescribing, I must be an addict.

Very unkind. They saw a person in crisis and thought that was a good time to attack. I cannot imagine that they treat their patients with respect, kindness and compassion, if that’s the way they treat me.

I am not able to do much work at the moment. I am far too unwell. My colleagues who live with constant, severe pain also have periods like this.

We support each other as much as we can, but we need support from healthier people.

We need allies.

We need people who live with less severe pain to help.

We need healthy people to help.

We need doctors, therapists, nurses and pharmacists to unlearn the crock science they’ve been taught and learn about real chronic pain. All the many types of chronic pain, not just one.

We need them to learn about chronic pain from the people who live with it. Not the people who profit from it.

We need allies.

Neen Monty is a writer and 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. She has created a website for Pain Patient Advocacy Australia to show that prescription opioids can be safe and effective, even when taken long term. You can subscribe to Neen’s free newsletter on Substack, “Arthritic Chick on Chronic Pain.”

Sen. Joni Ernst Said the Quiet Part Out Loud

By Crystal Lindell

Last week Sen. Joni Ernst (R) of Iowa said the quiet part out loud at a town hall meeting. 

While responding to a comment about President Trump’s planned Medicaid cuts possibly killing people, Ernst shrugged and said, “Well, we all are going to die.”

Her remark drew a chorus of boos, as you’ll see in the video:

Ernst may have been talking about Medicaid, but the implication was that everyone was going to die eventually. Of course, the key word here is “eventually.”

There’s a big difference between dying at 21 and dying at 97. Just because someone is going to die eventually, that doesn’t mean that it’s OK for them to die today. In fact, that’s why when someone cuts another person’s life short via murder, we usually punish them for doing so. 

I’m sure Ernst can understand this concept when it comes to herself. After all, I doubt she’d be OK with being denied urgent medical care herself, and then being met with a shrug and a dismissive, “Well she was going to die anyway.” 

The thing is, Ernst wasn’t thinking of herself when she made the comment. Rather, she was thinking of the general public, the masses if you will.  

She was thinking of you and me. 

And to Ernst, our lives are disposable. We are just the peasants who are going to die eventually, so we might as well die today as far as she’s concerned.

Just in case you thought that perhaps Ernst misspoke or was taken out of context, she doubled down a day later with a weird selfie video filmed in a cemetery, of all places. 

“I made an incorrect assumption that everyone in the auditorium understood that yes, we are all going to perish from this Earth. So I apologize,” she said in the video, before glibly adding, “And I'm really, really glad that I did not have to bring up the subject of the tooth fairy as well."

You can see her full “apology” here:

Our lives are truly just a joke to Sen. Ernst.

The thing is, as a chronically ill patient with a bachelor’s degree in political science, I can report that Ernst’s blase attitude about our deaths is all too common. Both our political leaders and many of our healthcare professionals view the (lack of) value of our lives the same way she does. 

You saw it in the government’s poor response to the COVID pandemic, when they did things like prioritizing the economy over people’s lives. 

You also see it Trump’s “One Big Beautiful Bill,” which would take healthcare benefits away from 10 million people and cut $700 billion from Medicaid

And you see it in the way that chronic pain patients are treated by doctors and government policies. 

Many doctors will do anything to avoid the personal stress and intense scrutiny from law enforcement and state medical boards for prescribing opioids. And some don’t care if it means that patients suffer or even die as a result. Doctors know that untreated pain can be dangerous, especially if it pushes patients to the black market looking for relief. 

They share the same attitude that Ernst expressed: “We all are going to die.”

Most doctors would do anything possible to extend their own lives. They would also do anything possible to extend the quality of their lives, even if that means taking the same opioids they might deny pain patients. 

The root of these issues is that a lot of people with power – whether its political power or power in the exam room – see themselves as belonging to a superior class of humans. And anytime a human feels like they are superior to another human, they can start to justify some really awful things. 

Ernst saying, “We all are going to die” is the natural end point of that thought process. 

But she wasn’t talking about herself.

What Ernst really meant was much darker: “You are all going to die – and I don’t care.”

Care and Control of Adhesive Arachnoiditis Depends on Water

By Dr. Forest Tennant

Chronic illness tends to decrease one’s desire to drink fluids. If you have Adhesive Arachnoiditis (AA), however, you must drink some fluids about every 2 hours while awake. Why?

AA is an inflammatory disease of the spinal canal in which cauda equina nerve roots become attached by adhesions to the arachnoid-dural membranes covering the spinal canal. 

The arachnoid membrane is unique among tissues in the body as it doesn’t have its own blood supply. No arteries feed into it. Consequently, it depends on a “full tank” of spinal fluid that comes from the fluids you drink. Spinal fluid brings nutrients and medication to the arachnoid. It also bathes the inflamed area and washes away inflammatory waste and toxins.

Spinal fluid must be constantly kept at a high level. The body makes about 500 milliliters (17 ounces) of spinal fluid a day. If you are dehydrated due to lack of regular fluid intake, you may not make enough spinal fluid to control AA, including its pain.

Water Soak Every Day

Soaking in water daily is also important to control pain and inflammation from AA.

Water soaking is an age-old remedy for pain that is still worthwhile. It is believed to relieve pain by relaxing muscles and increasing blood flow to damaged areas of the body.  

Water soaking also extracts excess bioelectricity and inflammatory toxins that have accumulated due to inflammation and damage to the neurologic circuitry in the body. 

Here is a list of water soaking measures that are applicable to a person with AA: 

1. Stand in the shower and let water flow off your back, neck and legs.

2. Immerse your body up to your neck in a bathtub, hot tub, jacuzzi or pool.

3. Drape a warm, water-soaked towel over your back.

4. Soak your feet and ankles in warm water.

The soaks should be done for 5 to 15 minutes. Minerals or herbs can be put in foot baths. The most popular mineral preparation is Epsom Salts.

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

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

5 Tips for Showering with Chronic Pain

By Crystal Lindell

One of the first things I had to come to terms with when I developed chronic pain in 2013 was that showers were no longer something I could do on a whim. 

My pain, which was eventually diagnosed as intercostal neuralgia in my right ribs, flares up when I put the energy and work into taking a shower. 

I’m not sure why showering seems to aggravate it, but I assume it’s related to the fact that I’m standing in one place for a long time, moving my arms in a certain way to clean my hair, and then the movements I do to get dressed afterward. 

All this means that I have to plan my showering schedule the way other people plan their gym workouts – with the expectation that I’ll need rest afterwards. 

I do still shower almost every day, because it’s important to me and I like feeling clean. But that doesn’t mean it’s not a struggle. And I will confess that there are some days when the pain is just too intense to get through a full shower. 

However, there are things you can do to make it both easier to shower with chronic pain, and to go longer periods of time between showers. 

Below are suggestions and advice that I’ve learned from living with chronic pain and caring for disabled relatives who live near me. 

Tip 1: Change your showering schedule to nights 

The first thing I did when I realized that showering was going to be an ordeal was to shift to showering at night. This sounds like a small thing, but for me it was a major change in my daily routine. 

Back when I started having chronic pain, I was still driving into an office everyday for a day job. Getting up to take a full shower, wash my long hair, and then get dressed in office clothes sometimes meant that I didn’t have the ability to drive into the office at all. I would literally have to call my boss to ask if I could work from home or take a sick day. 

When I realized that I no longer had the luxury of showering in the morning, I shifted to doing it the night before. That way, I could save my morning energy for throwing on clothes and light make-up before heading to work.

I no longer drive into an office job everyday, but I do still shower at night if I have anything I have to do outside of the house in the morning. 

It’s honestly one of the foundations of living with chronic pain: you have to plan out things that you didn’t have to think about before. You have to make sure you’re rationing your energy to get the most out of your limited supply. 

For showering, that means scheduling it for times when it doesn’t conflict with other high-energy activities. 

Tip 2: Use dry shampoo when you can’t shower

A lot of people already know about the wonders of dry shampoo, and how it can help you go longer between washing your hair. But most people don’t realize that it works best when it’s used as a preventative measure to keep your hair relatively clean. 

The trick to getting it to work best is to use it on freshly washed and dried hair, so that it can absorb the hair’s natural oil as it comes in. 

There are a ton of dry shampoo options on the market, but in my experience, the more expensive ones aren’t necessarily better. So feel free to reach for whatever you see at your local drug store. 

Personally, I’ve had a lot of success with the Batiste Brand. I like that their shampoos come in a lot of different scents and that they even offer versions for brunettes, who want to avoid the white residue that’s common with dry shampoos. 

Tip 3: Sponge roller curls can help you go longer between hair washings

After watching Agent Carter – a 1940s Marvel super hero TV show – I went through a phase where I was obsessed with all things 1940s style, including hair. 

That’s how I accidentally stumbled onto my next tip: setting your wet hair in foam sponge rollers will help you go a lot longer between washes. The women of the 1940s did this because shampoo was rationed or hard to come by during World War 2. It turns out they knew what they were doing. 

That’s because curly hair, even if it’s been brushed out, does not get oily as fast as straight hair. So if you add curls to straight hair, you won’t have to wash it as often. 

Here’s a quick Youtube tutorial that goes over the basics of using sponge rollers. There are tons more in-depth tutorials if you’re interested. Just make sure your hair is completely dry before you take the curlers out, otherwise they won’t set.

There are sponge rollers on Amazon currently listed for less than $10, but you can also find them at almost every drug store and discount retailer. 

Of course, there is one massive downside to using sponge rollers or any type of curling method at home – they take a lot of time and energy to do your hair. 

However, most salons will offer a service called a “wet set” for a reasonable price. It’s a tried and true service for older women, who tend to be in the demographic of people who aren’t able to wash their hair every day. 

As part of a wet set, the stylist will usually use rollers to give you tight curls, and then style it afterwards so that you can go longer between hair washes. 

Tip 4: Invest in a shower chair 

There are also accommodations that you can use to get through a shower easier. For example, I think a lot of people don’t realize just how helpful a shower chair can be. 

While I don’t use one myself, I have relatives who use a shower chair, which often is the difference between them being able to shower vs. not being able to shower at all. 

These days, you don’t have to order shower chairs from special medical supply services. You can get them for a very reasonable price online. This shower chair on Amazon is currently listed for less than $40, and it features a removable back. 

Tip 5: Use cleansing wipes between showers

Of course, there may be days when you just can’t get through a full shower, but you don’t want to feel dirty. In that case, I suggest investing in some bath wipes for adults. 

Again, I have not personally used a product like this, but I have multiple disabled relatives who found them to be extremely helpful. 

These bath wipes on Amazon are currently listed for less than $20, and they claim to both cleanse and soften your skin. 

You don’t need bath wipes to achieve this effect though. A wet washcloth with some soap used in a few key places can also achieve a similar effect. 

Hopefully you found some good tips on this list, and if you have any other tips or advice for getting through a life where showering is sometimes a luxury, please share them in the comments below!

Pain News Network may receive a small commission from the Amazon links listed in this article.

Knee Arthritis Made Worse by Steroid Injections

By Pat Anson

Corticosteroid injections are often given to patients with osteoarthritis to reduce pain and inflammation in the knee joint, with the relief sometimes lasting for days, weeks or even months. A new study, however, found that steroid injections in the knee may only make arthritis worse in the long run.

The study by researchers at the University of California, San Francisco (UCSF) compared the long-term effects of corticosteroid injections to patients who received injections of hyaluronic acid, a polymer gel that acts as a lubricant and shock absorber.

The research, recently published in the journal Radiology, found that a single hyaluronic acid injection was associated with decreased progression of knee osteoarthritis up to two years later. Just one corticosteroid injection led to more knee joint damage.

“Our study directly challenges a common clinical practice: the use of corticosteroid injections for knee osteoarthritis symptom relief,” said lead author Upasana Bharadwaj, MD, who was a research fellow in the Department of Radiology at UCSF at the time of the research. “It presents robust evidence that corticosteroids accelerate structural knee degeneration, even after a single injection.”

Osteoarthritis (OA) is the most common form of arthritis, with the knee being the most frequently affected joint. Over 32 million U.S. adults have knee OA, and about 10% of them receive corticosteroid or hyaluronic injections.

UCSF researchers followed 70 patients with knee OA who had one injection -- 44 were injected with corticosteroids and 26 were given hyaluronic acid. MRI images were taken before, at the time of, and two years after the injection to assess how much damage and OA progression occurred in the knee joint over time. The scores were then compared to a control group of 140 patients who did not receive any injection.

The researcher team found that both types of injections helped reduce knee pain, but the corticosteroid injections were associated with more joint damage than both the control group and those who received hyaluronic acid injections. In contrast, the hyaluronic acid injections appeared to slow the progression of joint damage.

“The most striking finding is that a single corticosteroid injection led to significantly greater structural damage in the knee joint over two years, especially in cartilage, while hyaluronic acid injections not only avoided this damage but actually showed reduced joint deterioration post-injection,” Bharadwaj said. “Corticosteroids are known to reduce inflammation but also impair the repair mechanisms of cartilage.

“This study could lead to more judicious use of corticosteroid injections, especially for patients with mild to moderate osteoarthritis who are not yet surgical candidates.”

Current guidelines for knee OA often recommend corticosteroid injections for short-term pain relief, but limit the injections to one every three months or no more than three injections per year. Bharadwaj hopes the new research will persuade clinicians to opt for hyaluronic acid injections more frequently and stop the routine use of corticosteroids for knee OA.

“Given their widespread use, these findings could influence clinical guidelines and patient care decisions, encouraging more cautious use and stronger consideration of alternatives like hyaluronic acid,” she said. “The public impact is significant, as osteoarthritis is a major global cause of disability, and millions receive such injections annually.”

A 2022 study by researchers at the Chicago Medical School also compared corticosteroid injections for knee OA to hyaluronic acid injections. That study used X-ray images to evaluate patients after two years and came to the same conclusion that corticosteroids worsened osteoarthritis progression.

Pain Research and Treatment Missing From 2026 HHS Budget

By Pat Anson

An estimated 60 million Americans suffer from chronic pain, costing the U.S. healthcare system about $77 billion a year.  According to the National Institutes of Health (NIH), chronic pain affects more Americans than diabetes, heart disease, and cancer combined.

You’d never know it though by reading the proposed $94.7 billion budget for the Department of Health and Human Services (HHS) released on Friday by the Trump administration.

There are nearly 21,000 words in the 55-page budget for 2026, and not a single word or dollar is devoted to pain research, treatment, or how to help those 60 million Americans.   

The only reference to pain is a quote attributed to HHS Secretary Robert F. Kennedy, Jr.

“A healthy person has a thousand dreams. A sick person only has one, and right now, there’s 60% of the people in this country who have only one dream – that they can make it through the day without pain, with energy, without having to take medications, and we are going to change that for this country,” Kennedy is quoted as saying.

One can quibble about whether RFK Jr. actually said those exact words or if they were invented for the budget document. In either case, many Americans living with chronic pain already get through the day without taking an effective pain medication, although its not by choice.

Kennedy has previously used the line about “a healthy person has a thousand dreams,” which is paraphrased from Confucius. Kennedy used it without attribution in his Senate confirmation hearing in January and again when he was sworn in as HHS Secretary a month later, but didn’t mention pain in either instance.   

Perhaps it’s only fitting, given how the topic of pain is notably absent from the HHS budget. What we get instead are platitudes about “making Americans the healthiest in the world,” while at the same time reducing the HHS budget by 26 percent, and downsizing or eliminating dozens of federal health programs.

The NIH faces some of the steepest cuts, with its $27.5 billion budget cutback to $18 billion. The Trump administration has already gutted the NIH’s Office of Pain Policy and Planning (OPPP), which focused on pain research. The OPPP’s entire staff was fired in April.

“Even though chronic pain is one of the leading health issues in America, it has never had a true home at NIH with a dedicated institute. Many pain researchers have described the NIH as a place where ‘pain lives everywhere and nowhere,’ and now, with the dismantling of the OPPP, I fear that pain may literally have no home at all,” Dr. Juan Hincapie-Castillo, an assistant professor at UNC Chapel Hill, wrote in The Charlotte Observer. Hincapie-Castillo received funding from OPPP for his studies of trigeminal neuralgia.

‘Embrace Radical Change’

In all, HHS plans to consolidate 28 operating divisions into 15, close five of its regional offices, and end funding for 5,000 contracts – all in the name of saving money.

“This planned realignment will allow the Department to do more at a lower cost to taxpayers by increasing operational efficiency and cutting bureaucratic sprawl,” the budget document states.

“America spends nearly one-third of the federal budget on healthcare, only to rank last in terms of health among developed nations. Americans are seeing declines in life expectancy and facing the highest rates of chronic disease in the world. HHS is committed to making Americans healthy again, making the American health system the best in the world, and putting patients first. To accomplish this, we need to embrace radical change.”

HHS is planning to move several agencies — including the Substance Abuse and Mental Health Services Administration (SAMHSA) and some programs in the Centers for Disease Control and Prevention (CDC) -- into a new agency called the Administration for a Healthy America (AHA), which would be under Kennedy’s direct control. AHA will administer $14 billion in discretionary funding to combat the “chronic disease epidemic.”

“(AHA) will prioritize prevention — a missing piece in the American health system — primary care, maternal and child health, mental health, substance use prevention and treatment, environmental health, HIV/AIDS, workforce development, and policy, research, and oversight,” the HHS says.

Note the absence of pain prevention and treatment in that sentence.

Opioids are mentioned nearly half a dozen times in the budget, but only in the context of addiction treatment, not pain management. Many of the CDC programs that deal with opioid abuse and treatment are being moved to AHA, and $4 billion in block grants for mental health and substance abuse treatment is earmarked for states and rural communities.

“States and local communities best know the way to serve their populations – not the federal government,” HHS said.

When he was running for president, Kennedy had ambitious plans to create a series of “wellness farms” in rural areas, where people addicted to illicit or prescription drugs could get treatment, job training and grow their own organic food.

“I’m going to create these wellness farms where they can go to get off of illegal drugs, off of opiates, but also legal drugs, psychiatric drugs, if they want to, to get off of SSRIs, to get off of benzos, to get off of Adderall, and to spend time, as much time as they need — three or four years if they need it — to learn to get re-parented, to reconnect with communities, to understand how to talk to people,” Kennedy said in 2024.

There is no mention of wellness farms or anything like it in the HHS budget, or in the “Make America Healthy Again (MAHA) Report,” which was also released by the Trump Administration last month.

Like the budget document, pain research and treatment are not discussed in the MAHA report, which has been widely criticized for its sloppy science and fake citations, including some that were apparently generated by artificial intelligence (AI).        

American Doctors Are Moving to Canada to Escape Trump Administration

By Brett Kelman, KFF Health News

Earlier this year, as President Donald Trump was beginning to reshape the American government, Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and got out.

Michael now works in a small-town hospital in Canada. KFF Health News and NPR granted him anonymity because of fears he might face reprisal from the Trump administration if he returns to the U.S. He said he feels some guilt that he did not stay to resist the Trump agenda but is assured in his decision to leave. Too much of America has simply grown too comfortable with violence and cruelty, he said.

“Part of being a physician is being kind to people who are in their weakest place,” Michael said. “And I feel like our country is devolving to really step on people who are weak and vulnerable.”

Michael is among a new wave of doctors who are leaving the United States to escape the Trump administration. In the months since Trump was reelected and returned to the White House, American doctors have shown skyrocketing interest in becoming licensed in Canada, where dozens more than normal have already been cleared to practice, according to Canadian licensing officials and recruiting businesses.

The Medical Council of Canada said in an email statement that the number of American doctors creating accounts on physiciansapply.ca, which is “typically the first step” to being licensed in Canada, has increased more than 750% over the past seven months compared with the same time period last year — from 71 applicants to 615. Separately, medical licensing organizations in Canada’s most populous provinces reported a rise in Americans either applying for or receiving Canadian licenses, with at least some doctors disclosing they were moving specifically because of Trump.

“The doctors that we are talking to are embarrassed to say they’re Americans,” said John Philpott, CEO of CanAm Physician Recruiting, which recruits doctors into Canada. “They state that right out of the gate: ‘I have to leave this country. It is not what it used to be.’”

Canada, which has universal publicly funded health care, has long been an option for U.S.-trained doctors seeking an alternative to the American health care system. While it was once more difficult for American doctors to practice in Canada due to discrepancies in medical education standards, Canadian provinces have relaxed some licensing regulations in recent years, and some are expediting licensing for U.S.-trained physicians.

In mere months, the Trump administration has jeopardized the economy with tariffs, ignored court orders and due process, and threatened the sovereignty of U.S. allies, including Canada. The administration has also taken steps that may unnerve doctors specifically, including appointing Robert F. Kennedy Jr. to lead federal health agencies, shifting money away from pandemic preparedness, discouraging gender-affirming care, demonizing fluoride, and supporting deep cuts to Medicaid.

The Trump administration did not provide any comment for this article. When asked to respond to doctors’ leaving the U.S. for Canada, White House spokesperson Kush Desai asked whether KFF Health News knew the precise number of doctors and their “citizenship status,” then provided no further comment. KFF Health News did not have or provide this information.

Philpott, who founded CanAm Physician Recruiting in the 1990s, said the cross-border movement of American and Canadian doctors has for decades ebbed and flowed in reaction to political and economic fluctuations, but that the pull toward Canada has never been as strong as now.

Philpott said CanAm had seen a 65% increase in American doctors looking for Canadian jobs from January to April, and that the company has been contacted by as many as 15 American doctors a day.

Rohini Patel, a CanAm recruiter and doctor, said some consider pay cuts to move quickly.

“They’re ready to move to Canada tomorrow,” she said. “They are not concerned about what their income is.”

The College of Physicians and Surgeons of Ontario, which handles licensing in Canada’s most populous province, said in a statement that it registered 116 U.S.-trained doctors in the first quarter of 2025 — an increase of at least 50% over the prior two quarters. Ontario also received license applications from about 260 U.S.-trained doctors in the first quarter of this year, the organization said.

British Columbia, another populous province, saw a surge of licensure applications from U.S.-trained doctors after Election Day, according to an email statement from the College of Physicians and Surgeons of British Columbia. The statement also said the organization licensed 28 such doctors in the fiscal year that ended in February — triple the total of the prior year.

Quebec’s College of Physicians said applications from U.S.-trained doctors have increased, along with the number of Canadian doctors returning from America to practice within the province, but it did not provide specifics. In a statement, the organization said some applicants were trying to get permitted to practice in Canada “specifically because of the actual presidential administration.”

Michael, the physician who moved to Canada this year, said he had long been wary of what he described as escalating right-ring political rhetoric and unchecked gun violence in the United States, the latter of which he witnessed firsthand during a decade working in American emergency rooms.

Michael said he began considering the move as Trump was running for reelection in 2020. His breaking point came on Jan. 6, 2021, when a violent mob of Trump supporters besieged the U.S. Capitol in an attempt to stop the certification of the election of Joe Biden as president.

“Civil discourse was falling apart,” he said. “I had a conversation with my family about how Biden was going to be a one-term president and we were still headed in a direction of being increasingly radicalized toward the right and an acceptance of vigilantism.”

It then took about a year for Michael to become licensed in Canada, then longer for him to finalize his job and move, he said. While the licensing process was “not difficult,” he said, it did require him to obtain certified documents from his medical school and residency program.

“The process wasn’t any harder than getting your first license in the United States, which is also very bureaucratic,” Michael said. “The difference is, I think most people practicing in the U.S. have got so much administrative fatigue that they don’t want to go through that process again.”

Michael said he now receives near-daily emails or texts from American doctors who are seeking advice about moving to Canada.

‘You Left Just in Time’

This desire to leave has also been striking to Hippocratic Adventures, a small business that helps American doctors practice medicine in other countries.

The company was co-founded by Ashwini Bapat, a Yale-educated doctor who moved to Portugal in 2020 in part because she was “terrified that Trump would win again.” For years, Hippocratic Adventures catered to physicians with wanderlust, guiding them through the bureaucracy of getting licensed in foreign nations or conducting telemedicine from afar, Bapat said.

But after Trump was reelected, customers were no longer seeking grand travels across the globe, Bapat said. Now they were searching for the nearest emergency exit, she said.

“Previously it had been about adventure,” Bapat said. “But the biggest spike that we saw, for sure, hands down, was when Trump won reelection in November. And then Inauguration Day. And basically every single day since then.”

At least one Canadian province is actively marketing itself to American doctors.

Doctors Manitoba, which represents physicians in the rural province that struggles with one of Canada’s worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S.

The campaign focuses on Florida and North and South Dakota and advertises “zero political interference in physician patient relationship” as a selling point.

Alison Carleton, a family medicine doctor who moved from Iowa to Manitoba in 2017, said she left to escape the daily grind of America’s for-profit health care system and because she was appalled that Trump was elected the first time.

Carleton said she now runs a small-town clinic with low stress, less paperwork, and no fear of burying her patients in medical debt.

She dropped her American citizenship last year.

“People I know have said, ‘You left just in time,’” Carleton said. “I tell people, ‘I know. When are you going to move?’”

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

Eli Lilly Bet $1 Billion on Non-Opioids: Will Pain Patients Pay the Price?

By Crystal Lindell

Eli Lilly is investing heavily in new non-opioid pain treatments with its latest acquisition. The pharmaceutical company announced this week that it was acquiring SiteOne Therapeutics in a deal worth as much as $1 billion. 

SiteOne describes itself as “dedicated to the development of safe and effective pain therapeutics without the significant addiction potential and side effects of opioids.” 

The company has been working on a new class of non-opioid medication that targets sodium channels in the peripheral nervous system to treat pain and other nerve conditions. Blocking pain signals in peripheral nerves before they reach the brain means the drug is unlikely to lead to addiction or overdoses.

Its drug STC-004 is in Phase 2 of clinical trials. In a February 2025 press release about the medication, SiteOne said it's an oral medication that would likely be taken once a day “for acute and chronic peripheral pain.” 

Eli Lilly said it has high hopes that STC-004 “may represent a next-generation, non-opioid treatment for patients suffering from chronic pain.” 

It’s noteworthy that Lilly doesn’t even mention acute pain, which suggests the company sees the most potential for STC-004 as a chronic pain treatment.  

While any advancement in pain treatment is obviously welcome, it seems prudent to remain skeptical of any company touting a new medication because its a “non-opioid.”

Vertex Pharmaceuticals recently won FDA approval for Journavx (suzetrigine) a non-opioid that also blocks pain signals in the peripheral nervous system. The FDA approved Journavx for acute pain only, despite lackluster results in clinical trials showing that it works no better than a low dose of hydrocodone.

There’s been a gold rush over the last decade by Vertex, Lilly and other pharmaceutical companies hoping to cash in on the opioid-phobia that resulted from the 2016 CDC opioid guidelines. But it remains unclear if it will just result in fool’s gold for pain patients desperate for relief. 

Mark Mintun, VP of Neuroscience Research and Development for Lilly, admits that thus far “effective non-opioid treatment remains elusive.”

According to one estimate, the global chronic pain market was worth over $72 billion in 2024 and is projected to grow to $115 billion by 2031.

With so much money on the line for any company that even partially succeeds in developing new pain relievers, resources are going to keep pouring into these non-opioid alternatives, regardless of how effective they actually are. 

The sad fact is that there just isn’t as much money in reliable, well-researched generic opioid medications like morphine, which are vastly cheaper than the non-opioids being developed to replace them. 

For chronic pain patients, the $1 billion that Eli Lilly used to acquire SiteOne would be more beneficial if it was spent on lobbying the government and medical professionals to expand access to opioid pain relievers. 

While my hope is that these types of opioid alternatives will deliver on their promises — my fear is that patients will eventually be forced onto them, even if they don't work nearly as well as opioids.

‘I Can Do It With a Broken Body’: How I Learned to Live with Chronic Pain

By Crystal Lindell

I can still remember the exact day when everything I thought I knew about physical pain was destroyed.

It was 2013, and I had just started to have chronic pain in my ribs a few months prior. Although it would eventually be diagnosed as intercostal neuralgia, and then years later as Ehlers-Danlos Syndrome, at the time nobody seemed to know what was going on. 

The pain was debilitating and I had no idea how to cope with it. Every doctor I saw told me that my imaging and labs were “normal” so there was nothing they could do. They just repeatedly upped my dose of gabapentin and sent me on my way – wash, rinse, repeat as the gabapentin failed to help. 

I had spent another sleepless night tossing and turning in agony as the pain on my right side wrapped around my torso like a spiked metal snake tightening its hold on me. I was stuck in that impossible cycle where the less I slept, the more pain I felt – and the more pain I felt, the less I slept. 

At the time, I didn’t even know the term "chronic pain” yet, and I was struggling to find anyone else who seemed to understand what I was going through. Pain that never goes away was not supposed to happen – especially if there was no underlying injury that could be fixed with surgery. So it had not occurred to me to add "chronic" to my pain.

After being awake most of the night, I got up, dressed and drove myself to immediate care, hoping for a miracle. 

The miracle never came. 

I felt like I was going to die and thought that such a pain level would warrant some sort of response from a doctor – some sort of urgency. But instead, I was dismissed. Actually, worse than that, I was chastised for coming in again when they had already seen me a few weeks prior. 

After waiting over two hours to be seen, the doctor walked into the small exam room, looked up at me, recognized me from previous visits and scolded me, saying, “You still haven’t gotten this figured out?” 

As if I was the one who refused to figure it out. As if the doctors who all refused to help me couldn’t be held responsible because I was the one who was not doing my part. 

The only problem was, I had no idea what my part was even supposed to be. And more than a decade later, I’m still not always sure.

The doctor then quickly told me there was nothing they could do, and that I would need to follow up with my primary care physician. Then she told me to check out at the front desk. 

They did nothing to help me. Nothing at all. And the pain had only gotten more intense during all this. I went to my car feeling hopeless. And then I realized that my day was going to get worse. 

I had been dealing with this pain for multiple months at this point, which means I had already missed weeks worth of work. I suddenly realized that I was going to have to go to the office for the day. 

In pain. 

After spending all morning in immediate care. 

I was going to have to go to work. 

It’s a situation that would have seemed impossible to my healthy body just a few months before.. 

Up until that point, a trip to immediate care would have easily warranted a sick day from work. But even though it was only spring, I had already used up all my sick days for the year and then some. I couldn’t afford to miss a day for a health issue that was now as normal for me as it was horrific. 

After all, normal things require normal days. The pain was normal. So I had to go about my normal day and go to work. 

I sobbed in my car. It was the first time I truly understood that I was going to have to live my regular life in what was now regular pain. Prior to that moment, I would have assumed that the level of pain I was enduring was more than enough to make the world stop – or at least to make my world stop. 

I often think of the lyrics from the Taylor Swift song, “I Can Do It With a Broken Heart.” 

In the song, she laments having to go about her life with a smile after a bad romantic breakup left her feeling depressed, singing:

I was grinnin' like I'm winnin'

I was hittin' my marks

'Cause I can do it with a broken heart

For me, and millions of other people living with chronic pain, the title is slightly different: “I can do it with a broken body.”

Because that’s the thing about chronic pain, it seeps out into every aspect of your life like an oil spill, and you just have to live around it. I still have to work, feed my cats, feed myself, shower, pay bills, and see my family. 

It’s just that most days I have to do all that while also living with horrible pain. 

After more than a decade of living this way, I am relieved to report that I have found some coping strategies. I also moved and found new doctors, who took my pain more seriously, despite the lack of proof on MRI scans and blood work. 

I also meticulously scaled back my life over the years, peeling away things that I now understood were unnecessary. I live a quiet, low-commitment life, so that there is room to breathe while pain takes up all my oxygen. 

Things are not as bad as they were that day back in 2013. My pain is well managed, and my daily life is much more accommodating. 

And yet, the pain persists. It remains chronic. So I still spend most days “doing it with a broken body.”  Or as Taylor Swift put it:

Lights, camera, bitch, smile.

Even when you wanna die

Except for chronic pain patients, there are no lights and no camera. Just a life in pain. 

More Australians Are Trying Medical Cannabis for Chronic Pain

By Suzanne Nielsen and Myfanwy Graham  

More Australians than ever are being prescribed medicinal cannabis.

Medicinal cannabis refers to legally prescribed cannabis products. These are either the plant itself, or naturally occurring ingredients extracted from the plant. These ingredients, such as THC (tetrahydrocannabinol) and CBD (cannabidiol), are called cannabinoids. Some cannabinoids are also made in labs to act like the ones in the plant.

Medicinal cannabis comes in different forms, such as oils, capsules, dried flower, sprays and edible forms such as gummies.

Since regulatory changes in 2016 made medicinal cannabis more accessible, Australia’s regulator has issued more than 700,000 approvals. Around half of the approvals have been for chronic pain that isn’t caused by cancer.

In Australia, chronic pain affects around one in five Australians aged 45 and over, with an enormous impact on people’s lives.

So what does the current evidence tell us about the effectiveness of medicinal cannabis for chronic pain?

Limited Benefits

A 2021 review of 32 randomised controlled trials involving nearly 5,200 people with chronic pain, examined the effects of medicinal cannabis or cannabinoids. The study found a small improvements in pain and physical functioning compared with a placebo.

A previous review found that to achieve a 30% reduction in pain for one person, 24 people would need to be treated with medicinal cannabis.

The 2021 review also found small improvements in sleep, and no consistent benefits for other quality of life measures, consistent with previous reviews.

This doesn’t mean medicinal cannabis doesn’t help anyone. But it suggests that, on average, the benefits are limited to a smaller number of people.

Many pain specialists have questioned if the evidence for medicinal cannabis is sufficient to support its use for pain.

The Faculty of Pain Medicine, the professional body dedicated to the training and education of specialist pain physicians, recommends medical cannabis should be limited to clinical trials.

Guidance from Australia’s regulator, the Therapeutic Goods Administration (TGA), on medicinal cannabis for chronic non-cancer pain reflects these uncertainties. The TGA states there is limited evidence medicinal cannabis provides clinically significant pain relief for many pain conditions. Therefore, the potential benefits versus harms should be considered patient-by-patient.

The TGA says medicinal cannabis should only be trialled when other standard therapies have been tried and did not provide enough pain relief.

In terms of which type of medical cannabis product to use, due to concerns about the safety of inhaled cannabis, the TGA considers pharmaceutical-grade products (such as nabiximols or extracts containing THC and/or CBD) to be safer.

This evidence may feel at odds with the experiences of people who report relief from medicinal cannabis.

In clinical practice, it’s common for individuals to respond differently based on their health conditions, beliefs and many other factors. What works well for one person may not work for another.

Research helps us understand what outcomes are typical or expected for most people, but there is variation. Some people may find medicinal cannabis improves their pain, sleep or general well-being – especially if other treatments haven’t helped.

Side Effects and Risks

Like any medicine, medicinal cannabis has potential side effects. These are usually mild to moderate, including drowsiness or sedation, dizziness, impaired concentration, a dry mouth, nausea and cognitive slowing.

These side effects are often greater with higher-potency THC products. These are becoming more common on the Australian market. High-potency THC products represent more than half of approvals in 2025. In research studies, generally more people experience side effects than report benefits from medical cannabis.

Medical cannabis can also interact with other medications, especially those that cause drowsiness (such as opioids), medicines for mental illness, anti-epileptics, blood thinners and immunosuppressants. Even cannabidiol (CBD), which isn’t considered intoxicating like THC, has been linked to serious drug interactions.

These risks are greater when cannabis is prescribed by a doctor who doesn’t regularly manage the patient’s chronic pain or isn’t in contact with their other health-care providers. Since medicinal cannabis is often prescribed through separate telehealth clinics, this fragmented care may increase the risk of harmful interactions.

Another concern is developing cannabis use disorder (commonly understood as “addiction”). A 2024 study found one in four people using medical cannabis develop a cannabis use disorder. Withdrawal symptoms – such as irritability, sleep problems, or cravings – can occur with frequent and heavy use.

For some people, tolerance can also develop with long-term use, meaning you need to take higher doses to get the same effect. This can increase the risk of developing a cannabis use disorder.

Like many medicines for chronic pain, the effectiveness of medicinal cannabis is modest, and is not recommended as a sole treatment.

There’s good evidence that, for conditions like back pain, interventions such as exercise, cognitive behavioural therapy and pain self-management education can help and may have fewer risks than many medicines. But there are challenges with how accessible and affordable these treatments are for many Australians, especially outside major cities.

The growing use of medicinal cannabis for chronic pain reflects both a high burden of pain in the community and gaps in access to effective care. While some patients report benefits, the current evidence suggests these are likely to be small for most people, and must be weighed against the risks.

If you are considering medicinal cannabis, it’s important to talk to your usual health-care provider, ideally one familiar with your full medical history, to help you decide the best approaches to help manage your pain.

Suzanne Nielsen, PhD, is a Professor and Deputy Director of the Monash Addiction Research Centre at Monash University in Melbourne, Australia.  Suzanne has been a registered pharmacist for over 20 years. Her clinical experience in the treatment of substance use disorders includes working in specialist drug treatment and community-based alcohol and drug treatment settings in Australia and the United Kingdom.

Myfanwy Graham is a Postgraduate Scholar and Researcher at the Monash Addiction Research Centre. She has been a registered pharmacist for over 17 years and was a consultant to the United Nations Office on Drugs and Crime, the World Health Organization, and the National Academy of Sciences, Engineering and Medicine.

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

Flexible Implant Could Be Alternative to Spinal Cord Stimulators

By Pat Anson

Spinal cord stimulators have long been fraught with problems. First developed in the 1960’s, the devices are surgically implanted near the spine to deliver mild electric impulses that block pain signals from traveling to the brain.

Although their design and technology have improved over the years, making them smaller, rechargeable and programmable, spinal cord stimulators (SCSs) still have high failure rates and poor safety records. Recent studies have also questioned their effectiveness in treating back pain.

Researchers at the University of Southern California have developed an alternative: a small, flexible, wireless, and battery-free implant that could overcome some of the limitations of SCSs.

NATURE ELECTRONICS

The experimental device, recently introduced in a paper published in Nature Electronics, is powered by a wearable ultrasound transmitter and uses machine learning algorithms to customize treatment for each patient. The implant is designed to bend and twist, unlike traditional stimulators that tend to be bulky and are hard-wired to batteries.

“Implantable percutaneous electrical stimulators… are expensive, can cause damage during surgery and often rely on a battery power supply that must be periodically replaced. Here we report an integrated, flexible ultrasound-induced wireless implantable stimulator combined with a pain detection and management system for personalized chronic pain management," wrote a team of researchers at USC’s Alfred E. Mann Department of Biomedical Engineering.

The researchers tested the wireless stimulator in laboratory rodents experiencing different levels of pain. They found the device accurately predicted the levels of stress experienced by the animals and adapted the electrical stimulation it delivered, easing most of their pain.

“We classify pain stimuli from brain recordings by developing a machine learning model and program the acoustic energy from the ultrasound transmitter and, therefore, the intensity of electrical stimulation," researchers said. "The implant can generate targeted, self-adaptive and quantitative electrical stimulations to the spinal cord according to the classified pain levels for chronic pain management in free-moving animal models."

The research team is planning further tests on other lab animals, with the goal of eventually testing the device in clinical trials on humans.

About 50,000 traditional spinal cord stimulators are implanted every year in the U.S., where they are promoted as alternatives to opioids and other pain treatments. However, a 2022 study found that SCSs do not reduce patient use of opioids, epidurals, steroid injections or radiofrequency ablation. About a fifth of patients experienced complications so severe the devices had to be removed or revised.

Gender Bias: Why Gynecological Pain Is Often Dismissed

By Elizabeth Hintz and Marlene Berke

For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people – most of whom identify as women – sexual intercourse and routine pelvic exams are unbearable.

Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women.

Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain.

We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions.

We’ve consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training.

‘It’s All In Your Head’

A 2024 study of patients who went to a clinic for vulvovaginal pain – pain experienced in the external female genitals and vagina – found that 45% of these patients had been told that they “just needed to relax more” and 39% were made to feel that they were “crazy”. A staggering 55% had considered giving up on seeking care.

These results echo what one of us – Elizabeth Hintz – found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this “It’s all in your head” response from doctors.

Another study followed patients in two different major U.S. cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information.

These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care?

“Let me describe the pain that would drive me to try so many different doctors, tests and treatments,” a patient with vulvovaginal pain said to her doctor. For her, sex “is like taking your most sensitive area and trying to rip it apart.”

“I can now wear any pants or underwear that I want with no pain,” said another patient after successful treatment. “I never realized how much of a toll the pain took on my body every day until it was gone.”

Medical Gaslighting

Many patients worldwide experience medical gaslighting – a social phenomenon where a patient’s health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright.

Medical gaslighting is rooted in centuries of gender bias in medicine.

Women’s reproductive health issues have long been dismissed as psychological or “hysterical.” Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy.

These historical views help shed light on why these symptoms are still not taken seriously today.

In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity.

This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed.

Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist.

Disparities in Funding and Care

Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January 2025 report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men.

This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women’s health has actually declined over the past decade. Despite these known disparities, in April 2025 the Trump administration threatened to end funding for the Women’s Health Initiative, a long-running women’s health research program, further worsening the problem.

Without sustained federal funding for women’s health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded.

As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race.

One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients’ pain and offered them less accurate treatment recommendations.

Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men.

Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine.

These lingering erroneous beliefs about gender and race are key reasons patients’ pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death.

Learning and Listening

Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients’ lived experiences and admit when an answer isn’t known.

In the meantime, people navigating the health care system can take practical steps when encountering dismissive care.

They can educate themselves about chronic gynecological pain conditions by reading books like “When Sex Hurts: Understanding and Healing Pelvic Pain” or educational information from trusted sources like the International Society for the Study of Women’s Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease.

Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting.

If someone you know has experienced medical gaslighting and would like support, there are resources available.

Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information – like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.

Elizabeth Hintz, PhD, is an Assistant Professor in the Department of Communication at the University of Connecticut.

Marlene Berke recently completed her PhD in Philosophy at the Computational Social Cognition Lab at Yale University.

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

Are ‘Addicts’ to Blame for Prescription Opioid Crackdowns?

By Crystal Lindell

It’s been nearly a decade since the CDC released its infamous 2016 opioid guideline. In the years since, millions of pain patients have endured immense suffering, as doctors significantly reduced the amount of opioid medication they prescribe.

But who is really responsible for all that pain?

It’s tempting to lay the blame for all the crackdowns on “addicts.” After all, if it wasn’t for them, the rest of us could still get opioids for pain relief, right?

Unfortunately, it’s not so simple. 

The real culprits are the DEA, CDC, and the medical community at large, all of which have worked together to criminalize pain and punish patients.

But blaming ‘addicts” for the crackdown on opioids is exactly what the people with real power are hoping you will do. First and foremost, it has the effect of pitting opioid users against each other, when in reality we’re already on the same team. And as the old saying warns: United we stand, divided we fall. 

Many people who use opioids illegally have chronic pain or other health issues that opioids help address. In a country that does not have guaranteed healthcare, much less guaranteed pain treatment, they are left to fend for themselves. So, it’s no wonder that some of them turn to illegal drugs for relief. 

Using opioids illegally will get you labeled as “an addict,” regardless of the circumstances. In fact, that’s a big part of the reason why I no longer use the word “addict” when talking about illegal users. It’s a murky diagnosis that's often given to deprive patients of a controversial but effective treatment. 

Furthermore, blaming people who use illegal opioids for the fact that many pain patients can’t get an opioid prescription only serves to let the true oppressors off the hook for their crimes. 

We have to remember, it’s not “legal users vs. illegal users.” It’s “all users vs. the DEA, CDC and the medical community.”

I understand where the desire to blame “addicts” comes from. After all, illegal users make a very tempting target. It’s much easier to hate them than to admit that maybe your doctor, who has a lot of power over your life, is actually the one causing you harm. 

It’s also human nature to want to identify yourself as “one of the good ones.” As in: Yes, I use opioids. But I’m different and have a legitimate medical need. 

I mean, obviously, it’s not that simple. But I get why pain patients want to tell themselves that it is. 

The thing is, there are real solutions to the lack of access to opioid pain medication. But we won’t achieve them unless we all work together. 

For example, we could advocate for selling hydrocodone the same way we sell nicotine, alcohol and caffeine: over-the-counter and without a prescription. Eliminating doctors from the equation would help countless pain patients finally get relief, whether they used opioids illegally or legally. And it would be a whole lot safer than the Russian Roulette of drugs on the black market. 

That’s the kind of solution that’s only possible if all opioid users unite in the fight against opioid restrictions. But it won’t happen as long as pain patients insist on telling themselves that there are “addicts” out there that aren’t as worthy as they are.

Because that’s the crux of the issue, isn’t it? Deep down, a lot of pain patients think that people using medications illegally are a separate class of people that need to be banned from accessing opioids “for their own good.” 

Here’s the secret that your doctors won’t tell you though: The medical community has already put you into that group as well. They already think you need to be kept away from opioids “for your own good.” 

In their eyes, both legal and illegal users are one group – so we might as well embrace it. After all, we’re all worthy of pain relief. And all of us should have the right and the ability to treat our own pain as we see fit. 

If we all work together, maybe one day we can make the right to pain treatment a reality. 

‘Zombie’ Nerve Cells Make Chronic Pain Worse

By Pat Anson

The zombies are at it again.

Weeks after researchers announced a new way to treat low back pain by targeting so-called zombie cells – a new study suggests that peripheral nerve pain could also be treated with drugs that target aging cells.

Senescent neurons are cells that stop dividing, but refuse to die and linger in the central nervous system. As people age, more and more of these “zombie cells” build up, secreting inflammatory agents that increase pain sensitivity and raise the risk of age-related diseases like arthritis, Alzheimer’s and Parkinson’s.

“Very little is known about underlying causes of pain experienced during aging. The prevalence of chronic pain in aging populations and the lack of effective and non-addictive treatments motivated this exploration into neuronal senescence as a potential mechanism,” Lauren Donovan, PhD, a research scientist at Stanford University, told PsyPost.

In studies on laboratory animals, Donovan and her colleagues at Stanford found that pain was amplified in older mice by senescent cells, which released inflammatory signals when the mice were injured. The same inflammatory reaction was found in younger mice, but was more pronounced in the older ones.

When the injured mice were treated with a drug called ABT263 – a compound that destroys senescent cells – the older mice showed less pain sensitivity and significant improvement in their weight-bearing behavior.

The younger mice treated with ABT263 showed only modest improvements in their pain-related behavior, which suggests that senescent cells play a significant role in causing chronic pain.

“The key takeaway for the average person is that as we age, some of our sensory neurons undergo a process called senescence, which may contribute to chronic pain,” said Donovan, who reported the findings in the journal Nature Neuroscience.

“In addition, we found that injury can exacerbate senescence in neurons, leading to an additive effect of aging and injury that may enhance pain. This research identifies a new potential target for treating chronic pain, especially in older individuals. It suggests that addressing cellular senescence in the nervous system can lead to new ways of managing pain and sensory dysfunction.”

Researchers at McGill University reported similar findings last month in studies on laboratory mice with damaged discs. When the mice were given drugs that targeted senescent cells in their spines, they experienced less pain and their bone quality improved.

Previous animal studies have shown that senolytic drugs can reverse osteoarthritis by eliminating senescent cells, giving the body a chance to repair and rejuvenate damaged cartilage.

The findings need to be replicated in humans, but they suggest that senolytic drugs that target zombie cells have the potential to prevent or even cure some age-related diseases.

Doctors Finally Told to Take IUD Pain More Seriously

By Crystal Lindell

The American College of Obstetricians and Gynecologists (ACOG) is finally acknowledging just how painful some uterine and cervical procedures can be for women. 

They are now recommending pain treatment for in-office procedures that patients have long complained were under-addressed. 

The ACOG’s new guidelines address pain from intrauterine device (IUD) insertion, endometrial biopsy, hysteroscopy, intrauterine imaging, cervical biopsy, and other similar procedures. 

“There is an urgent need for health care professionals to have a better understanding of pain-management options and to not underestimate the pain experienced by patients and for patients to have more autonomy over pain-control options during in-office procedures,’ the ACOG said. 

While the recommendations vary by procedure, most of them involve some version of lidocaine, and a few recommend NSAIDs and naproxen. For more intense procedures and conditions like hysteroscopy, ablation, and polypectomy, they recommend local anesthesia. 

For IUD insertion, a procedure that patients have long complained was extremely painful, the ACOG recommends local anesthetic agents. More specifically, they recommend applying lidocaine cream, lidocaine spray, or a paracervical lidocaine block injection. 

The ACOG says pain management options “should be discussed with and offered to all patients seeking in-office gynecologic procedures."

However, there is a telling couple of sentences in the new guidelines that reveal how doctor-centered the thought processes around pain management still are. 

The ACOG acknowledges that some healthcare professionals tend to underestimate the pain that patients experience and that pain management “may not be discussed with or offered to patients.” Basically, some doctors don’t believe that patients experience pain, so they don’t even bother to offer pain treatment options. 

There may also be a false belief that a pain treatment that works for one patient must work for everyone.

“Several pain-management interventions being used have limited or conflicting evidence supporting their effectiveness at providing adequate pain control during in-office gynecologic procedures,” the ACOG said.

“Health care professionals therefore must be cautious when extrapolating data on what works for one procedure to another. Shared decision making with the patient should be practiced when discussing pain-management options because options that work for one patient may not work for another.”

It’s good they are acknowledging the issue. I always say that other people’s pain is always easier to endure. Of course doctors think pain management is unnecessary – they aren’t the ones in pain!

The ACOG adds that “despite patients reporting a higher level of pain than clinicians expect, patients still report a high level of satisfaction with office procedures.”

It’s so telling that they think that patient satisfaction scores should even be mentioned when deciding pain treatment guidance. As usual, there tends to be a focus on how patient pain impacts the doctor and their practice. And it’s even more telling that they think they don’t need to treat pain as long as patients don’t complain. 

In reality, doctors should be treating pain because pain sucks, and it’s the right thing to do!

I am glad to finally see more official guidance for doctors to treat pain that patients have long reported. But if doctors would just believe their patients when they report pain, they wouldn’t need the ACOG to tell them to treat it.