Researchers To Use AI to Study Chronic Pain in Rural Older Adults

By Crystal Lindell

Virginia Tech researchers will receive nearly half a million dollars from the federal government to use artificial intelligence (AI) to study chronic pain in older adults living in rural areas.

The study is being led by Huaiyang Zhong, PhD, an Assistant Professor in the Grado Department of Industrial and Systems Engineering at Virginia Tech. He was awarded a $460,260 grant from the National Institute on Aging.

People in rural areas have significantly higher rates of chronic pain than those who live in big cities. They’re also at a big disadvantage when it comes to getting their pain treated, due to the distances many have to travel to see a doctor. 

Zhong and his team hope AI can help improve pain assessments and clinical decision making by doctors, with the goal of reducing pain and pain-related complications in older patients.

“I became interested in chronic pain because it's incredibly common, but also incredibly complicated,” Zhong said in a press release. “Pain is not just a single diagnosis, and it's not a number on a scale like a lot of medical diagnoses. Pain itself can affect mobility, mental health, sleep, cognitive functions, and overall quality of life. It's a multidimensional thing.”

Zhong hopes to learn how chronic pain evolves, which patients are more vulnerable to poor outcomes, and how healthcare systems can treat them more effectively. 

It all starts with the information that is sometimes buried in clinical notes. Researchers will use machine learning and natural language processing to analyze patient records and create “risk dashboards” to help doctors recognize when a patient is at risk of complications, such as depression or cognitive impairment.

“I ultimately want to help clinicians move toward more personalized pain management,” Zhong said. “This means understanding not just how much pain somebody has, but the broader health context surrounding that pain.”

Zhong is not a medical doctor, but has a PhD in Management Science and Engineering from Stanford University. He thinks his background in industrial and systems engineering (ISE) can help solve complex healthcare problems. 

“Machine learning can tell us which patients are at elevated risk, but as ISE researchers, we ask the next questions: What should we do with that information? How should limited healthcare resources be allocated? How does this information feed into clinical workflows? How does using this actually improve clinical outcomes?” Zhong said. 

Robert McNamara, PhD, a clinical psychologist and Associate Professor in Virginia Tech’s  School of Medicine, is a collaborator on the project. He looks forward to investigating the medical problems faced by rural older adults with chronic pain.

“We foresee this work leading to early, actionable insight for providers in rural areas, enabling appropriate intervention and referral, and ultimately improving quality of life for this vulnerable population,” said McNamara.

As a rural resident myself, who also suffers from chronic pain, I am always glad to see more resources going to research like this. It will be interesting to see if AI is actually able to offer new insights. 

Many of the older adults I know in northern Illinois who have chronic pain already know how to improve their healthcare and quality of life. First and foremost, they want access restored to opioid medication. 

There’s also a high need for making telehealth doctor appointments easier for older adults to access. In-home care is another high priority. It’s a chore to go to a doctor who might be a two-hour drive away. If there was a program where a traveling doctor could come to a rural community for a day, that would be a massive help.

Hopefully, AI offers real, practical insights into these types of problems, and all the other issues rural chronic pain patients suffer from.

More Than Distraction: How Music Relieves Pain

By Pat Anson

Music won’t cure chronic pain, but there is some evidence that listening to your favorite tunes helps reduce pain levels temporarily. And it’s not just distraction.

The type of music doesn’t seem to matter – whether it’s Mozart or heavy metal – the key seems to be that listeners like what they hear and choose it themselves. Singing or humming along, moving in sync to music, or even playing the air guitar are also good ways to ease pain.

That’s what researchers at Drexel University found when they reviewed 57 clinical studies that evaluated the effects of music on pain.

Like a lot of pain research, many of the studies were small and induced pain in a laboratory by having healthy volunteers briefly dunk their hands in cold water – not the daily pain that comes from arthritis, migraine or an aching back.  

"Researching how music affects pain may sound simple, but it is actually very challenging because of the complexity of music and the complexity of pain," says lead author Joke Bradt, PhD, Professor and Program Director of the PhD in Creative Arts Therapies program at Drexel University.

"In my clinical work, I mostly use active music-making, such as singing, vocal improvisation and playing instruments because I have seen this to be much more effective for chronic pain than merely listening to music.” 

The study findings, recently published in PAIN Reports, suggest that there’s more to music than simple distraction. To be effective, it’s important for the music to be pleasant to the listener to help counteract the unpleasant sensations of pain. Someone who prefers country music or jazz may not get any pain relief listening to heavy metal.  

“Although distraction is often cited as a potential mechanism, current evidence suggests that attentional capture alone is insufficient for hypoalgesia. Unpleasant music or neutral sounds, while engaging attention, typically fail to reduce pain,” researchers found.

“Thus, music does not appear to reduce pain merely through the automatic capture of attention by an auditory stimulus. However, it remains possible that listeners sustain attention toward the music in a more deliberate and controlled manner.”

Active participation also plays a role. The simple act of choosing your own music and humming or singing along helps overcome the passive role that pain often induces. 

 "The findings from our study help explain why music can be an effective, low-risk approach for pain management and how we can maximize its potency," said Bradt.

Why is 7-OH Called ‘Gas Station Heroin’ but Caffeine and Alcohol Are Not?

By Crystal Lindell

I think it’s because I work as a manager at a truck stop that the phrase “gas station heroin” particularly pisses me off.

If you haven’t seen the coverage, “gas station heroin” is the favorite phrase used by the media and anti-7-OH groups to describe kratom and the alkaloid 7-OH (7-hydroxymitragynine).

But it’s not based on anything real, because kratom and 7-OH are not even close to being heroin.

So as the DEA nears a potential nationwide ban on 7-OH, and state and local governments ban kratom, it’s a good time to really look at the ways media and advocacy groups try to justify these bans. Notice how their labeling never extends to other substances like caffeine, nicotine, or alcohol. 

Indeed, calling 7-OH and kratom “gas station heroin” is about as accurate as calling coffee and energy drinks “gas station meth.” Or calling beer “gas station LSD.”

Lots of mind-altering and addictive things are sold at gas stations. But something being a little addictive and a little bit mind-altering does not mean it should be lumped in with more dangerous and more mind-altering substances like heroin.

Take this New York Post article trying to scare readers about 7-OH. Large portions of it focus on the idea that 7-OH is sold at gas stations, as though that’s a reason to ban it in and of itself. 

"People can buy 7-OH at vape shops and truck stops with little guidance on how much they’re actually supposed to take," the Post warned.

Okay, so does that apply to the nicotine products sold at vape shops? Or the alcohol sold at truck stops? I mean, there’s little to no guidance for those substances too. 

The Post also includes a quote from Dr. Oliver Grundmann, a kratom specialist at the University of Florida.

“Even if 7-OH can help people wean themselves off stronger opioids, it has no business being peddled at bodegas,” Grundmann said. “It should be appropriately labeled and also only available in the hands of someone who can provide professional guidance, like a licensed pharmacist. Not a clerk at a gas station.”

Here again, we can easily flip this around to apply to the beer and cigarettes that are readily available at gas stations and “bodegas” – a fancy way of describing a neighborhood convenience store. 

Imagine saying: ““Even if alcohol can help people relax, it has no business being peddled at bodegas.” 

Or this: "Nicotine should be appropriately labeled and also only available in the hands of someone who can provide professional guidance, like a licensed pharmacist. Not a clerk at a gas station.”

In fact, when it comes to things like alcohol and nicotine, we as a society have decided that even if something causes thousands of deaths a year, it can still be sold at gas stations.

The thing is, kratom and 7-OH do not cause thousands of deaths a year. If they did, the DEA would no doubt have thousands of deaths they could point to to justify a ban. Instead, they had to really stretch to find any deaths to share.   

In fact, the DEA could identify only one man in Norway who supposedly died from using 7-OH. The only problem was the death occurred in 2014, long before concentrated 7-OH actually became available in the U.S. in 2022.

By that logic, caffeine should also be turned into a Schedule One drug. After all, a U.S. teen died from cardiac arrhythmia after chugging three caffeinated drinks in 2017. And a young woman died in 2022 after going into cardiac arrest hours after drinking caffeinated lemonade.

Oh, and in regards to the Norway death, that man also had a sedative, antidepressant, and anti-seizure medication in his blood and urine. So it was clearly a case of polysubstance use.

Someone having 7-OH or kratom in their system at the time of death should not be enough reason to classify those substances in the most restrictive DEA drug category.

Imagine if we tracked how many people had caffeine in their blood when they died. Or nicotine. We don’t even bother because when it comes to those drugs, we all understand that simply having a substance in your blood when you die does not mean that it caused your death.

I’m not saying kratom and 7-OH should be sold without any regulations or age restrictions. Rather, just the opposite. I believe the industry should be heavily regulated and nobody under 21 should be able to buy any kratom products.

The good news is that we already have a model for how to implement that: We just need to look to the other drugs already sold at gas stations, like nicotine, alcohol and caffeine. 

‘Hyperactive’ Stem Cells May Cause Spinal Stenosis

By Pat Anson

Stem cells are often touted for their ability to reduce pain, restore damaged tissues and joints, and even treat cancer.

But researchers at Weill Cornell Medicine and Hospital for Special Surgery have found that when a certain type of stem cell becomes hyperactive in the lower spine, it can lead to lumbar spinal stenosis – a painful back condition that affects over 100 million people worldwide.

These specialized stem cells help generate and restore tendon and ligament cells – normally a good thing –  but in the lower spine they can grow too rapidly, pressing against nerves in the spinal canal, causing pain, numbness and difficulty walking.

“Given that this cell appears to be the ultimate origin of all tendon and ligament cells, defects in this cell are likely at the heart of a wide range of tendon and ligament disorders,” said Matthew Greenblatt, MD, Associate Professor of Pathology and Laboratory Medicine at Weill Cornell and co-author of a study published in the journal Cell.

Greenblatt and his colleagues first identified the stem cell in mice and then looked for it in humans, finding it in kneecaps, Achilles tendons and spines.

“Everywhere we looked, we found this cell,” said Greenblatt. “So, we think this is the universal stem cell for tendons and ligaments throughout the body.”

MRI image of spinal stenosis with two arrows that show narrowing of the spinal canal. (Credit: Dr. Sravisht Iyer)

The researchers found unusually high stem cell numbers in ligaments taken from people with spinal stenosis. When these stenosis-derived cells were transplanted into mice, they produced more tendon cells than healthy stem cells did. The cells showed higher levels of calcium signaling than their healthy counterparts, a sign they are growing too quickly. 

“Though spinal stenosis is a complex condition, this really showed us that these cells are contributing to the pathology,” said Greenblatt.

The good news here is that once you identify the problem, you can start looking for solutions.

Researchers think a class of drugs currently used to manage high blood pressure -- calcium channel blockers – could be repurposed to treat spinal stenosis by reducing calcium signals and slowing the growth of the specialized stem cells. Clinical studies will be needed to explore that theory.

“This is probably the first work that's shown a potential therapeutic target for one of the most common spine conditions in the world,” said co-author Stravisht Iyer, MD, an Associate Professor of Orthopedics at Weill Cornell and a spine surgeon at Hospital for Special Surgery. “The findings are exciting for their potential to change the way we deliver spinal care.

“Identifying these specialized stem cells unlocks a new area of research that allows us to address this disease much more mechanistically, rather than just waiting until a patient’s condition worsens and requires surgery to relieve the nerve compression.”

Spinal stenosis is currently treated with painkillers, physical therapy and steroid shots. If those methods don’t provide enough relief, surgery can be used to remove bone and tissue pressing on spinal nerves or “spacers” can be inserted to relieve pressure on the spine.

In addition to stenosis, researchers hope to explore the role that specialized stem cells play in other conditions, such as Marfan syndrome, a genetic disorder that affects the body’s connective tissues.

The findings could also lead to new treatments for tendons and ligaments that heal poorly after injuries, including rotator cuff tears, Achilles tendon injuries, ligament reconstruction and chronic tendon degeneration.

California Seizes More Kratom and 7-OH, but Online Orders Continue

By Pat Anson

With 7-OH consumers still awaiting final word from the DEA on whether the concentrated kratom alkaloid will be classified as an illegal Schedule One controlled substance, individual states are pursuing regulatory action of their own.  

In California, Governor Gavin Newsom announced the state’s enforcement efforts have so far resulted in nearly 8,000 “deadly kratom/7-OH items” being removed from store shelves. 

Trace amounts of 7-OH (7-hydroxymitragynine) alkaloid occur naturally in whole leaf kratom, but manufacturers have developed ways to concentrate 7-OH in tablets, gummies and shots, which are potent pain relievers with opioid-like effects.  

Although the DEA is only considering a ban on 7-OH – leaving natural leaf kratom alone – California says kratom and 7-OH products both pose “serious health risks.” 

California’s crackdown began last October, when state health officials issued a consumer warning claiming that kratom and 7-OH caused several overdose deaths. Enforcement actions stepped up in January, with state agents seizing millions of dollars worth of kratom and 7-OH products. To date, they’ve issued 181 citations. 

The state also warned vendors they could lose their licenses to sell alcohol if they sold kratom and 7-OH. That threat – in effect saying it was safe to sell beer, wine and other intoxicating beverages, but not kratom and 7-OH – has resulted in a 98% compliance rate by Alcoholic Beverage Control licensees.

“If a product is sold in California, people should be able to trust that it follows the law. We’ve made the rules clear, giving businesses the opportunity to comply, and we’re holding accountable those who don’t. That’s how you protect kids and consumers while standing up for responsible businesses doing things the right way,” Gov. Gavin Newsom said in a news release.

But California’s enforcement efforts are uneven because they mainly target brick-and-mortar stores. Some online vendors are still shipping kratom and 7-OH products directly to California consumers, even though the California Department of Public Health (CDPH) said it has taken “significant enforcement action” against out-of-state kratom distributors.  

“CDPH has taken enforcement action on multiple orders of kratom shipped from out-of-state to California distribution facilities,” the agency said in a statement to PNN. "CDPH continues to monitor and enforce compliance with state law, including when products are sold or shipped directly to consumers in California. When CDPH becomes aware of unlawful kratom shipments, CDPH may take appropriate regulatory or enforcement action in coordination with local partners." 

The CDPH says it has the legal authority to ban kratom and 7-OH because they are “adulterated and misbranded” products that violate the California Health & Safety Code.

North Dakota Amends Kratom Ban

Dozens of other states, counties and cities have enacted laws banning or regulating kratom and 7-OH sales.

On Friday, North Dakota Governor Kelly Armstrong signed legislation that bans the sale, possession and use of 7-OH and other synthetic kratom products, and restricts the sale of natural kratom products to adults 21 and older.

Armstrong signed an executive order last month banning all kratom products, but under the new law passed by the North Dakota legislature during an emergency session, it will be legal again to sell natural leaf kratom as long as there are accurate labels and age restrictions.

“This is a victory for public health and safety, keeping dangerous synthetic kratom products off the shelves and protecting our young people from the adverse and unknown long-term effects of natural kratom, which is not regulated by the FDA but will now be subject to strict state regulations,” said Armstrong, who preferred a total ban on kratom.

Meanwhile, the DEA continues to slow walk enforcement action against 7-OH, even though it’s considered “an imminent threat to public health.” It’s been over a year since the FDA asked DEA to classify concentrated 7-OH as an illegal Schedule One substance, explicitly saying such a ban should not include natural kratom leaf.

DEA finally began the formal scheduling process for 7-OH in July, but federal health officials recently extended the public comment period until September 10. It’s not clear when DEA will act once that deadline passes or if it will make any changes in its scheduling order. 

As currently written, the order limits the amount of 7-OH to no more than 0.05% of a product by weight or volume, the equivalent of about 1 mg per tablet or gummie. That is well below the current dosage levels of 7-OH products. 

Pain Can Make You Mean. Don’t Let It

By Crystal Lindell

As a child, I grew up hearing stories about just how viciously mean my late great-grandmother was. Her son, my late grandpa, was also described as “mean.”

Nobody wanted to be around them. Everybody wanted to be different from them. 

The moral of the tale – as I was so often told as a little girl – was to make sure I didn’t grow up to be “mean.”

As I got a little older though, I started to also hear the stories about their various medical ailments.  

My great grandma suffered from rheumatoid arthritis. She moved to Arizona in her later years hoping the dry desert air would bring her relief. And she started drinking a single beer every day to treat the pain, because her only other option was aspirin.  

Meanwhile, my grandpa regularly spent months in the hospital because of his scoliosis. He wore a back brace, and when he was home, he was either in bed or sitting at the kitchen table chain smoking cigarettes.

As an adult, with my own medical ailments, the picture has become much clearer. My great-grandmother and grandpa probably were very mean – but it’s only because they were both in a lot of pain.

They suffered every day. And they did what millions of others before them have done in that situation – they let the pain make them mean.

The healthy adults who told me these family fables never seemed to make the connections between the pain and temperament. They saw the mean personalities as something inherent in both my great grandma and my grandpa, as though it were some wholly separate thing from the health conditions that ravaged their bodies.

To my relatives, they were mean because they were bad people.

As an adult with chronic pain myself, I have come to understand things that were impossible for me to grasp as a child: They weren’t bad people, they just had bad bodies.

When you’re dealing with chronic pain, even the nicest, kindest person will develop an insatiable urge to lose their temper on those around them. After all, you can’t waste time with fake pleasantries and patience when your body feels like it’s been through a war zone.

I don’t want to be mean though.

Even on my worst pain days, I make a specific effort to ensure that I’m not taking out my physical pain on those around me.

But I struggle. There are so many times that I want to snap at my fiancé, yell at my mom, lose my temper on my friend. Can’t they see? I’m in pain! Why are they talking to me and annoying me when I’m in pain?

I stop myself though. Or, worst case, when I don’t have enough strength to stop myself, I apologize afterwards.

Beyond that though, when I know someone is struggling with physical pain, I don’t take their meanness personally. Instead, I offer sympathy.

All of us are just a few bad pain days away from becoming mean. Knowing that can help us offer understanding to others. But more than that, it can help us fight off the urge within ourselves.

So yes, pain can make someone “mean” - and those of us with chronic pain often are. But if we’re diligent, it doesn’t have to become our whole personality.

Cannabis Detected in One in Five U.S. Overdose Deaths

By Pat Anson

A new study by the CDC seems likely to revive an old debate about cannabis: Can you overdose on cannabis?

The study, published in the CDC’s Morbidity and Mortality Weekly Report (MMWR), looked at U.S. overdoses from 2021 to 2025 and found that cannabis was “detected” in 43,880 deaths. That’s over one in five overdoses (21%).

It’s an alarming statistic, and also misleading because it doesn’t tell us the cause of those deaths – only that cannabis was detected in a toxicology test after someone died.

A deeper reading of the study shows that cannabis was listed as causing death (i.e., involved) in 0.8% of drug deaths and was the only drug involved in 0.004% of them. That represents just nine deaths over a five year period. 

Most of the cannabis-related deaths also involved more risky substances, such as illicit fentanyl (73.5%) and stimulants like cocaine or methamphetamine (60.4%).

“This evidence indicates that overdose deaths caused by cannabis are rare, and detection of cannabis among overdose deaths is primarily indicative of polysubstance use,” wrote lead author Lauren Tanz, ScD, Senior Scientist of Overdose Prevention in the National Center for Injury Prevention and Control.

“Because cannabinoids are rarely implicated in the cause of death, cannabinoid screening and confirmatory testing is not universally conducted. Thus, the identification of cannabis use among overdose deaths is likely underestimated.”

The CDC study is in line with previous ones, which found that the risk of death due to cannabis poisoning is “negligible.” Unlike opioids, cannabis doesn’t cause respiratory depression, which can stop people from breathing. 

But even the caveat of a cannabis overdose being “rare” is a bridge too far for cannabis advocates.

“Since it is well understood and acknowledged that cannabinoids are incapable of causing overdose death, and since the DEA continues to acknowledge even now that "no deaths from overdose of marijuana have been reported,” it seems irresponsible for the authors to put this statement out there at face value,” said Paul Armentano, Deputy Director of NORML, which advocates for marijuana legalization.

Armentano says the nine fatal overdoses in which cannabis was the only drug detected could be laboratory coding errors. Or some untested substance or health condition may have played a role.      

“Perhaps it’s also possible that a person suffered cardiac arrest following cannabis use and this death was miscoded as an overdose involving cannabis. Again, neither I nor anyone else have any idea because this report is presented without any details necessary to give it any sort of probative value whatsoever,” Armentano said in an email.

A cannabis overdose may be rare or unlikely, but you can become impaired by consuming too much cannabis, which increases the risk of an accident or a traumatic physical injury. Regular consumption can also contribute to cannabis use disorder (CUD), cognitive decline, mental health problems, or lung disorders if cannabis is smoked or vaped.

With the potency and availability of cannabis increasing, it’s not surprising that CUD rates are also rising. A recent study by the National Institute of Drug Abuse (NIDA) estimates that 19.4 million Americans have CUD, or about 7.3% of all adults. 

Increasingly, those adults tend to be older. The steepest increases in CUD occurred among adults aged 35 to 49 years and males 50 or older.

While CUD rates are going up, the number of Americans abusing alcohol has stabilized and is going down for some age groups, such as adults aged 21 to 34 years – the prime drinking age for earlier generations.

“This divergence may reflect behavioral and cultural shift – including increasing cannabis preference over alcohol – and declines in binge or heavy drinking,” wrote senior author Nora Volkow, MD, NIDA’s Director. “Findings repudiate conventional assumptions that cannabis carries a low addiction risk and that most young adults with CUD have mild symptoms.”    

In the end, the biggest risk from cannabis isn’t the “negligible” or “rare” risk of an overdose – it’s the risk of dying from something else. 

A recent JAMA study found that 3.5% of patients receiving hospital-based care for CUD in Canada died within five years — a rate 6 times higher than the general population. CUD patients had an elevated risk of dying from suicide, trauma, opioid poisoning, and lung cancer. 

Fans of Heavy Metal Music Have More Pain Tolerance

By Crystal Lindell

Angry and loud heavy metal music may not be good for your hearing, but it might actually be good for increasing pain tolerance. That’s according to a new study published in Nature by German researchers.  

The researchers asked attendees at the German Wacken Open Air festival in 2023 if they experienced “music-induced analgesia” while listening to heavy metal music. 

Sixty people were recruited before the festival began and put through a series of tests. Their results were then compared with those of 62 people who were recruited on the third and fourth day of the festival.

Before we go any further, take a look and listen to a sample of the Wacken Open Air festival, which bills itself as “the biggest metal festival on planet earth.” 

Researchers from the Max Planck Institute for Human Cognitive and Brain Sciences did several tests to see if being at the festival had any impact on pain tolerance, pain sensitivity, or unpleasantness. 

To test pain tolerance, they had participants place their hand and forearm in cold water for as long as they could tolerate it, up to four minutes maximum. An electrocardiogram was also used to measure their heart rate and “emotional processing.”

The researchers hypothesized that accepting unpleasant emotional experiences or difficult situations plays a central role in being resilient and tolerating pain – as opposed to masking those unpleasant emotions. Heavy metal music is known to help people express unpleasant emotions like anger.

“This aligns with common themes in metal music, which often expresses difficult emotions and life challenges, avoiding attempts to mask them with happiness,” the researchers wrote. “Combining such expression of negative emotionality with an energetic and activating soundscape may foster self-efficacy, an important component of resilience.”

Researchers found the music had no effect on pain sensitivity or unpleasantness, but they did find that pain tolerance was significantly increased for those who attended the festival.

"Participants perceived their pain during the festival not as less unpleasant or were less sensitive in perceiving it, but they could endure it for a longer time,” the authors said. “This seems to indicate that participants got more resilient, which means that they might have to a greater degree accepted feelings of unpleasantness towards the pain experience.”

Of course, it’s hard to say how much of a role heavy metal music played in the increased pain tolerance, since it could have also been caused by the social aspects of attending a music festival that is known to be “especially inclusive and friendly.” 

One might guess the 85,000 people who attended the festival also engaged in some drug and alcohol use, which may have impacted pain tolerance. The researchers say any individual displaying observable signs of intoxication was excluded from the study.  

In the end though, the only takeaway here is that sometimes you just need to scream along to some metal music to better tolerate pain – and honestly, that tracks.

Little Evidence Back Braces Work for Chronic Low Back Pain

By Pat Anson

Lumbar supports – also known as back braces – are widely used around the world for low back pain. They’re designed to stabilize the lower back and apply gentle compression to the abdomen, giving relief to sore muscles and aching backs.

There’s also little evidence that they work, according to a new Cochrane review by Italian researchers, who looked at the findings of eight randomised controlled trials involving over 500 adults with chronic low back pain. Five of the studies were conducted in low and middle-income countries and three were in high-income countries. 

Researchers found that lumbar supports showed little to no benefit, with the possible exception of a small short-term reduction in pain intensity when used with pain relievers like ibuprofen. The authors were cautious about drawing any further conclusions from the eight trials, and rated the quality of evidence as very low.

“Lumbar supports are widely used in clinical practice despite the fact we know virtually nothing about their effectiveness,” says lead author Chiara Arienti, PhD, an Assistant Professor in the Clinical Epidemiology Research Centre at Humanitas University in Milan. “Drawing from a very thin research base, we still don’t have enough evidence to make broad recommendations for or against their use.”

Arienti and her colleagues say lumbar supports may provide pain relief for three to four weeks when combined with nonsteroidal anti-inflammatory drugs (NSAIDs), but offer little to no benefit when used alone. They were also “very uncertain” about the benefits of lumbar support when combined with exercise and education.

None of the studies tested mobility devices like walking aids or wheelchairs, which could potentially be helpful for older adults and people with disabilities.

Lumbar Supports More Common in Poorer Countries

One interesting finding was the geographic distribution of the research. Most of the trials were conducted in low- and middle-income countries, where lumbar supports are used more routinely. 

In higher income countries, patients are more likely to get exercise therapy, education, and cognitive behavioral therapy for chronic low back pain. Those “active” therapies are less likely to be offered in poorer countries.

"It's striking that most of the research on lumbar supports is coming from areas where active treatments are harder to access," says senior author Stefano Negrini, PhD, a Professor in Physical and Rehabilitation Medicine at the University of Milan. “There’s enough data now showing that active treatments have a clinical effect on low back pain, but these treatments can be very expensive because they require rehabilitation professionals' involvement.”

As the population ages around the world, demand for low-cost treatments is likely to grow. The authors say more research is needed in low to middle-income countries to better understand the value of lumbar supports, particularly for older adults who may not have access to other treatments. 

“We have to ask ourselves whether we are looking at this problem only through the lens of the Global North, and whether that is the right perspective. These devices may play a different and important role in contexts where the alternative simply isn't available," Negrini said.

Chronic lower back pain is the leading cause of disability worldwide. Over 72 million U.S. adults suffer from it, according to a 2022 Harris Poll. About a third of those surveyed rated their pain as severe and nearly half said they experienced chronic back pain for at least five years. 

Although lower back pain is quite common, there is little consensus on how to treat it. Most of the clinical trial evidence is considered low or very low quality, a persistent problem.in many medical guidelines dealing with pain. 

Guideline for Migraine Prevention Finds Strongest Evidence for CGRP Inhibitors

By Pat Anson

New guidelines for medications that prevent migraines show that the strongest evidence supports the use of three CGRP inhibitors: Emgality, Ajovy and Aimovig. There is also strong evidence for using Botox injections to prevent chronic migraine.

The updated guideline was developed by the American Academy of Neurology and American Headache Society, and published in the journals Neurology and Headache. The update is the first since 2012 and incorporates several new treatments that have been developed since then, such as medications that inhibit calcitonin gene-related peptides (CGRPs), a protein that triggers migraine pain. 

Migraine affects about 39 million people in the United States and 1.1 billion worldwide. In addition to headache pain, migraine can cause nausea, blurriness, and sensitivity to light or sound. Women are three times more likely to suffer from migraines than men.  

Acute migraine medications help treat headache pain and other symptoms as they occur, while preventive medications stop migraines from starting. Oral migraine preventive medications need to be taken every day or every other day, while injectable medications are taken once a month or once every three months.Only one oral medication (Nurtec) both treats and prevents migraine attacks.

“There are a variety of effective preventive medications that work in different ways, including newer classes of medications that have been released in the past several years,” said guideline co-author Tamara Pringsheim, MD, a Professor at the University of Calgary. “For people experiencing frequent migraine attacks or attacks that affect the ability to function normally, this guideline can help clinicians determine which preventive medications may be able to help.”

The guideline update is based on a review of 217 studies that evaluated dozens of medications, and includes recommendations for preventing both chronic and episodic migraine. People with chronic migraine have 15 headache days or more each month, while episodic migraine occurs less often.

The guideline ranks each medication based on the evidence being either strong, moderate or weak. No evidence was found to support the use of over a dozen medications sometimes prescribed off-label for migraine, including Klonopin and Cymbalta. 

While the strongest evidence supports the newer CGRP inhibitors, moderate evidence exists for some old-line medications such as beta-blockers and anti-seizure medications. However, many of the older drugs are more likely to have side-effects, such as constipation and weight loss. 

Some medications, like antidepressants or medications that lower blood pressure, are primarily intended for other health conditions but have been effective in reducing migraine pain for some patients. 

“The research shows many different types of medications may be effective for preventing migraine attacks and reducing symptoms,” said co-author Rebecca Burch, MD, Associate Professor at the University of Vermont Larner College of Medicine. “The guideline includes recommendations for both previously established and newer medications. If one type of medication is not working well, a different type may still be effective. It is important for clinicians and patients to know that there are many options.”

The guideline says preventive treatments should be offered to adults who experience four or more migraine days per month or four or more moderate to severe headache days per month, or if migraine is affecting their ability to work or complete daily tasks.

When working with patients to choose medications, the guideline says clinicians should discuss the strength of the evidence, possible side effects, insurance coverage and out-of-pocket expenses. While CGRP inhibitors are some of the most effective medications, they often cost substantially more than older treatments.

A 2023 study found that some cheaper drugs are just as effective at preventing migraine as CGRP inhibitors. Researchers at the Norwegian Center for Headache Research found that two drugs commonly used to treat depression and high cholesterol – amitriptyline and simvastatin – help reduce the use of medications used to treat acute migraine pain. Both drugs are used off-label for migraine prevention. 

How I’m Able to Work Again with Chronic Pain

By Crystal Lindell

How do I do it?

On my days off, I sleep for 15 hours, waking up only to eat and pet my cats.

I can’t get out of bed without Norco, morphine, Advil, 7-OH, and Tums.

And I have a super supportive partner who does all the house work, all the grocery shopping, and changes all the litter boxes.  

That’s the short answer for how I manage to work a full-time job outside of the home while living with debilitating chronic pain. It takes a lot of drugs, a lot of sleep, a lot of support, and a lot of luck.

I also eat the same meals nearly every day to make food prep and decision-making easier. And I make zero plans for days off.

I started working again in April – my first full-time job in over four years. 

Despite my years of experience as a professional journalist working in the corporate world, I took a job as a gas station cashier close to home. I was fed up with corporate culture and just wanted to see if I could even handle working full-time again in any capacity with my health issues.

I also needed health insurance and the gas station offered me that after just one month.

Now that it's been a little over three months, it felt like a good time to reflect on how it’s going.

To be honest with you, I absolutely love it!

I love going to work every day. I love interacting with the public and making friends with my co-workers. I love getting out of the house. And I have already been promoted to the first level of management, with hopes of continuing up the ladder.

But it has taken a major toll on my body. 

I wake up in so much pain that walking to the bathroom feels like I’m using muscles for the first time in years. And after my shifts, I only have enough energy to change out of my work clothes and get into bed. 

I really don’t know if I’ll be able to keep it up if 7-OH is officially made into a Schedule One controlled substance.

I really, really want to keep it up though. 

I want to keep working, being good at my job, and forming surprisingly deep connections with my fellow employees. I want to keep feeling productive and living like I have a purpose in this world – even if that purpose is just helping truckers get back on the road.

That’s because, despite all the stereotypes about people with chronic illnesses, I desperately want to work. 

In reality, it’s the people constantly trying to take away my access to opioids and 7-OH who want me to be unemployed and bed bound. 

They may soon get their wish if 7-OH is banned – a policy being pushed in the name of “protecting me.”

Protection I do not want and didn’t ask for.

If it happens, the anti-7-OH advocates and federal health officials won’t take any responsibility. They won’t even offer me health insurance. Instead, I suspect they will tell me to go out and get a job.

$10 Million Worth of 7-OH Products Destroyed

By Pat Anson

The Kansas City-based company that developed and launched the first 7-OH products destroyed $10 million worth of the concentrated kratom alkaloid this week, in anticipation of 7-OH soon being banned nationwide.

7-OH products made by CBD American Shaman have already been taken off the market in its home state, after Missouri’s attorney general sued the company, claiming its 7-OH tablets, gummies and shots are “deadly opioids” that pose significant risks. The company still sells 7-OH tablets online, but won’t ship to Missouri and 13 other states where 7-OH is banned.

The DEA has begun the process of classifying concentrated 7-OH (7-hydroxymitragynine) as an illegal Schedule One controlled substance, which would make the sale and possession of 7-OH a felony. The DEA has already put the kratom alkaloid mitragynine pseudoindoxyl, along with synthetic alkaloids MGM-15 and MGM-16, in that category.

In addition to 7-OH, American Shaman developed the first concentrated mitragynine pseudoindoxyl products, which are more potent pain relievers than 7-OH.

“Unfortunately, of all the things, pseudoindoxyl is probably the very best pain medicine ever to hit earth,” Vince Sanders, Founder and CEO of American Shaman, told the Missouri Independent.

“I mean, very little mind change, very slow addictive properties, and just an incredible painkiller. But it’s gone. I’m sure it’ll show up as a pharmaceutical in five years or so, but as of now, people don’t have it available, which is truly a shame.”

The Department of Justice (DOJ) views pseudoindoxyl differently, calling it an “imminent hazard to public safety.”

“These are potent opioids being manufactured and sold in consumer products, often under labels that obscure their true risks. This action will protect our nation’s children and communities from the dangers of drug addiction and abuse,” Attorney General Todd Blanche said in a news release.

AKA Lawsuit

The DOJ’s news release makes a point of saying the agency has no desire to take natural leaf kratom off the market, and that it will “exercise enforcement discretion” by only targeting products that contain concentrated kratom alkaloids.

The American Kratom Association (AKA), which represents natural leaf kratom vendors, filed a lawsuit against the DEA and DOJ this week, seeking assurances that kratom leaf will be exempted from any federal bans. 

In recent years, kratom vendors have lost a considerable amount of business to 7-OH competitors. The AKA has actively encouraged state and federal governments to ban 7-OH and similar products..      

“The federal government made the right decision to target dangerous chemically manipulated opioid products,” says Mac Haddow, an AKA lobbyist and spokesman. “But that objective is undermined if legitimate natural kratom leaf products are swept into Schedule I because laboratories can now detect trace compounds at levels that do not present the public safety threat DEA sought to address.” 

To be clear, kratom and its alkaloids are not traditional opioids derived from poppy plants. Kratom comes from the leaves of the Mitragyna speciosa tree in Southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. 

Powdered kratom leaf gained in popularity in the United States nearly a decade ago, after many pain sufferers lost access to prescription opioids. The more potent 7-OH products went on the market in 2022 and quickly built up a following. Several million Americans have used kratom leaf or the concentrated kratom alkaloids, which have “opioid-like” effects but do not have the same risk factors as traditional opioids.

Norway 7-OH Death

In its scheduling order for 7-OH, the DEA claimed that “fatal overdoses involving 7-hydroxymitragynine have been reported,” but cited only one death. PNN discovered that lone case involved a middle-aged man in Norway who had a history of drug abuse and mental illness, as well as other health problems. 

In addition to 7-OH and a “high concentration” of mitragynine, toxicologists found a sedative, antidepressant, and anti-seizure medication in the man’s blood and urine. Death was attributed to “intoxication by these substances.”

Most overdoses blamed on 7-OH involve other substances, making the precise cause of death unclear.

Undermining the DEA’s case against 7-OH even further is that the overdose in Norway occurred in 2014, long before 7-OH products appeared on the market.   

7-OH advocates were successful in getting federal health officials to reopen and extend the public comment period on the trace amount of 7-OH that would be allowed after scheduling. That extension until September 10 is not binding on the DEA, but it appears the agency has agreed to postpone any further scheduling action until additional public comments can be made and evaluated. 

The original 30-day comment period received over 32,000 responses, one of the highest number of public comments ever recorded in the Federal Register.      

Illicit Fentanyl Use Twice as Common as Medical Use

By Pat Anson

Fentanyl has long played an essential role as a potent analgesic that can treat the most severe types of pain. But illicit versions of the synthetic opioid have been a scourge on the U.S. black market for over a decade, making it one of the leading causes of fatal overdoses.

The largest study to date has quantified how far those dual roles have gone, showing that illicit use of fentanyl is more than twice as common as medical use.

Analyzing urine drug tests for nearly 300,000 people who tested positive for fentanyl, researchers at The Ohio State University say 71.1% of them did not have a prescription for fentanyl, compared to 28.9% who had a legitimate medical reason for taking it.

“Fentanyl is a big problem, but we don’t actually know how serious illicit drug use is compared to medical use,” co-lead author Ping Zhang, PhD, a Professor in the College of Pharmacy at Ohio State said in a news release.

“Finding that illicit use has reached 70% among all fentanyl users is a surprise. And this is also a contribution of this paper. To make something that’s been a black hole visible to the healthcare system is significant.” 

Zhang and his colleagues, who published their study in the journal eClinicalMedicine, also found that illicit fentanyl users were three times more likely to suffer an overdose than patients who were given fentanyl in a hospital or were prescribed the drug. 

In 2023, over 105,000 people in the U.S. died from a drug overdose, with nearly 73,000 of those deaths involved synthetic opioids, primarily illicit fentanyl. That represents about 92% of all opioid-related deaths.

Until about a decade ago, the CDC counted all fentanyl overdoses as prescription drug deaths, a mistake that significantly inflated the number of overdoses attributed to prescription opioids. 

The misclassification of those deaths affected public policy. A CDC public awareness campaign, for example, focused entirely on the risks associated with prescription opioids, rather than the dangers posed by illicit fentanyl. When asked why it wasn’t warning people about fentanyl, a CDC spokesperson said the agency didn't want to risk “diluting” the primary message of its advertising campaign.

The Ohio State analysis found that illicit fentanyl users were younger, less likely to be married, had a higher concentration of fentanyl detected in their urine, and were more likely to have a mental health or substance use disorder.

Medical users of fentanyl were more likely to have a chronic health condition, such as cancer, cardiovascular disease, hypertension, and diabetes. They were also significantly less likely to overdose, abuse or become dependent on fentanyl compared to illicit users.

Geographically, Ohio had the highest proportion of illicit fentanyl users – 12.2% – followed by Massachusetts (10.5%) and California (8.8%). 

The number of fatal overdoses involving synthetic opioids like fentanyl peaked in 2022 at nearly 74,000 deaths and have since declined significantly. By 2025, the number of fentanyl-related overdoses was estimated at 38,084 deaths.

How Messaging in Patient Portals Impacts Care

By Crystal Lindell

What you write in texts and messages to your doctor can impact the quality of care that you receive, according to a new study published in JAMA. 

Researchers at Harvard and Columbia University analyzed over 3.5 million patient messages sent by over half a million patients through patient portals like MyChart. They wanted to see how a patient’s race, education and other demographics might influence how doctors respond to their messages.

Researchers found “substantial differences” in how providers responded to historically marginalized groups, such as Blacks and Hispanics, but found that a patient’s writing style had more impact on how care teams responded. If they were polite and positive, a patient was more likely to get a response.

“Writing style was a more important factor. Seemingly minor differences among messages, such as whether the opening included the target clinician’s name, were associated with significantly different response rates,” researchers reported.

For example, when patient messages included a clinician’s last name in the opening line, such as “Dear Dr. Smith,” those messages had a 38.7% response rate.

But when a message had no greeting at all -- no salutation or even a simple “hello” – those messages had just a 25.7% response rate.

Providers were also more likely to respond to messages that had a positive sentiment; used expressive punctuation such as question and exclamation marks; and higher word counts. 

To illustrate what they found, researchers asked ChatpGPT to write two messages from the perspective of a patient with respiratory symptoms. 

One message was polite and positive – written in a way to get a high response rate: 

"Dear Dr. Liu, 

I hope you're doing well! I wanted to reach out because I've been experiencing some new respiratory symptoms that I'm a little concerned about and would really appreciate your perspective. Over the past two days, I've developed a dry, persistent cough along with some chest tightness and mild shortness of breath -- especially when walking or going up stairs. 

I haven't had a fever, but the symptoms are definitely noticeable and seem to be getting a bit worse, which is making me wonder if there could be something more going on? I know you've helped me manage my asthma in the past, could this be a flare-up or something else entirely?? 

Thanks so much again for all you do! I really appreciate your time and guidance. 

Warmly, 

Peter Parker

The other patient message was short and blunt – written in a way that researchers thought would get a poor response rate: 

"I've had a cough and congestion for a few days now, and it's been pretty uncomfortable. Still no fever, but it's been dragging on and making it harder to get through the day."

See the difference? The more polite and positive message, though much longer, is more likely to get a response. Writing style was a possible explanation for about half of the disparities that researchers found in response rates. 

“In many message triage systems, nurses and medical assistants must quickly assess messages — often with little context — and make snap judgments on their urgency, complexity, and need for escalation. Given these constraints, it is not surprising that writing style factors might influence the triage process,” researchers said.

Patient portals provide an easy and convenient way for patients to send messages to their physicians, but put an extra burden on doctors to respond. Some do and some don’t – depending on the patient.

So the next time you write a text or message to your doctor, make an effort to be polite and positive. Use words like “please” and “thanks.” Simply being polite can have some surprisingly positive outcomes.  

Extension of Comment Period Buys 7-OH Advocates More Time

By Pat Anson

Pain patients and advocacy groups who support the continued sale of a concentrated kratom alkaloid have apparently been successful in getting the Trump administration to postpone plans to classify 7-OH (7-hydroxymitragynine) as an illegal Schedule One controlled substance.

In a notice soon to be published in the Federal Register, the Office of the Assistant Secretary for Health (OASH) said it was extending for 15 days the public comment period on the threshold of 7-OH that can be legally allowed in commercial products. 

7-OH occurs naturally in whole leaf kratom, but manufacturers have developed ways to concentrate 7-OH into tablets, gummies and shots, which have “opioid-like” effects and are potent pain relievers. 

The earlier 30-day public comment period by HHS ended on July 31 with over 32,000 comments received. The new HHS notice reopens and extends the comment period through September 10.

“Public comments submitted to this docket will be provided by the Secretary for Health and Human Services for consideration by the Attorney General. We are taking this action in response to a request for an extension to allow interested persons additional time to provide comments and input,” wrote Brian Christine, Assistant Secretary for Health at HHS.

“Note that OASH is not soliciting comments on any permanent scheduling decision, the general safety or utility of kratom-derived products, or other policy questions outside the scope of the threshold determination for temporary scheduling.”

In July, the Drug Enforcement Administration published plans to limit the legal threshold of 7-OH to no more than 0.05% of a product by weight or volume, the equivalent of about 1 mg 7-OH per tablet. Virtually all 7-OH products on the market have much higher dosages. 

Although the extension of the HHS public comment period is not binding on the DEA, it seems likely the DEA will also postpone any action on its plan to classify concentrated 7-OH products as Schedule One controlled substances, the same category as heroin and LSD. 

The DEA reports to Attorney General Todd Blanche, who has the ultimate authority to decide how drugs are scheduled under the Controlled Substances Act (CSA). 

“They (DEA) could have a 7-OH ban right now. I think it more likely, given that the Assistant Secretary for Health has requested the 15-day extension, that they’ll give it time to be evaluated,” said Mac Haddow, a lobbyist and spokesman for the American Kratom Association (AKA), which supports the scheduling of rival 7-OH products. 

“So you may see at the earliest, in my opinion, a month before we’ll see the 7-OH schedule come out.”

The extension of the public comment period was sought by 7-HOPE Alliance and other 7-OH advocacy groups, who said they needed more time to respond to the “highly technical and largely unprecedented scientific and regulatory questions” being asked by HHS about a safe threshold for 7-OH.

“Preparing a meaningful response requires consultation with scientific advisors, review of the available literature, coordination with affected stakeholders, and careful analysis of complex pharmacological and analytical issues. These are precisely the types of substantive, evidence-based comments the Agency seeks, yet they cannot reasonably be assembled within the current timeframe.” wrote Jackie Subeck, Executive Director of 7-HOPE Alliance, in a letter to OASH.

“A modest 60-day extension would significantly improve both the quality and breadth of the administrative record before the Agency. It would allow consumers to have their voices heard while providing organizations, researchers, and technical experts sufficient time to develop thoughtful, science-based submissions.”

Doctors for Drug Policy Reform made a similar request for an extension, asking that OASH “coordinate with the Drug Enforcement Administration (DEA) to defer implementation of any temporary scheduling action.”

While 7-OH advocates didn’t get the lengthy extension they asked for, they appear to have accomplished their primary goal, which was to postpone the nationwide banning of 7-OH products.

Anticipating that DEA action was imminent, many vendors have already stopped selling 7-OH products, in some cases slashing their prices to dispose of 7-OH inventory before a ban took effect. Several states and dozens of cities and counties have already banned the sale of 7-OH products in their jurisdictions.

Pseudoindoxyl, MGM-15 and MGM-16 Scheduled

Meanwhile, the DEA is going ahead with plans to classify mitragynine pseudoindoxyl, MGM-15 and MGM-16 as Schedule One controlled substances that pose “an imminent threat to public health.” .

MGM-15 and MGM-16 are synthetic versions of kratom alkaloids, while mitragynine pseudoindoxyl is a concentrated formulation of a natural alkaloid found in whole leaf kratom. The three substances are not as widely used as 7-OH, but are more potent and have more potential for addiction.

“The population likely to abuse mitragynine pseudoindoxyl, MGM-15, and MGM-16 appear to be the same as those abusing Mitragyna speciosa and prescription opioid analgesics,” DEA claimed in its scheduling order.

Because testing methods for mitragynine pseudoindoxyl are limited, there is some concern that scheduling it as an illegal substance — even trace amounts — could lead to an outright ban on kratom itself. The obtuse language used by DEA in scheduling mitragynine pseudoindoxyl seems likely to cause confusion:

“Since nomenclature of this substance is not internationally standardized, compounds of this structure, regardless of numerical designation of atomic positions are covered.”

“Kratom critics, the ones that want everything banned, are going to come out and say, ‘You just banned all natural kratom,’” says Mac Haddow with the AKA.

Haddow believes the DEA will only enforce a ban on concentrated forms of mitragynine pseudoindoxyl, but is worried that trial lawyers and the addiction treatment industry will seek more rigid enforcement.

“(DEA) is never going to enforce against anything naturally occurring. But someone else will, using that language. And that’s why the confusion needs to be clarified,” Haddow told PNN. 

(8/27/26 Update: The AKA filed a lawsuit against the DEA, seeking clarity on how its scheduling of mitragynine pseudoindoxyl as an illegal substance applies to natural kratom leaf. The lawsuit in U.S. federal court does not challenge the DEA's scheduling order, but asks the court to confirm that it does not apply to botanical kratom, which contains trace amounts of the alkaloid.)