You Don’t Really Know What Chronic Pain Is Like Until You Have It

By Crystal Lindell

I was recently talking to two people who asked me about various pain treatments. One was an older woman and the other was a young man. 

When I mentioned kratom – because I could tell that at least one of them was desperate for help – they had two very different reactions. 

One was receptive, while the other was adamantly against it. But it may not be the ones you’d expect.The older woman immediately wanted to know more, while the young man – the much more stereotypical kratom user – was immediately against the idea.

And from their reactions, I could immediately discern which of the two was actually suffering from chronic pain – the older woman.

Because when you have pain that never goes away, you will try anything to find relief. It’s one of the many truths I have come to learn first-hand as a long-time chronic pain sufferer myself.

In fact, there is a lot about living with chronic pain that’s difficult to understand unless you have been through it.

The way it wears you down and damages every aspect of your life. How expensive it is. How much it impacts your relationships.

The special type of despair that comes from the fear that you might never get better.

I have learned just how hard it is for someone with chronic pain just to get out of bed everyday. How much of an accomplishment that is.  

I know that my fellow chronic pain sufferers have likely struggled with doctors and pharmacists and health insurance companies. That they have tried every medication and treatment they could access. And that they have probably contemplated even the most extreme “solution.”

I know that they probably never feel truly rested, because of the way chronic pain even infects your sacred sleep.

And I know what it’s like when loved ones become much less helpful, as they have to keep helping you into eternity. How quickly they lose patience with the situation. 

Or, as French author and chronic pain sufferer Alphonse Daudet once wrote, "Pain is always new to the sufferer, but loses its originality for those around him.”

There’s a bond that comes from the unique experience of shared suffering. A special level of empathy. Which is why I have such a special place in my heart for anyone else enduring chronic pain. 

But it’s nearly impossible to fully grasp life with chronic pain from the outside. 

My theory is that our brains are not set up to process even the concept of chronic pain in the abstract, because recognizing that it could happen to us would be too devastating to accept.

People who have had acute pain, from an injury, accident or surgery, might assume they know what it would be like. But they can only understand so much.

A lot of people like to pretend that if they had chronic pain, they would somehow manage it better than you can. 

They’d yoga their way out of it, or simply go to a chiropractor. They’d be more stoic, and less tired. They would never get frustrated, and they would still do all the activities they did before the chronic pain started.

They’d be wrong though.

You never know how you’ll actually handle chronic pain until you’re enduring it. It has a way of humbling you faster than you expect. Opening you up to trying treatments you thought you’d never consider, like kratom. 

In the end, none of us are as strong as we like to pretend we are. But when we are forced to confront our own weaknesses, we do have the opportunity to see just how strong others have been the whole time.

How Neurosteroids Made Their Debut in Chronic Pain Care

By Dr. Forest Tennant and Ingrid Hollis

In 1981, some neuroscience researchers discovered a group of hormones being made in the brain and spinal cord.  Some are also made in the gonads, the primary reproductive glands. 

Initially, the scientists didn’t know why the central nervous system (CNS) produces these hormones, but they soon learned that they protect, energize, and heal CNS tissues, such as nerves and glial cells that may be injured or damaged. They also found that these hormones control pain. 

The hormones were named neurosteroids because their chemical structure resembled that of the corticosteroids, such as prednisone and hydrocortisone.

A main function of neurosteroids is to heal injured nerve tissue and relieve pain. This includes the glial cells that cause neuroinflammation, central sensitivity, and constant pain. Neurosteroids are potent anti-neuroinflammatory hormones. 

The main neurosteroids are:

• Pregnenolone

• Allopregnanolone

• Estradiol (estrogen)

• Testosterone

• Progesterone

• Nandrolone

• Dehydroepiandrosterone (DHEA)

You will note that some neurosteroids such as estrogen have biologic effects outside the spine, controlling mood, cognition and neurological health.

Neurosteroid Research

Animal research into neurosteroids is large, well done, and compelling, in that the studies clearly show that these hormones will benefit pain care. For example, rats that had their spinal cords damaged totally recovered when given neurosteroids. 

Glial cell inflammation -- which causes central pain -- was also controlled by neurosteroids, which are potent suppressors of neuroinflammation. Researchers found that if there was a tissue tear, injury or inflammation in the cells, neurosteroids immediately restored them to their normal state. 

Once the functions of neurosteroids were better understood, it was widely believed among neuroscientists that they could be a powerful therapeutic tool to treat severe chronic and intractable pain. 

Like many great scientific discoveries, the main clinical constituency didn’t know and didn’t care about these findings.  Fortunately, two clinical innovators figured out that neurosteroids can be utilized for treating two severe painful conditions: burning mouth syndrome and adhesive arachnoiditis (AA).  Treatment of the latter utilizes pregnenolone, DHEA, and palmitoylethanolamide (PEA).

The Transition from Animals to Humans 

The transition from giving a drug to laboratory animals to using them safely and effectively in humans takes a lot of time and experimentation.   Factors that have to be considered include dosage, formulation, and various combinations of neurosteroids. 

The first physician to make the transition is Dr. Susan Sklar, who has developed a neurosteroid protocol for the previously untreatable intractable pain condition known as burning mouth syndrome. 

Learning to great extent from Dr. Sklar’s success, I and my associates developed a neurosteroid protocol for adhesive arachnoiditis.  Results to date are gratifying and correlate with the therapeutic improvements seen in animal research.

In summary, neurosteroids are a group of hormones produced in the CNS that protect and heal nerve tissues.  Animal studies show they heal injured spinal cord nerves and glial cells, and suppress inflammation, regenerate tissues, and reduce pain.

Neurosteroids are not a substitute for pain treatment with opioids and neuropathic agents, but an additional resource that greatly enhances pain relief.  Experience to date should be a motivator to expand the use of neurosteroids for all intractable and chronic pain conditions.

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 bulletins here.

Ingrid Hollis is a person in pain, patient advocate, and advisor to the Tennant Foundation.

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

Doctor, the Patient Will See You Now

By Julie Titone

Have you ever gone to an appointment with a new doctor, hoping to meet Patch Adams, the true story of a compassionate and funny doctor played by the late Robin Williams in a 1998 movie?

Instead of Dr. Adams, you find Dr. Doom waiting in the exam room. 

My experience hasn’t been that extreme, but there are certainly physicians I wouldn’t recommend. Or revisit.

I say this in the wake of my annual checkup with a primary care doc who cheerfully answered my inevitable list of questions. She remembered that my mom is 102, and suggested I may have another 30 years ahead (oy). 

After four years, she knows me. When I asked if she would continue being my doctor as I age, she said, “I’m not going anywhere.” 

Good to know! Because finding and adjusting to a new healthcare provider can be fraught.

In fact, among those of us with adhesive arachnoiditis, there are few hotter topics than where to find someone willing to treat our chronic, uncommon and often debilitating form of spinal nerve damage. One man told me that a new doctor literally backed out of the exam room upon seeing the arachnoiditis diagnosis on his chart.

I’ve come to think of office visits as stage plays. The opening act —  that first appointment – features two characters who are wary of each other. 

Let’s say the patient has been disappointed by previous doctors and is worried about the cost of treatment. Her emotions are rubbed raw by unrelieved pain. On top of all that, she has little trust in what my pain specialist calls, with an ironic eye roll, “our health care system.” (One study determined that, from 2020 to 2024, public trust in doctors and hospitals plummeted from 71 to 40 percent.)

The doctor, meanwhile, has dealt with all manner of personalities and diagnoses that day, and has no idea what awaits behind the exam room door. He hasn’t had sufficient time to even read the patient’s lengthy chart because he was busy dealing with insurance companies, on top of a packed schedule.

There may be too much ego or too few communication skills present in an exam room. A doctor’s deep experience – in general, a good thing – can get in the way of seeing a patient as an individual who might differ significantly from previous patients with similar symptoms. 

I once saw a doctor who clearly was brilliant. She bombarded me with questions, but then didn’t give me time to properly answer them.

I do see improvement in doctors’ acceptance of patients who have done their own health research. We’ve come a long way since about 20 years ago, when I asked an informed question of a doctor who responded, “Oh, you’re one of those internet people.” 

In the case of rare diseases, patients are quite likely to know more about their condition than the physician does. That should be a chance for mutual problem solving, not wisecracks about Dr. Google.

Sure, there are genuine cases of “cyberchondria.” Some people are bound to misdiagnose themselves and catastrophize. But that seems like a lesser problem than having people show up at clinics totally uneducated on matters of health.

If I were a physician, I might relish the challenging cases. But I’m not sure I would have the emotional stamina that the job requires, especially if it involved seeing people in pain, day in and day out. Simply dealing with an endless parade of suffering humans could be taxing.

Let’s hope there are always doctors who get enough satisfaction out of helping people, so that they’re willing to put up with the downsides and stick with the profession. We need them.

Julie Titone is a journalist who frequently writes about health issues. Find her work at julietitone.substack.com/. 

Millions of Americans Go Uninsured After ACA Subsidies Cut

By Andrew Jones, Kaiser Health News

Year after year, Ross and Rebecca Tobiassen saw their healthcare costs rise, having relied on the Affordable Care Act (ACA) for federally subsidized health insurance since its start in 2014. Year after year, the couple in western North Carolina kept their coverage, believing the peace of mind was worth the cost.

But in December, that changed. The Tobiassens decided to cancel their insurance when Rebecca saw the cost of their monthly premiums would jump from $130 to more than $550.

“It makes no sense,” she said. “It’s not worth it anymore.”

The couple own and are the only employees of a small auto shop just west of Appalachian State University in the North Carolina mountains.

Rebecca worries about her husband, whose work as a mechanic can be dangerous. A spring once shot a metal ball joint into their garage wall like a gun. A heavy object crushed Ross’ thumb.

In 2020, Ross became mostly blind in one eye after repeatedly getting metal shards in it and developing an infection in his cornea.

The Tobiassens are among the Americans who canceled their ACA coverage after Congress allowed enhanced tax credits that helped pay for insurance plans to expire at the end of 2025.

Rebecca and ross Tobiassen

The Tobiassens benefited from those tax credits — like millions of other enrollees expected to drop or be dropped from their coverage as the year progresses, unable to keep up with the higher costs.

Established by the Biden administration’s American Rescue Plan Act during the covid pandemic, the expanded subsidies reduced monthly premiums for many families and prompted a tidal wave of new sign-ups, doubling ACA enrollment to about 24 million.

The Centers for Medicare & Medicaid Services is expected to soon release complete data on how many people are no longer covered under the ACA, but an early analysis from KFF, citing Wakely Consulting Group research, showed enrollment could drop from over 22 million at the end of 2025 to as low as 16.5 million in 2026. 

In North Carolina, individual ACA sign-ups for 2026 were down 22% compared with the year before, a greater drop than any other state, amounting to a decrease of more than 213,000 people, according to enrollment data. While the Tobiassens’ two teenage daughters remain on Medicaid, Rebecca said the new prices showed that the federal government doesn’t care about families like hers.

“We’ve known that you don’t care about us,” she said, “but you’re making it plain and simple now.”

The couple’s insurance hadn’t helped them cover all their medical needs. When the pain from Ross’ eye infection worsened five years ago, Rebecca insisted he go to a specialist, who told them that fixing the eye through cornea replacement surgery would cost them up to $30,000 and require Ross to take six months off.

Ross chose a less expensive treatment to kill nerves in the eye instead.

The couple know they’re taking a risk by not being insured. If something were to happen, they could face an enormous medical bill.

Ross, 47, said the blindness in the one eye doesn’t significantly affect his job. He works long hours, sometimes into the night to keep up with demand.

“I try not to think about it too much,” he said. “I just work.”

‘Don’t Get Hurt. Don’t Get Sick’

Katie Alexander oversees volunteers for Pisgah Legal Services, a western North Carolina nonprofit that helps low-income people secure health insurance. Alexander has helped North Carolina and Tennessee residents try to get ACA marketplace plans since Obamacare’s launch. She said she’s never seen anything like this year. 

Nearly 100 Pisgah clients, out of about 700 that Alexander’s team worked with during open enrollment, decided to drop insurance this year, and many others chose cheaper ACA plans with less coverage, Alexander said. 

Alexander said the people who have dropped their coverage include Lyft and Uber drivers. They’re trying to start their own businesses. They are artists and people who can work only part-time, because they’re chronically ill. Some are unable to get insurance through their employers, or they make too much to be on Medicaid.

“Even for folks who don’t have chronic illnesses,” Alexander said, “there’s just this nagging at the back of your mind, kind of constantly, of: ‘Don’t get hurt. Don’t get sick. Because you can’t afford that.’”

ACA premiums and deductibles steadily increased for years starting in 2022, then spiked during the enrollment period for 2026 plans, according to data analyzed by KFF. The Tobiassens have seen every dip and rise in plan costs since 2014 when the plans launched. They joined immediately and paid about $30 a month, Rebecca Tobiassen said.  

“You actually felt like you were benefiting,” she said.

But through the years as the marketplace became more expensive, the couple made concessions, switching at one point from a silver plan — historically the most popular — to a bronze. The plan mostly provided for the couple’s basic needs.

As they saw their deductibles and premiums rise over more than a decade, Rebecca feared the day would come when they could no longer afford even the cheapest plan.

“Plans are unaffordable, no matter how you cut it,” said Risha Gidwani, a healthcare policy researcher at the University of Colorado Anschutz School of Medicine. “It’s just who is shouldering the unaffordability.” 

Gidwani and health economist Cheryl Damberg, in a study published earlier this year, found that most bronze plans, the cheapest ACA options for many, would be unaffordable without subsidies for the average person using the federal healthcare coverage.

Without subsidies, many families using these plans don’t make enough to afford premiums or deductibles, Gidwani’s research shows.

People who drop health insurance also change what’s known as the “risk pool,” Gidwani said, when a group of people share financial hazards. 

If healthier people drop out of the risk pool, fewer people subsidize the people who get sick, Gidwani said. That means premiums for the people who get sick will increase again in the future, she added.

“That becomes what we call a death spiral,” Gidwani said.

Even if the subsidies hadn’t expired, taxpayers would have borne an estimated $350 billion burden over the next decade to cover them, Gidwani’s study noted.

After dropping coverage they’d relied on for 11 years, the Tobiassens have no plans to return to the ACA marketplace. They looked into alternative options through a faith-based healthcare organization but decided to go without.

For now, they don’t have a plan B. They’ve set aside some money for a medical emergency. And if their savings run out, Rebecca Tobiassen said, they have a couple of last resorts to lean on: credit cards or family members.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

I Hate When Doctors Insist on Physical Therapy for Chronic Pain

By Crystal Lindell

There is definitely an over-prescription crisis in this country, but it’s not about pills – it’s physical therapy referrals. 

While many doctors see it as an “easy” way to reduce their opioid prescribing, the only thing easy about it is how easy it is for them to write the referral and then immediately blame the patient for any lack of progress. 

In fact, I recently stumbled onto a discussion about physical therapy in the “Family Medicine” subreddit, where medical professionals, who’ve confirmed their credentials, were discussing just how much they love to push PT on patients and why. 

In the thread, a poster who claims to be a new physical therapist asked providers when they typically will prescribe it. 

A nurse practitioner responded with, "I only prescribe PT on days that end with Y." 

A physician's assistant said they prescribe physical therapy "as soon as [patients] open the door."

A medical doctor lamented, "I wish my patients took [physical therapy] more seriously because recovery for a lot of [musculoskeletal] and chronic pain takes work and they want the one shot fix."

Ironically, it really seems that it’s the doctors who are looking for a one-shot fix with their physical therapy referrals. As another doctor on the thread admits, they prescribe PT "for any pain, gait, chronic respiratory, chronic pulmonary, or weakness complaints."

As a long-time pain patient, the thread confirmed everything I assumed doctors thought about pain patients and physical therapy. But unless you’re recovering from a specific injury, like a bone break or surgery, physical therapy can be a huge waste of time and money. 

For patients, the reality is that physical therapy is a massive time commitment and a huge financial expense.

Way back before I even developed intercostal neuralgia in my ribs, I started having pain in my wrists, likely caused by years of undiagnosed Ehlers Danlos syndrome and typing for a living. The official diagnosis for me at the time was “tendonitis.”

As someone who writes for work, dealing with sudden wrist pain was causing me massive issues. There were days when the pain was so intense that I couldn’t even type up a column.

I was also younger and more naïve then, so at the time my only goal was to do everything my doctor told me to do. I genuinely believed that that was my best chance at getting better, and that he had my best interest at heart. 

So when he told me to take Advil and go to physical therapy three times a week, I happily agreed.

The only issue was that I had to miss a ton of work, use a bunch of gas to get to the appointments, pay for parking, and then also come up with the $30-per-session co-pay, which added up to almost $100 a week! Times that by four weeks, and suddenly you’re looking at a car payment, easy.

God forbid, you have a job where you can’t get time off during the limited business hours offered by physical therapists. Plus, there’s the issue of finding a babysitter if you have kids.

Maybe that’s not a lot of money to doctors, but to many patients it’s enough to put you into crushing debt and maybe even lead to you losing your job for missing too much work.

The worst part was that physical therapy did almost nothing to relieve my pain. The appointments themselves mostly consisted of the therapist massaging my wrists, which only helped in the moment. In truth, the most effective part was the wrist braces they gave me to sleep in, something my primary care doctor could have easily given me himself.

Many doctors seem to think that if a patient is “really” in pain, they will try anything to get better. And thus, if a patient is reluctant to spend a bunch of time and money on physical therapy, then the only logical conclusion is that they must be a drug-seeking junkie looking to get high.

But there’s a reason that pain medication, especially opioids, are so popular. They are known to be immediately effective, and they are very cheap compared to physical therapy. Plus, instead of forcing you to miss work, they actually allow you to go to work despite the pain.

Looking back, I do not think that I needed opioid medication for my wrist pain, so I’m not arguing for that. I’m just saying that I also did not need physical therapy. But, like many of the doctors on that Reddit thread, my physician had gotten into the habit of prescribing PT for almost anything. 

Unfortunately, that would not be the last time a doctor tried to push physical therapy onto me. It happened to me and my loved ones many times over the years. While I have seen it work for family members who had just had a major operation or an acute injury, I have rarely seen it help much with chronic pain.

Of course, there are certainly patients who have benefited from it, and physical therapy should definitely be an “easy” option for them. Unfortunately, insurance coverage of PT is often limited. My fiancé can’t get insurance to cover any more physical therapy for him, despite the fact that he does find the sessions to be beneficial for his chronic pain.

In essence, doctors will happily prescribe physical therapy, but that’s about where their concern ends. After that, you need to figure out the health insurance requirements, assuming you even have insurance. Then you have to come up with co-pays, transportation, time off work, potential babysitters, and the energy to go to PT appointments while also maintaining the rest of your responsibilities. 

That last one is something doctors often fail to consider. If you’re working one or more jobs, running a household, and trying to get through the week, adding in the time and emotional energy to go to physical therapy a few times a week can be almost impossible.

In short, there’s a long list of negative side effects that come with physical therapy. They start with the referral by your doctor. Physical therapy should not be used by them as a secret test that patients have to pass just to prove they’re not trying to score some hydrocodone. It also shouldn’t be used as a first-line treatment for patients who may greatly benefit from other treatments.

There were a couple people on that Reddit thread attempting to stick up for patients. One doctor said this: 

"To be fair, it's financially out of reach for many (most of my) patients. My low income patients can get 4 visits/year but finding a PT who can provide the low income service can be challenging. These same patients are getting a maximum income support of $1787/month (a 700 square foot basement apartment rents for about $1500/mo right now in our city, if you can find one).

Sometimes people don't make bad choices, they fail to have good choices to make."

The only problem with that response is that it still assumes that physical therapy is a “good” choice. As a patient, I’m not convinced that it is. In fact, sometimes it’s a bad one. 

Do Steroid Injections Work for Joint Pain?

By Sarah Golding

Osteoarthritis affects around 600 million people globally. It causes pain, stiffness and reduced joint function – most commonly in the knees, hands and hips.

There’s currently no cure for osteoarthritis. Many people manage the condition through exercise, maintaining a healthy weight, using walking aids and medications.

Commonly used medications include anti-inflammatories and opioids. While these help some, they also carry downsides – including significant side-effects, particularly in over-60s, and risk of addiction from long-term opioid use.

Joint replacement surgery can be very effective for relieving pain and improving mobility, but waiting lists in the last two years hit an all time high, due to increasing demands and reduced capacity since the COVID pandemic.

Surgery also carries risks such as infection, blood clots and nerve damage. Joint replacement surgery is typically suitable for those with advanced stage osteoarthritis.

So how else can osteoarthritis be treated?

Corticosteroid injections, commonly known as steroid injections or cortisone, have been used for joint pain for more than 70 years. They offer a rapid, effective way of reducing pain.

Corticosteroids are anti-inflammatory drugs able to reduce inflammation and pain associated with osteoarthritis. Injecting corticosteroid directly into the joint means it has maximum effect where needed, while minimising effects on the rest of the body.

The effects of steroid injections can last for months, reducing the need for surgery and reliance on prescription drugs. Those most likely to benefit from steroid injections have persistent pain which disrupts sleep and function, and who find other medications unsuitable or ineffective.

Not For Everyone

But as effective as steroid injections can be, their effects will vary from person to person. They may not be as effective in severe cases of osteoarthritis, as they only reduce inflammation and cannot repair damaged or lost cartilage.

Steroid injections may also risk accelerating arthritis or causing bone problems in some people, particularly if used in high doses or too often. Routine use in early stages of osteoarthritis is therefore generally avoided. This is because steroid injections can damage cartilage and bone cells which may further weaken and damage the joint.

Steroid injections may also not be suitable for people already taking high doses of steroids for other health problems (such as rheumatoid arthritis or asthma), and those who have a weakened immune system or are otherwise unwell. Taking too much artificial steroid affects the body’s production of natural steroid, which is essential for our metabolism.

Steroid injections may increase risk of infection following surgery if an injection has been given beforehand. For this reason, the majority of surgeons recommend a minimum of three months between your last injection before surgery.

Although side-effects from steroid injections are fortunately rare, people need to be aware of these to make an informed decision about treatment. These can include: infection, allergic reaction, bleeding, bruising, skin colour changes, temporary flare in pain, bone and joint changes and increased blood sugar levels in those with diabetes.

It’s advised that injections aren’t performed more than every three to four months to reduce risk of side-effects and accelerating the arthritis. With hip injections there is need to be more cautious due to risks of cartilage and bone damage from even just one injection .

Managing Joint Health

Depending on the country, you may be able to have a steroid injection done by your GP, a nurse or a physiotherapist.

Within the UK, first contact physiotherapists working in primary care are accessible in the same way the GP is, many are trained and can offer early access to steroid injections. Injections may be provided within a GP surgery, however hip and spine injections are usually guided by ultrasound or X-ray imaging, which may only be available within a hospital.

Since injections can temporarily reduce osteoarthritis pain, this provides a window of opportunity within which to start exercising. Exercise is important for managing osteoarthritis, as it can strengthen joint-supporting muscles and reduce pain. Physical activity can even be beneficial for those planning to undergo joint replacement surgery as it can improve pain, function and length of hospital stay after surgery.

After injection, it’s recommended people initially rest for a few days, but then gradually increase the amount of exercise they undertake. A physiotherapist can advise on the best types of exercise you can do to help manage your osteoarthritis.

Addressing other contributing factors is essential for managing osteoarthritis, as well. There’s strong evidence linking various metabolic factors to osteoarthritis – such as obesity, diabetes, high cholesterol and high blood pressure. These factors increase inflammation within the body, which affects cartilage in joints. Losing weight where needed is also hugely beneficial in reducing strain on joints.

For those who may not want to use steroid injections, there are other options.

Hyaluronic acid injections, for instance. These help our natural joint lubrication, called synovial fluid. In osteoarthritis, synovial fluid has less viscosity and levels are reduced. Hyaluronic acid is also believed to work as an anti-inflammatory.

Similar to steroid injections, they can reduce pain and increase movement and function. They may be more beneficial to people with earlier stage osteoarthritis and may theoretically have fewer negative effects to cartilage. There may also be value in combining the two types of injection.

Hyaluronic acid has a similar safety profile to corticosteroid, with few reported side-effects. It may, however, take up to 12 weeks for effects to show – though the benefits can last up to six months.

Accessibility is limited in the UK, hyaluronic acid is not currently recommended within NICE guidelines, primarily due to cost effectiveness, so may only be available to those privately funding their care.

Joint injections are not a cure for osteoarthritis. They can have variable effects, and work best combined with other management approaches (such as weight loss and exercise). But with long wait times for surgery, they may offer a valuable way to reduce pain and manage the condition.

Sarah Golding is a Musculoskeletal Physiotherapist and Lecturer at the University of Essex.

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

How Chronic Pain Kills Your Independence

By Crystal Lindell

There’s a myth that I heard a lot as a little girl. That when I grow up and become a woman, the ultimate goal should be full independence.

Or as Destiny's Child famously sang in their 2000 anthem, Independent Woman: "I depend on me / All the women, who independent / Throw your hands up at me.”

But if you have a chronic illness or chronic pain, the reality is actually: I depend on me… and my fiancé, my mom, my grandma, my siblings, and my friends.

I have Ehlers-Danlos Syndrome (EDS). It’s a connective tissue disorder that I was born with, although I was not officially diagnosed until 2018. The only reason I was diagnosed then was because five years earlier, in 2013, I developed debilitating pain in my right ribs that would later be labeled by doctors as intercostal neuralgia.

Despite living most of my life without a diagnosis, the EDS has always been there, impacting my life. I just didn’t know that it was the cause of my clumsiness — and the countless injuries, sprained ankles, and crushing fatigue.

I remember when the symptoms made my life feel impossible to handle. Like the time I sprained my ankle in college. I remember going home after a long day of hobbling on crutches around campus, and having to drag myself up a flight of stairs to my walk-up studio. 

When I finally got into bed, I remember crying myself to sleep in pain and frustration, just begging the universe for help. 

These days, I recently started working outside the home again, a cashier job at a local gas station. Because of my chronic pain, there’s absolutely no way I could manage my life independently while also working there. I need help to pull it off.

My fiancé handles so many of the day-to-day tasks required to keep me functioning. Without him doing laundry, washing dishes, cleaning the bathroom, feeding the cats, cleaning the litter boxes, doing yard work, and countless other chores, I would never have enough energy to do  my job and handle the rest of my life.

At the end of the day, we all need people like that. And when you have a chronic illness or chronic pain, you need them even more urgently.  

I don’t even get to pretend I live an independent life. A dependent life was forced on me by my broken body. 

Over the years, I have come to realize that the ultimate goal is not independence. The ultimate goal is surrounding yourself with people who you can trust to help take care of you -- and who you love enough to take care of in return.

More Non-Opioid Drugs Recommended for ER Pain Relief

By Pat Anson

Would you take an anti-depressant for back pain? 

An anti-psychotic medication for headache?

What about an anti-anxiety drug for stomach pain? 

Those are some of the non-opioid alternatives being recommended for pain relief in emergency rooms, as the healthcare industry continues to move away from using opioids.

The latest example is a study by researchers at University of California, San Francisco (UCSF), who recommend over a dozen non-opioid medications for five acute pain conditions commonly treated in emergency departments: back pain, abdominal pain, chest pain, fracture pain and headache. 

The findings are published in the Western Journal of Emergency Medicine.  

Researchers initially screened 246 clinical studies to prepare their non-opioid list, but narrowed it down to 23 of the most promising studies. First author Akash Shanmugam, a UCSF medical student, told The Guardian that the goal was to “create a very targeted list for specific pain conditions” to be utilized by ER physicians.

Many of the drugs that made the list, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are already widely used for acute pain. But some of the selections are puzzling, as they are psychotropic drugs not typically used to treat pain and are not fast-acting.

For example, the anti-psychotic drug haloperidol is recommended for both headaches and abdominal pain. Haloperidol is usually prescribed for schizophrenia or acute agitation, and is sometimes used off-label for conditions like psychosis and Tourette's syndrome.

Venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), is typically used to treat depression and anxiety, but UCSF researchers think it could be used for back pain.

Other oddities that made the non-opioid list are ketamine for chest pain, abdominal pain and headache; benzodiazepines for abdominal pain; and the anti-nausea drug metoclopramide for headaches. 

Gabapentin would have made the list of non-opioid alternatives, but researchers decided the evidence was too weak to support its use for the five conditions they evaluated.  

“Our findings hold significant implications for pain management approaches in the ED and public health efforts aiming to address the opioid epidemic. By providing alternatives to opioid prescriptions, this review supports efforts to reduce opioid overexposure in the ED while helping to manage patient pain,” researchers said.

“Encouraging the use of these alternatives aligns with broader initiatives aimed at optimizing pain management practices, improving patient outcomes, and contributing to the overall mitigation of the ED’s contribution to the opioid crisis.” 

‘Made Me Feel Worse’

But are the drugs effective for pain? Posters on Reddit are skeptical that antidepressants and anti-psychotics would be helpful.

“This is ironic because codeine does a better job of making my brain quiet than any antidepressant I've tried so far,” said one poster. “I've never developed an addiction to codeine and it's also never induced suicidal thoughts, unlike a couple of the antidepressants I've tried. It also didn't make me so physically sick that I almost went to hospital, unlike the SNRI I stopped taking.”

“Tried tons of antidepressants for pain and depression, nothing worked in fact many made me suicidal. And then had tramadol prescribed for my back pain, low dose but my depression also improved a huge amount,” wrote another.

“These types of medications have made me feel worse than anything else I’ve ever taken. If I had to choose between pain and feeling like that again, I would choose the pain. But maybe that’s what they’re after since doctors don’t like prescribing pain medicine anyway,” said another Reddit poster.

“That's just ridiculous. Antidepressants and antipsychotics are not going to do anything at all to relieve pain,” said another. “The war on drugs has gone too far.”

But researchers say there’s frequently an overlap between physical and emotional pain that justifies the use of psychotropic drugs.

“Chronic pain is often linked to things like poor sleep, depression, anxiety, fatigue,” co-author Kathy LeSaint, MD, Associate Professor of Emergency Medicine at UCSF, told The Guardian. “In chronic pain conditions, the nervous system can become highly sensitive, and it’s thought that antidepressants and antipsychotics can maybe reduce this heightened sensitivity in the brain.”

Although the risk of addiction and overdose are often cited as reasons to avoid using opioids, that risk is often exaggerated. A 2024 study found that the risk of long-term opioid use after being treated with intravenous opioids in the ER is quite low – less than two-tenths of one percent (0.19%).

That mirrors the findings of a 2017 Mayo Clinic study, which found that the risk of long-term opioid use is only 1.1% for ER patients — less than it is for patients treated in other medical settings.

Nevertheless, some pharmaceutical companies are betting that non-opioids are the future of pain relief. Eli Lilly today announced the purchase of 4E Therapeutics, a biotechnology company that’s developing MNK inhibitors, which interfere with pain signals by blocking enzymes in the peripheral nervous system. 4E is the second non-opioid drug developer to be acquired by Lilly in a little over a year.

People Who Live Without Pain Rarely Think or Care About Those Who Do

By Ann Marie Gaudon

As I crawl into bed early at night, so grateful for the bed I have, I strategically place two separate heating pads for pain relief. Simultaneously, I strategically place two ice packs for pain relief. 

What’s one to do? “A” and “B” require heat for relief, and “C” and “D” require ice for relief. 

Such is my life.

What is it like to not have pain? To just go to bed at a regular adult time, slip into your sheets, and drift off? I have no idea, and so I can only imagine this. I would have to go back at least four decades in time and I just cannot remember that far back.

It’s ironic that I am so high maintenance, but not as you might think. I couldn’t be less of a diva. The days of hair, make-up, and stylish clothes are long gone. I care nothing for those things because they don’t do anything to make me feel better. 

I putter along with regular haircuts, minimal make-up on days I can manage it, and that’s about it.

I have no fear of what any pain may or may not mean. I do not have a cascade of stress hormones flooding my system daily out of fear. That is not in my life, and is what I have achieved from a healthy dose of self-care and chronic pain management. 

What it cannot do, however, is stop a body from deteriorating, stop pain from increasing, or stop the course of disease.  

As a young person, I can assure you I never saw this coming. There are other illnesses in my family of origin, but not chronic pain as I have experienced for 40+ years.

Unfortunately, there is not a lot of help out there. Health Canada, which is the Canadian agency responsible for “helping Canadians maintain and improve their health,” claims to ensure that everyone has access to high-quality health services. 

But from all that I have read and meetings I have attended, Health Canada remains essentially clueless to the plight of a person in pain. They have always drunk the Kool-Aid of anti-opioid zealots, and believe the endless published rubbish about those medications. 

As sickening as that is (no pun intended), I was never able to find anyone with any type of power that actually was a person in pain. That’s a big problem. 

Just to be clear, this is not a column about opioids or any other type of medication. It’s about the sheer ugliness of chronic pain. For some of us, the diagnoses just keep rollin’ along. I have officially lost count. 

There are two new ones that I can tell you about. One is Baxter’s nerve entrapment, which feels like a razor sliding up into your heel with every step. For a long time, I thought it was a very stubborn case of plantar fasciitis in both feet. However, I have since learned there’s a different diagnosis entirely in my right heel. 

The second newer diagnosis is something called costochondritis. No, I hadn’t heard of it either. I thought I was having a massive heart attack when I awoke in the middle of the night in severe chest pain. I resigned myself and just felt ready to go unconscious. However, that didn’t happen. 

I was advised over the next three days to go to the emergency department, but having care-avoidant health anxiety, I refused to go. 

I was in tremendous pain and could hardly move at all, but on the third day, someone said to me that I might have pneumonia. That word is what got me to the emergency department, because I could not forgive myself if I ever infected someone else. 

It wasn’t pneumonia, it wasn’t a heart attack, and it wasn’t a pulmonary embolism. It was costochondritis, which the Mayo Clinic advises can feel much like a heart attack. Now the chest pain comes and goes.

At times I feel angry and sad for myself, but where my heart really lies is for younger people. What’s to become of the young at the beginning of their chronic pain or not quite there yet? I shudder at the thought of it. 

I recently had a young client with painful rheumatoid arthritis who was especially suffering with pain in one hip that was causing mobility issues. Practically begging her neurologist for pain relief, the response was: “No one with rheumatoid arthritis should expect to live a pain-free life.” 

They were gutted by those words. 

Is this what to expect? “Don’t expect to live a pain-free life” when there are scores of medications out there developed for just that? What is wrong with people? 

I can tell you my unscientific theory about this. People who do not live in pain rarely think or care about others that do.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 40 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.     

How CDC Cuts Endanger American Lives

By Candice Johnson

Since the Trump administration took office in January 2025, the workforce at the Centers for Disease Control and Prevention has weathered uncertainty and change.

Mass firings, communication freezes, political interference in the CDC’s scientific mission and a revolving door of leaders have created a challenging work environment for the CDC’s employees.

I’m a public health researcher who studies how working conditions affect employee health and well-being. I also worked at the CDC from 2012 to 2020. Given the turmoil imposed on the CDC workforce since Inauguration Day, I worked with a team of researchers at Michigan State University to conduct an anonymous survey of more than 600 CDC workers.

We found a CDC workforce concerned by a declining ability to achieve the agency’s public health mission, a shrinking and overworked staff and wide-ranging effects that threaten Americans’ health.

CDC’s mission is to protect and improve the health of Americans, which it fulfills by preventing, detecting and controlling disease. CDC also staffs a pool of public health experts who are rapidly deployed to respond to public health emergencies – including disease outbreaks – worldwide. The cuts to CDC put these functions in jeopardy.

Key CDC Posts Empty As Ebola Outbreak Grows

As an explosive Ebola virus outbreak takes hold in Central Africa, infectious disease experts are questioning the U.S. government’s ability to effectively respond to public health emergencies following the cuts to the CDC and foreign aid, as well as the U.S. withdrawal from the World Health Organization.

The CDC remains without strong leadership at a critical point in the outbreak response.

In August 2025, Health and Human Services secretary Robert F. Kennedy Jr. fired CDC Director Susan Monarez after she refused to accept political interference with the agency, causing multiple senior CDC leaders to resign in protest. Almost one year later, the CDC’s top leadership positions remain vacant. The agency has no director, principal deputy director, chief of staff or chief medical officer to lead employees through a complicated emergency response.

But in our survey, we were most interested in knowing how this administration’s changes have affected CDC’s rank-and-file workforce, who are on the front lines of protecting Americans’ health.

Emergency Response Eroded

Between February and April 2026, our team distributed our anonymous survey through employee and alumni groups, LinkedIn and professional networks. We received responses from 433 current and 191 former CDC employees who had left since January 2025; 95% were federal employees and the rest contractors or other nonfederal workers.

The survey questions asked how the second Trump administration’s changes have affected their day-to-day work.

In June, we presented our initial findings at the annual meeting of the Council of State and Territorial Epidemiologists as we prepare for publication in an academic journal.

More than 99% of CDC employees we surveyed – 604 out of 605 – said that the administration’s changes to the CDC reduced its capacity to respond to a public health emergency.

For example, during the 2014–2016 Ebola virus outbreak, the CDC sent its public health professionals – including me – on more than 3,000 deployments to West Africa to control the outbreak. But today, in the midst of another growing Ebola outbreak, deep cuts to the CDC workforce mean that the agency may no longer have sufficient personnel to deploy at the same capacity if needed.

Americans are already seeing this in the CDC’s response to ongoing measles outbreaks in the U.S. Public health experts note that the CDC’s communication with the public about the outbreaks has been confusing and sparse, which they attribute to the cuts.

85% of CDC Workforce Burned Out

The CDC is home to a specialized public health workforce tasked with responding to the nation’s most important health problems.

Since January 2025, the CDC has lost just over a quarter of its federal employee workforce. More than 1,000 employees were fired after their positions were eliminated, with hundreds remaining on administrative leave due to a court order preventing their firing. Resignations, retirements and contract nonrenewals have further shrunk the workforce.

“We have the same amount of work,” wrote a CDC manager whose work unit was particularly hard-hit by staff losses, “but it is not possible to do all of it with half the staff.”

Among the current CDC workers we surveyed, 85% said they were burning out.

These cuts and challenges have made CDC employees pessimistic about the agency’s future. Of the current CDC employees we surveyed, 1 in 5 have decided to leave, further straining CDC’s resources. The vast majority who left voluntarily – 95% – told us they left mostly or entirely because of changes implemented by the current administration.

“The anti-vaccine, anti-science stance of this administration meant that I could no longer in good conscience continue to work there given the type of work that I did,” a former CDC manager explained.

Similar reasons were given by senior CDC leaders and scientists who resigned in protest since January 2025, citing budget cuts, scientific censorship and political interference with the CDC’s public health mission as the reasons they resigned.

The CDC’s nonscientific workforce was also hard-hit, with the Department of Health and Human Services eliminating CDC’s digital media teams, offices handling Equal Employment Opportunity complaints and Freedom of Information Act requests, and much of human resources and acquisitions. In our survey, 94% of CDC employees said that under this administration, it became harder to do their job.

Cuts to Chronic Disease and Injury Prevention

Although the CDC’s responses to infectious disease outbreaks like hantavirus or Ebola virus tend to dominate headlines, much of the agency’s day-to-day work focuses on chronic disease and injury prevention.

Chronic diseases are the No. 1 killer of Americans, and injuries are the No. 1 killer of American children.

Despite Kennedy’s assertions that his administration will focus on preventing chronic disease, he has quietly shuttered many of the CDC’s chronic disease and injury prevention programs, including those dedicated to improving women’s health, preventing violence and injuries, tracking infertility, reducing tobacco use and promoting healthy aging.

President Donald Trump’s fiscal year 2026 budget proposed eliminating the CDC’s chronic disease and injury prevention programs entirely. The final funding bill rejected these cuts.

We asked current and former CDC employees in chronic disease and injury prevention programs what happened to their work unit under this administration. Only three of 142, or 2%, said their work unit remains fully operational and able to meet its public health mission.

We asked everyone we surveyed if they thought Americans will die because of the administration’s changes to the agency; 95% said yes.

Public Health Cuts Ripple Through the Country

Many of the CDC’s functions are invisible to the general public, making it easy to hide the extent to which the agency has been damaged.

In addition to responding to public health emergencies and preventing disease, the CDC plays a vital role in sustaining the nation’s public health infrastructure. About 80% of the CDC’s domestic budget goes to fund public health programs run by state, territorial, tribal and local partners, directly protecting health in local communities.

Health departments around the country are now grappling with sudden cuts to the federal funding that sustains their health data collection and health promotion activities.

I believe that current and recent CDC employees have the best view of how the administration’s cuts are affecting the agency. Their observations warn of a U.S. government losing its ability to protect the nation’s health.

Candice Johnson, PhD, is an Assistant Professor of Epidemiology at Michigan State University. Prior to academia, she was an epidemiologist at the CDC and a member of the CDC's Epidemic Intelligence Service.

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

A Fentanyl Vaccine Is a Horrible Idea

By Crystal Lindell

A few years ago, I saved a loved one’s life when he was overdosing on fentanyl.

His lips and fingertips were blue when I found him, and as I administered NARCAN (naloxone), all I could think at that moment was that if he was dead, I never got the chance to say good-bye.

It was one of the most traumatizing experiences of my life, and I’m forever grateful that my efforts to save him were successful.

Even with that experience, I’m here to tell you that a fentanyl vaccine is an absolutely horrible idea. And I pray that nobody I love ever takes it – even the man who’s life I saved.

This week, JAMA published an article about the current status of the fentanyl vaccine, which is in development.

In the article, Associate Managing Editor Kate Schweitzer interviews Collin Gage, a cofounder and chief executive officer of ARMR Sciences, which has begun early-phase human trials of a fentanyl vaccine in the Netherlands.

Schweitzer seems to think such a vaccine would be a net positive for the world.

"If proven safe and effective, it could become the first proactive pharmaceutical approach designed to prevent fentanyl overdose and, potentially, treat addiction," she writes.

However, as both a chronic pain sufferer and someone whose loved one struggled with fentanyl addiction, I’m here to tell you that this entire research project should be ended right now.  

First and foremost, my biggest concern is that such a vaccine would be pushed onto people who do not want or need it, including pain patients.

I can already see doctors having a policy where they won’t prescribe opioids unless the patient agrees to receive the fentanyl vaccine. They’ll claim the policy is meant to protect patients, when in reality, it would only cause them more harm.

The article even points out what those harms could look like. Schweitzer quotes Kathryn Frietze, PhD, associate professor of molecular genetics and microbiology at the University of New Mexico, who is one of many researchers working to develop vaccines against drugs of abuse.

Doctors, according to Frietze, have expressed concern about how a vaccine could complicate medical care, given that prescription fentanyl is a widely used medication for acute pain control and anesthesia.

“Can they increase the fentanyl dose medically if needed, or is it going to completely eliminate fentanyl as an option?” Fritze asked. 

Read that again. Do we really want to eliminate fentanyl as an option for pain control and anesthesia? This is a medication used in hospitals, usually on patients in severe trauma or undergoing surgery.

Do we really want a vaccine to make fentanyl ineffective for them? 

Do we really want a vaccine that requires more fentanyl to be administered?

In practice, either scenario could be disastrous, especially in an emergency situation where an unconscious patient would be unable to explain to doctors that they had the fentanyl vaccine.

The thing about fentanyl is that you have no idea that you might need it someday. We don’t usually know when we’ll need anesthesia or acute pain control.

That is particularly relevant in this situation, because the article quotes multiple experts who seem excited about pushing a fentanyl vaccine onto high-risk groups, such as college students and young adults, who are experimenting with drugs. They may not be aware that the counterfeit pill they bought or got from a friend has a lethal dose of fentanyl. 

“Overdose from fentanyl doesn’t just happen to people who are purposely taking fentanyl,” Frietze said. “People may be exposed without their knowledge.” 

So they want to go to college campuses and give students a vaccine against a very valid pain medication, when they have no idea if they will ever need it?

Schweitzer says a vaccine that specifically targets fentanyl could still allow for the use of other analgesics, such as morphine and propofol. 

As a pain patient, I’m skeptical about that. If a vaccine blocks the effects of one opioid, it may also dampen the effects of other ones.  

The other major issue with a potential fentanyl vaccine is a phrase coined by Richard Cowan in 1986: “The Iron Law of Prohibition.” That essentially means that when law enforcement targets a specific drug, the potency of other prohibited substances increases.

Or, as Cowan said, "The harder the enforcement, the harder the drugs."

If you give everyone fentanyl vaccines, people will just find even stronger drugs to take. And those drugs will likely be more deadly. It’s no coincidence that illicit fentanyl arrived on the black market just as opioid pain medication became harder to get. 

As such, a fentanyl vaccine could result in more overdose deaths, not less, as people seek substitute drugs that bypass the vaccine.

Gage’s response to that possibility is to call the fentanyl vaccine “a platform technology—one that we plan to adapt."

In other words, they will just make new vaccines for new drugs. But in practice, how long would it take to actually develop new ones? And how long would it take to get them to drug users, who are often difficult for the medical community to reach?

Trust me when I tell you that drug users and their dealers will move exponentially faster than any research and development team ever could.

In practice, the reason street fentanyl is so deadly is because it’s unregulated. Users don’t know how much they are taking or what is mixed in with it – and those two things make it more likely that the drug will cause an overdose.

The solution then is to offer drug users a regulated supply, which is what methadone treatment is. In a perfect world, if they really wanted to help fentanyl users, these researchers would be working to make methadone treatment more accessible.

Instead, they’d rather make it so patients can’t use one of the most effective pain and anesthesia medications on the market, while pushing them onto harder or less effective drugs.

It’s a bad idea, and I hope these researchers see the error of their ways before it’s too late.

AMA Calls for Complete Ban on Sales of 7-OH

By Pat Anson

The American Medical Association (AMA) is calling for a complete ban on the sale, distribution and marketing of products containing 7-hydroxymitragynine (7-OH), a kratom alkaloid that is of growing concern for its potential to cause dependence and addiction.

7-OH occurs naturally in kratom in trace amounts, but when concentrated acts as a potent pain reliever and stimulant with “opioid-like” effects.

The policy adopted by the AMA at its annual meeting urges the FDA to classify “7-OH kratom products” as adulterated or misbranded. It is particularly concerned about sales to minors and the packaging of 7-OH in colorful, child-friendly forms that could be mistaken for candy.

“We cannot ignore the growing availability of unregulated products marketed in ways that appeal to children and adolescents. Concentrated 7-OH products are being sold in forms that can resemble candy and other treats, creating unnecessary risks for young people,” Dr. Melissa Garretson, a member of the AMA Board of Trustees, said in a statement.

As for kratom itself, the AMA’s House of Delegates passed Resolution 201, which recommends that kratom be evaluated for regulation as a drug under the Controlled Substances Act:

“Our AMA recommends kratom, and its derivatives, should be regulated by the FDA, and its safety and efficacy should be determined through clinical trials before it can be marketed or prescribed as treatment for any condition.”

As dietary supplements, kratom and 7-OH are currently regulated as food — not as drugs — by the FDA, as long as unverified claims are not made about their medical uses. The FDA has repeatedly warned kratom distributors not to make such claims.

Several states and dozens of cities and counties have already banned kratom and 7-OH or put age restrictions on sales. The AMA’s new policy position will likely add weight to further efforts to ban kratom products.

The American Kratom Association (AKA), an association of natural leaf kratom vendors, supports efforts to ban 7-OH products. but is concerned the AMA was not specific enough about its concerns.

“The AMA correctly identifies the danger posed by concentrated 7-OH products, but it stops short of making the most important distinction,” Mac Haddow, an AKA lobbyist, said in a statement. “These chemically manipulated 7-OH opioids are not traditional kratom products. They are highly concentrated opioids manufactured through chemical conversion processes that fundamentally alter the natural composition of kratom.” 

The AKA’s position is at odds with the 7-HOPE Alliance and the Holistic Alternative Recovery Trust (HART), which represent 7-OH consumers and manufacturers. Those groups support age restrictions and regulation of 7-OH, but not outright bans.  

“As discussions surrounding kratom continue, HART urges policymakers, medical organizations, and regulators to engage with the available scientific evidence and work toward regulatory solutions that protect children and consumers while preserving access for responsible adults,” Jeff Smith, HART’s National Policy Director, said in a statement to PNN.

“The fixation and misinformation on 7-OH is a deliberate distraction from far more concerning products that remain widely available to consumers. Instead of pursuing misguided bans on naturally occurring compounds, policymakers and regulators should focus on protecting consumers through consistent, science-based standards that apply equally across all kratom products.”

(Editor’s note: An earlier version of this story incorrectly reported that the AMA only wanted a ban on sales of 7-OH products to minors. PNN regrets the error.)

Kratom and 7-OH Often Confused

The lines between kratom and 7-OH often get blurred. A case in point is a recent news release from the Laguna Treatment Center, an addiction recovery clinic in Southern California, which warned of the “growing threat of kratom and its byproducts.”

In the first 5 months of 2026, the center said it was treating 25 patients “who sought help for kratom dependence.” That represents a 525% increase from the 4 kratom consumers who sought treatment at the center in all of 2025. The center makes no distinction between the different forms of kratom. 

“An alarming number of patients are coming in dependent on and addicted to kratom and its byproducts, such as 7-OH, who were previously unaware of the risks. This is relatively new territory for many providers, and we encourage insurance providers to expand and prioritize coverage for those seeking treatment for kratom misuse,” said Trace Swartzfager, Executive Director of the Laguna Treatment Center. 

Federal policies about kratom and 7-OH are also confusing, if not incoherent. Last month, President Trump said his administration would support the approval of “natural 7-OH,” without clarifying whether he was talking about natural leaf kratom or concentrated 7-OH versions.  

Nearly a year ago, FDA commissioner Marty Makary, MD, called on the DEA to classify 7-OH as an illegal Schedule I controlled substance, but not “natural kratom leaf products.” The DEA has yet to act on the FDA’s request and Makary has since been fired. The Trump administration has yet to replace him.

Claims are often made that 7-OH and kratom are opioids that cause addiction and overdoses. Technically, they are alkaloids and are not derived from poppy plants. Kratom and 7-OH stimulate endorphin nerve receptors in the brain – often called “opioid receptors” – but the same could be said about chocolate and coffee, which stimulate the production of endorphins and other natural “feel good” hormones.

Most of the overdose deaths attributed to kratom and 7-OH involve other substances, so it is not clear if they were the actual causes – much as opioid pain medications were mistakenly blamed for many overdose deaths. The FDA admits there is “ambiguity about the contributory role of 7-OH” in many overdoses.

Further muddying the waters about kratom, the National Institutes of Health (NIH) recently said it would study one of its purported health benefits. The NIH is launching a preliminary study to see if the kratom alkaloid  mitragynine could be used as a treatment for opioid addiction. Many kratom consumers already use the herbal supplement to help reduce their cravings for opioids and alcohol. 

A previous NIH study concluded that kratom is an effective treatment for pain, helps users reduce their use of opioids, and is “relatively safe” to use.

Black Patients Consider Many Things Before Deciding on Surgery

By Crystal Lindell

When Black patients with carpal tunnel syndrome are deciding whether to have surgery, they aren’t just considering their doctor’s recommendations. 

They are also thinking about a range of social, cultural and financial issues, such as how much work they’ll miss, whether insurance will pay for surgery, and what their loved ones think. That’s according to a new study published in JAMA. 

Researchers were inspired to look into the matter because Black patients in the U.S. are significantly less likely than White patients to have surgery for carpal tunnel syndrome, even when their symptoms are similar or more severe.

Carpal tunnel syndrome (CTS) is a common condition caused by compression of a nerve that passes through the wrist. Symptoms include numbness, tingling, weakness, and pain in the thumb and fingers.

The research team recruited 28 Black patients with CTS and asked them in individual interviews what their decision-making process was like. All had reached a point where their pain and loss of hand function prompted them to consider surgery. 

Although the study focused on Blacks, the same basic questions are faced by all patients: Will the surgery help and can I afford it? But due to treatment disparities and racial bias in the healthcare system, Black patients are more likely to be cautious about trusting doctors. 

“Participants emphasized the importance of being heard, respected, and actively involved in decisions; they carried prior experiences forward, shaping how they approached future interactions, including their willingness to trust clinicians, ask questions, or pursue recommended treatments,” wrote lead author Rachel Hooper, MD, a plastic surgeon and Assistant Professor of Surgery at University of Michigan Medical School. 

The patients who were interviewed welcomed collaborative and transparent approaches to their treatment, and wanted to have space to make informed, independent decisions about their surgery. As one participant said: 

“I just like my doctor to have an open communication, not tell me … ‘You need to do this. You need to do that’ but, ‘What can we do to get this working for you?’”

Researchers found that patients' social influences were an important part of the decision-making process. Some participants prioritized advice from friends, family, or coworkers over a doctor’s recommendation. They valued the experiences of other people in their lives:

"People from work... that was the other thing that discouraged me... surgery wasn't a help to them."

Patients also said financial concerns and a lack of paid leave led to delays in moving forward: 

"I kind of did prolong it... I didn't want to stop at work...never wanted to take the time off."

The authors suggested a number of ways to address these issues. They said surgeons should develop more educational material to clarify the impact that delaying surgery could have on hand function and long-term recovery.

They also recommended training in humility and how to collaborate more with patients. For example, surgeons could ask patients, "What matters most to you about hand use?"

They said surgical practices should be more involved in discussing financial issues, such as co-pays, time off, and insurance coverage. It would also be helpful to have patient advocates and social workers available to assist with insurance coverage, charity care applications, and to offer flexible scheduling to help hourly or shift workers.

Long-term, the researchers recommended more recruitment, hiring and mentorship of minorities in surgical teams.

It’s great to see a medical study published in JAMA that focuses entirely on the patient perspective, going so far as to do one-on-one interviews with patients.

Frankly, it’s long past time to acknowledge the full scope of patient decision making when it comes to things like surgery. In my experience, doctors are often shocked to discover that a patient might want to consider things like cost, time-off work, or post-op support.

Research like this is vital to help the medical community better understand patient perspectives. Ideally, it will help doctors better respond to the very real – and very valid – concerns that all patients have.

Glucosamine May Contribute to Alzheimer’s Disease

By Pat Anson

An over-the-counter supplement used by millions of people around the world to relieve joint pain has been associated with Alzheimer’s disease and other advanced forms of dementia, according to a new study.

Neuroscientists at the University of Florida say glucosamine raises the risk of someone progressing from mild cognitive impairment to Alzheimer’s disease by about 25 percent.

Glucosamine is an amino sugar found in shellfish that helps build cartilage, ligaments, tendons, and synovial fluid in joints. It is used annually by about 40 million Americans, many of them elderly, to reduce inflammation and symptoms of osteoarthritis.

What many seniors don’t realize is that glucosamine may also be accelerating the formation of protein plaques in their brain, which have been linked to dementia. 

“A lot of these people actively take an over-the-counter supplement that could be making their disease progression worse,” senior author Ramon Sun, PhD, a biochemist and molecular biologist, said in a press release.

It’s important to note that the study findings, published in the journal Nature Metabolism, are preliminary and don’t establish a cause and effect relationship between glucosamine and Alzheimer’s – only an association.

The findings are based on a large retrospective analysis of health records for over 50,000 patients diagnosed with Alzheimer’s disease-related dementias (ADRDs) or mild cognitive impairment (MCI). While most patients with MCI remained stable or even recovered cognitive ability, about 5% progressed to ADRD, representing a clinical worsening of cognitive decline. 

About 8% of the patients studied reported taking glucosamine supplements. When compared to patients who didn’t take glucosamine, researchers saw a 25% higher risk of patients with MCI transitioning to ADRD in the glucosamine user group. In addition, glucosamine use was associated with a 25% increase in mortality risk among ADRD patients.

Researchers believe glucosamine crosses the blood-brain barrier and feeds into pathways that build sugar residue on protein cells. Patients with Alzheimer’s appear to be more vulnerable to this metabolic activity than those with healthy brains.

“The electronic health record data are very provocative,” said co-author Matt Gentry, PhD, chair of UF’s Department of Biochemistry and Molecular Biology. “While it’s an association and not proof of causality, it does raise an important clinical question that now deserves much more attention.”

In tests on genetically modified mice, the UF research team found that glucosamine significantly increased sugar residue on proteins in the brain and reduced the social recognition behavior of mice. When researchers chemically suppressed this process, their “social memory” improved.

Advanced imaging studies on human Alzheimer’s brains also showed significantly increased sugar attachment to proteins compared to healthy brains. 

Taken together, the findings suggest that metabolic dysfunction is not simply a secondary aspect of Alzheimer’s pathology, but a contributing cause. 

“Proteins are the cell’s molecular machines, and many of them need sugar tags added in just the right way to fold correctly, travel to the right place and do their jobs,” Gentry said. “What we found in Alzheimer’s is that this sugar-tagging system appears to be overactive. The Alzheimer’s brain is adding too many of these sugar structures, and this seems to contribute to the disease rather than protect against it.”

The good news about this research is that it could lead to new ways to prevent Alzheimer’s or slow its development.

“Our results suggest that altered metabolism is a significant contributor to Alzheimer’s progression and, in addition, addressing the metabolic defect could be an important complement to approaches focused on Alzheimer’s plaques and tangles,” Sun said.    

Glucosamine is the fourth most widely used supplement in the United States. It is also widely used in China and Europe. Glucosamine is often combined with chondroitin to help build or restore joint cartilage. 

While further studies are needed, the Mayo Clinic says glucosamine “might provide some pain relief” for people with knee osteoarthritis. 

Tell Me Who the Real Criminals Are

By Cathy Kean 

Close your eyes. Go back to the worst pain you have ever known. A broken bone. A car wreck. Surgery. Childbirth without relief. Stay there for fifteen seconds. 

Feel the desperation. The begging. The need for it to stop.

Now imagine never leaving that place. You feel that pain every second. Every day. No break. Not in sleep. Not ever.

That is my life. Millions of us live here.

There is something that helps. Prescription opioids do not erase my pain, but they turn down the volume enough for me to be able to shower. To work. To keep my home. To hug my grand child without screaming inside.

Then they took them away. They said it was for my own good.

Before my chronic pain worsened after the release of the CDC opioid guideline, I worked as a real estate agent and special education advocate. 

Now I cannot walk. I have lost my job. My home of 32 years is in foreclosure. Friends stopped calling. I need help to use the bathroom. My independence is a corpse they are still kicking.

And the final cruelty? The people who did this lied to you.

CATHY KEAN

The Lies Behind the ‘Opioid Crisis’

You have been told prescription opioids are killing America. In 2021, the CDC reported a 1,040% increase in overdose deaths involving synthetic opioids from 2013 to 2019. They said those deaths were largely caused by illicitly manufactured fentanyl.

Here is what they didn’t tell you in that report: For many years, CDC misclassified most of those overdoses as prescription opioid deaths, and those deaths were used to help justify the agency’s 2016 opioid guideline, which led to wholesale restrictions on opioid prescribing. 

Not until 2018 was the error quietly acknowledged by four CDC researchers. And that tens of thousands of illicit fentanyl deaths were misclassified for years as prescription opioid deaths. 

The error was so serious that in 2016 alone, over 15,000 deaths caused by illicit fentanyl were mistakenly attributed to prescription opioids. Millions of Americans were misled by these and other errors that inflated the overdose numbers.

The White House told you prescription painkillers were the enemy. The media screamed it. Meanwhile, the real causes – illicit fentanyl, heroin and methadone – were hidden inside the CDC's overdose numbers.

The Death Toll They Won't Count

Because of the CDC guideline, thousands of chronic pain patients killed themselves. 

Not because they wanted to die, but because they could no longer get the prescription opioids that made life bearable. The pain became more than they could endure. And suicide offered a way out.

Others died slowly. From heart failure. Stroke. Organ collapse. The brutal physics of untreated pain grinding a body into dust.

No one in power keeps track of those deaths or says a word about them. No government agency. No major news outlet. No one with a microphone stands up and says, "We made a mistake. We are killing innocent people."

Instead, they push Suboxone and “alternative treatments.” For money. Not thy fellow man.

We have lost our First Amendment rights in the doctor's office. If you speak up about your pain, you are labeled a drug seeker and abandoned as a patient. I would rather die at home than face contempt again in the ER.

What I Want You to Do

Now imagine those 15 seconds of the worst pain you’ve ever felt. Really do them. Feel that pain.

Could you live like that? For one week? One year?

I am not asking for your pity. I am demanding your understanding. Your voice. Your outrage.

We are not criminals. We are not drug seekers. We are not addicts. We are not statistics on a CDC spreadsheet.

We are mothers and fathers. Veterans who served you. Construction workers who built your cities. Nurses who held your hand. Grandparents who babysat your children.

And we are dying. Some by suicide. And some by the slow, grinding destruction of our lives and bodies.

So here is what I need from you:

Do not look away. Say our names. Help us get our lives back.

Because if you could spend fifteen seconds in my body — really spent them — you would not need to be asked twice. You would be screaming with us.

Cathy Kean lives in California. She is a grandmother of 9 and mother of 4. Cathy lives with intractable pain from a botched surgery, along with fibromyalgia, arachnoiditis, stiff person syndrome, lupus, Parkinson's disease and insomnia. 

Cathy is the creator and administrator of the Facebook pages Chronic Illness Awareness and Advocacy Coalition and Pain is Pain. She writes to give a voice to the millions of chronic pain patients who have been silenced, stigmatized, and left to suffer—and to ensure her grandchildren never have to ask why Grandma couldn't be there.