The Stress of Being Drug Tested by My Own Doctor

By Crystal Lindell

I went for one of my regularly scheduled appointments with my primary care physician yesterday, and as soon as I got there the nurse plopped a urine sample cup and a new drug contract on the table.

I had not been drug tested in a while, and actually started to wonder if they had seen the light and stopped doing them. Alas, that was not the case. 

Drug testing causes stress and anxiety for patients, even when we’re doing everything right. It also erodes the patient-provider relationship and makes it harder to be completely honest with them about our substance use.  

And then they also have the audacity to bill you for the privilege!

The whole thing gives criminal probation vibes so strong, I half expected a police officer to show up and watch me pee.

They also don’t tell you in advance what they are even testing for – or how the results might affect your care. Like, will they immediately cut you off if you test positive for kratom? Are they even testing for kratom?

What happens if you get a false positive? Do you get another chance to take a drug test? And who pays for it?

Asking anything like that in advance only makes you sound super suspicious. 

Mostly they want to make sure you are taking the drugs you are prescribed, but beyond that you have to hope you haven’t accidentally taken anything that could make you fail, like poppy seeds.

Thankfully, I passed. And when the results showed up in MyChart, I saw that they did not test for kratom. 

In addition to testing for stimulants and opioids, they also tested for naloxone and naltrexone – which was strange. Naloxone is used to reverse opioid overdoses, while naltrexone is primarily used to treat alcohol and opioid use disorders. 

It seems odd that they would check to see if either drug was in my urine, and I have no idea how my doctor would respond if they had turned up positive. Would he think I was having issues managing my opioid use? Or perhaps hiding an overdose from him? I really don’t know.

But peeing in the cup is only half the stress. They also have a new patient contract I had to sign, which lists 21 specific conditions for my treatment to continue.

No. 14 reads in part: “I will not ask for early refills. I understand that lost or stolen prescriptions will not be replaced.”

It ends with, “I will report stolen medicines right away to my clinician and to the police. This report does not mean that my stolen medicine(s) will be replaced.”

I was surprised to see that stolen prescriptions might not be replaced. Even with a police report?

That’s very disheartening to read, especially since I recently had my cell phone stolen, so I know how easy it is for a theft to occur.

No. 14 also includes a demand that I keep "my controlled medicines in a safe and secure place, such as a locked cabinet or safe."

No. 18 gives them permission to conduct pill counts: “I authorize my clinician to order counts of my controlled medicines to check that I am taking them properly. I agree to bring in my medicines in their original containers to be counted.”

What if I get robbed on the way to the doctor? What then? I’m just completely screwed for the rest of the month? Am I supposed to travel with my locked cabinet or safe in this hypothetical situation?

Then there’s No. 11, which reads: "I may not use emergency or urgent care visits to get more controlled medicine for my chronic pain. If I do, my clinician may decide to stop prescribing controlled medicines."

Early on in my chronic pain journey, I would often have horrible breakthrough pain that was only resolved when I went to the emergency room. They would give me a shot of Dilaudid to get the pain back under control.

Apparently, I’m no longer allowed to do that. It’s not a huge issue for me these days because my pain is now well controlled and I have learned lots of ways to manage it. But my heart goes out to other pain sufferers who may not be so lucky.

The contract also specifies in No. 8 that, "I will get my controlled medicines from one pharmacy."

God forbid there’s a drug shortage or the pharmacist tells me they’re out-of-stock, an all too common experience. I can’t go to another pharmacy?

I have been with my primary care physician for over a decade now, and we have a relatively strong relationship. So if I ever actually needed exceptions to any of these rules, I would hope that he would be accommodating. But that's a lot of faith to put in a doctor, and it’s not something most patients can count on.

While I understand that opioid hysteria has led a lot of providers to respond with drug tests and patient contracts over the last few years, I think it’s time we got rid of them.

If you actually want to know if your patient is using forbidden substances, or if they aren’t taking all of their prescribed medications, the best solution is the one nobody wants to do: Build a trust-based relationship with them so they feel comfortable telling you themselves!

As it stands, with urine drug screens and intimidating contracts that feel like criminal probation requirements, the only real result is that patients will see their doctors as cops. And everyone knows you never, ever talk to cops. 

‘Patients Do Worse’ After Common Knee Surgery

By Elisabeth Rosenthal, KFF Health News

Thousands of Americans who undergo a common knee surgery might be making their problems worse rather than better.

Researchers who followed patients for 10 years after they received either the actual procedure, arthroscopic knee surgery to trim degenerative cartilage tears, or merely “sham surgery” — a skin incision — for knee pain, found that the surgery provided little or no benefit and was, in fact, associated with accelerated osteoarthritis and higher rates of reoperation. That generally meant a total knee replacement.

“I don’t know how I would defend this procedure at all,” said one of the study’s authors, Teppo Järvinen, an orthopedist and the head of the Finnish Centre for Evidence-Based Orthopaedics. “What has been shown dramatically is that patients who have this procedure have more pain — they do worse. All the scores pointed in the same direction.”

Järvinen said the Finnish study, published in April in the New England Journal of Medicine, was the first to show the surgery left many patients worse off. Though the study was small, the results were compelling, he said, because his team picked the patients “most likely to benefit.”

The study does not apply to cartilage tears incurred from an acute pain-causing injury. It included subjects middle-aged or older who were experiencing knee pain and whose MRIs showed cartilage tears.

Evidence has been accumulating steadily for over a decade that arthroscopic knee surgery to shave torn, degenerative cartilage does not help more than physical therapy. Arthroscopic rates in Finland have dropped 90%, Järvinen said. They have been falling in the U.S., too, but at a far slower rate.

One study of commercial claims in the U.S., which counted over 2 million meniscus surgeries from 2010 to 2020, found the number decreased by about 4% each year. Most procedures were performed on women and patients in their 50s.

In the traditional Medicare fee-for-service program, the number of procedures has declined steadily in recent years, from about 169,000 in 2014 to 91,000 in 2024, federal data shows. These figures do not include beneficiaries in Medicare Advantage, private insurance plans that cover more than half of Medicare enrollees.

Prior studies of scans have found that such tears are common in people over 50, the result of wear and tear and often not painful.

“Nothing supports the idea that a patient’s pain comes from the meniscus,” Järvinen said.

Robert Brophy, director of the Orthopaedic Clinical Research Center at Washington University in St. Louis, said that “evidence is growing for judicious use of this surgery in this population.” But, he noted, “many patients do benefit.”

All the same, he acknowledged that current practice among his peers is “all over the map.” For example, data shows that surgery for meniscus tears in the Medicare population is far more common in the South than in the Northeast.

‘Save the Meniscus’

A massive study committee of orthopedic societies in Europe and the U.S. last June released a consensus statement noting that “degenerative meniscus lesions can be treated with comparable results with either non-operative (including physical therapy) or surgical approach.” It recommended a trial of physical therapy before surgery but still endorsed the operation.

A concerted campaign by orthopedic specialty societies called the Save the Meniscus Society has been ongoing for years. The group advocates for protecting and maintaining long-term knee health through nonsurgical treatments, surgical repair, and other therapies.

One inherent issue in all medical specialties is that appropriate treatment is often in the eye of the physician beholder, meaning that specialists create the guidelines for when a treatment is in order. And financial considerations may influence that decision, Järvinen said.  

In the U.S., physician payments are decided by the Relative Value Scale Update Committee, or RUC, a committee of the American Medical Association composed largely of specialists. 

Department of Health and Human Services Secretary Robert F. Kennedy Jr. and his advisers have reportedly looked into wresting control of that committee from the association, though it’s not clear how that could be done, since the AMA owns the billing codes used to calculate patients’ charges.

Arthroscopic knee surgery takes 30 to 60 minutes in the operating room, and the patients spend a few hours recovering in a surgery center or in a hospital outpatient department. Medicare allots on average $2,159 to $3,875 for the procedure, depending on where it is performed; patients pay 20% of the fee as coinsurance. There may be additional costs, for example, if more than one doctor is involved in the procedure. 

Commercial insurers average well more than twice that, said Marcus Dorstel, a senior vice president at the data analytics firm Turquoise Health, adding that the amount providers charge for the procedure varies widely. Those charges do not include the fees of the surgeons and the anesthesiologist.

Treating chronic knee pain has a variegated history.

Fifty years ago, the treatment for cartilage tears, from acute injury or from wear and tear, was to remove the entire piece of cartilage. At that time, doctors did not consider it a shock absorber but a useless, vestigial piece of tissue like the appendix.

Today, the first-line therapy for a painful knee with degenerative tears is physical therapy and, for some people, weight loss. Then there is arthroscopic surgery, depending on the view of the surgeon about its utility.

There is also a menu of injections: Steroids have proved scientifically valuable in the short term. And injections of stem cells and plasma-rich protein are widely offered but are controversial — and not covered by most insurance — because studies have been at best inconclusive about their benefit.

And as orthopedists are backing away from shaving off meniscus tears, they are highlighting a newer procedure — sewing the torn cartilage back into a whole. But that is typically an option for patients under 50 with acute injuries and clean tears, and it is unclear exactly which patients might benefit.

When all else fails, there’s a different surgery that’s also a big moneymaker for hospitals and doctors: knee replacement.

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

A Brief History of Human Pain

By Lars Arendt-Nielsen 

Pain is one of the few things all of us experience, from stubbing a toe to waking up with an aching back; we can all relate to the feeling of being in pain.

Although pain is a universal experience, the way we understand it has changed dramatically over time.

Ancient societies might have blamed pain on demons entering the body through the nose or ears, but we now know pain to be more about nerve endings and biology.

Cures have also moved on a lot. While our ancestors may have tried to sneeze, vomit, or even urinate out their pain, these days we’re much more likely to take medications to ease our suffering.

Strange as these ancient “treatments” sound today, they do reveal something important about pain: that it’s never just a physical sensation. Because throughout history, culture, religion and social beliefs have shaped how people talk about and respond to suffering — and many of those ideas still influence us to this day.

Indeed, after more than 30 years studying pain, one thing has become clear to me: while pain is universal, our experience of it is anything but.

Ancient Pain

To understand the roots of how we think about pain today, it helps to go back and see how earlier cultures made sense of it.

In many ancient cultures, for example, people believed pain was caused by external forces. Treatments relied on occult rituals, amulets, or trying to drain “bewitched” fluids from the body to expel such forces.

The ancient Egyptians believed that if you hadn’t obviously hurt yourself (so no broken bones, no visible wound), then clearly something more sinister was at play. This could be the gods or perhaps a wandering spirit of death, which had decided to pay your body an unwelcome visit.

Others tried to explain pain in more bodily, rather than spiritual, terms. The ancient Greeks, including physicians like Hippocrates, believed pain and disease arose when the body’s “four humours” — blood, phlegm, yellow bile and black bile — fell out of balance. Healers would use plant and animal remedies to try to restore harmony.

Moral Judgement

By the middle ages, pain had taken on a moral and religious meaning.

Across Europe, convents and monasteries often served as early hospitals and had access to powerful pain-relieving substances such as opium. Yet pain was not always treated.

This is because many Christians believed suffering to be a test of faith, while others saw it as a path to spiritual purification.

As a result, enduring pain was viewed as virtuous. So rather than seeking relief, sufferers were often encouraged to bear their discomfort with patience and devotion.

Echoes of these beliefs can still be seen today. For example, some women choose to go without pain relief during childbirth because of the idea that labour pain is a meaningful or a necessary part of the experience.

Toughing It Out

Indeed, the idea that suffering should be endured hasn’t disappeared as religion’s influence has waned. In many societies, it has simply found a new home in philosophy.

If you’ve ever felt pressure to “tough it out” when you’re ill or injured, you may recognise the influence of stoicism. At its core is the idea that we cannot always control pain, but we can control how we respond to it.

In many parts of the world, to this day, enduring pain quietly can be seen as a sign of resilience and self-control, with people often encouraged to minimise their discomfort and avoid making a fuss. This is despite the fact that vocalisations of pain are a common way for humans to bond, with research showing that human exclamations of pain are similar across the world.

So whether you like to express your pain or keep it on the down low, one thing is certain: the way we think about and even feel our pain has been directly influenced by human history.

And although most of us no longer blame demons or divine punishment for our aches and illnesses, we are still, in many ways, just trying to make sense of our suffering — much in the same way as our ancestors did.

Lars Arendt-Nielsen, PhD, is a Professor and Head of Pain Research at Aalborg University in Denmark.

He served as the President of the International Association for the Study of Pain (IASP) from 2018 to 2020, and is an active member of the IASP council. 

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

First Cannabis-Based Medication for Chronic Pain to Launch in Europe

By Pat Anson

The world’s first cannabis-based medication for chronic pain is expected to launch in Germany and Austria next month after getting marketing authorization from regulators.

Exilby is a full spectrum extract derived from THC, CBD and terpenes found in cannabis sativa, a strain of cannabis that has pain relieving properties. Exilby was approved for treatment of chronic lower back pain, although it’s likely to be prescribed for other chronic pain conditions.

“There is an extra or additional law in Germany, which says for all patients who do not have any adequate treatment left, our drug can be prescribed as well, whether they have low back pain or any other chronic pain condition,” said Dr. Clemens Fischer, founder of Vertanical, which makes Exilby. “We launch at the end of August in Germany and Austria, and then we go to Europe step by step.”

In the United States, Exilby recently received a Breakthrough Therapy designation from the FDA, which will speed up its development and review. But even with that designation, Exilby is not expected to get full FDA approval until 2028 or 2029, due to the slow regulatory process in the U.S.

Much of it hinges on the outcome of a Phase 3 placebo-controlled clinical trial that will evaluate Exilby as a treatment for chronic back pain caused by lumbosacral radiculopathy (sciatica).

Recruitment of 810 patients at various locations in the U.S. is expected to begin in the next few weeks, with the estimated completion date for the study in 2028. If the results are positive, then Vertancal will submit a new drug application to the FDA.

VERTANICAL IMAGE

The recent legalization of medical marijuana in the U.S. creates a faster potential pathway for Exilby. Medical cannabis products already approved at the state level are being reclassified by the DEA as Schedule 3 controlled substances, which allows for some medical use.   

If Exilby were available in state-licensed marijuana dispensaries, it could enter the U.S. market much sooner and without FDA approval. Fischer says he’s tempted, but unlikely to take that approach. 

“We really want to go to the track of having a pharmaceutical and an FDA-approved drug, so this is actually the track we are following. But I think about it. Why not, right? It might be easier,” Fischer told PNN.

In addition to chronic low back pain, Vertanical hopes to eventually get FDA approval for Exilby as a treatment for osteoarthritis and peripheral neuropathy.

In two completed Phase 3 studies in Europe, Exilby was more effective than moderate doses of opioids (27-32 MME) in treating chronic low back pain. Patients taking Exilby also had better sleep quality and were less likely to be constipated. Each dose contains a modest 2.5 mg of THC, but patients did not become “high” or intoxicated.

Chronic Pain Can Happen to Anyone

By Crystal Lindell

There’s this thing about chronic pain that people without it like to ignore: It could happen to anyone.

When you’re still healthy, the very concept of “pain that never ends” feels impossible.

Unfortunately, not only is it possible, it’s likely.

Between injuries, illness, genetics and bad luck, you never know how long you’ll have your health. You could be in a car accident tomorrow that permanently damages your back. You could get cancer and the treatment permanently damages your nerves. You could fall off your bike. Stumble on a Lego. Slip on some ice. 

Suddenly, the body you thought you could count on doesn’t function like it used to. You can’t do the activities you once did, you have no energy, and the medical bills are piling up. Even the concept of time feels different because you’ve lost your stamina and simple tasks take forever.

In an instant, you could lose your job, your social life, and even your personality.  

People spend decades trying to prevent such fates. They eat healthy, stay active, take vitamins, practice yoga -- all in an attempt to avoid the inevitable.  

Perhaps some of those efforts would be better spent making the world a better place for people living with chronic pain or chronic illness. After all, if you know it will likely happen to you, shouldn’t you prepare for the day you will join them?

There are so many ways society could better serve people with chronic pain and illness.

There’s the obvious ones, like universal healthcare and universal basic income. But there are also the things you don’t even notice when you’re still healthy. Things like a better public transit system for when you’re in too much pain to drive. Or government funded food delivery programs for when you’re in too much pain to cook.

There’s also the fight for better pain care. Access to opioid medication or even 7-OH might sound frivolous today, when you’re still walking around in a healthy body. But one day, when you need them, you’ll regret that it took so long for you to care.

I understand why people live in denial about their body’s eventual decline. It’s much easier to get through the day that way. But if you take the time to care about things like affordable healthcare and disability rights today, it will be that much easier to get through your painful tomorrows.

We should be building a world that plans for our bodies to age and get injured, instead of building a world around denial of that fact. It’s only when we truly accept our fate, that we can actually make our lives better.

Banning 7-OH Will Make Consumers Less Safe

By Jeff Smith

The DEA’s rushed proposal to ban 7-OH is a horrendous mistake.

7-hydroxymitragynine, or 7-OH, is an alkaloid from the kratom plant. Many adults use it for serious chronic pain and to help with withdrawal from dangerous opioids. A lot of them say they use 7-OH because whole-leaf kratom was not enough to alleviate their chronic pain. 

Despite initially opposing the scheduling of concentrated 7-OH products, Mac Haddow and his American Kratom Association (AKA), which represent the whole-leaf kratom industry, have spent the last year trying to ban them with fanatical zeal.

In his recent PNN op/ed, Haddow finally acknowledges that these pain patients exist and that their suffering should not be dismissed. But belated sympathy is not enough when the policy he supports, and – indeed – has been spending millions of dollars to lobby, would eliminate access, expose consumers to the consequences of illegal possession, and push people toward products no regulator can inspect. 

This should trouble anyone who cares about ending the opioid crisis. Untreated and undertreated pain are a core reason so many people turn to prescription opioids. When they cannot get adequate pain care, some look for relief wherever they can find it, including the black market – which comes with the risk of illicit fentanyl. 

For some chronic pain patients, 7-OH has been one of the few tools that allow them to work, care for family, avoid withdrawal, and stay away from more dangerous substances.Those consumers deserve transparency, real standards, and the freedom to make informed decisions.

The Holistic Alternative Recovery Trust (HART) has long supported rules around 7-OH, including requiring accurate labels, independent testing, age restrictions, serving limits, contaminant screening, responsible packaging, and enforcement against false medical claims.

Haddow and the AKA have chosen another path. They offer no comparable solution for chronic pain patients. They are trying to make sure adults cannot use 7-OH at all, regardless of the consequences for thousands of people.

Let’s be clear about what classifying 7-OH as a Schedule One controlled substance will mean. Legal access to 7-OH would be cut off for ordinary consumers, potentially for years. The DEA’s own statement says covered 7-OH products would be subject to criminal, civil, and administrative provisions of the Controlled Substances Act, including those for possession.

Haddow has claimed that this prospective ban is mainly about manufacturers, not consumers. But that is disingenuous. Consumers would still face the legal consequences of possession, and many would lose one of the few tools they say has helped them manage pain.

Those who keep using 7-OH anyway will not be safer. Indeed, they will be in much more danger than they are now. Schedule One will not create labels, require testing, set serving limits, punish only bad manufacturers, build a lawful pathway for adult access, or help consumers speak openly with doctors. Instead, it will push consumers toward unregulated supply chains, unknown products, and sellers no regulator can inspect.

Haddow and the AKA have pursued this course by painting 7-OH as a public health emergency. But their evidence does not support the solution they prescribe. They often point to adverse-event reports involving 7-OH or kratom-related products. But many of those reports do not clearly establish what product was used, how much was taken, whether it contained 7-OH, or what other substances were involved. 

Further, many reports involve more than one substance, underlying health conditions, products of unknown strength or composition, or labels that do not identify what the person consumed. It is almost impossible to determine whether whole-leaf kratom was involved in an overdose or a concentrated 7-OH product. 

Regardless, Haddow and the AKA have traveled to one state after another, filling the heads of state legislators and regulators with unprovable scary stories more characteristic of a moral panic than a public health issue.

But the truth is, this was never about safety. As recently as early 2025, Haddow did not call for a  ban on 7-OH. The reason for his 180 degree shift was explored in a recent piece in The New York Times. The article described an influence campaign by kratom companies and their allies to protect their whole-leaf products by urging federal action against 7-OH competitors. 

According to The Times, Secretary of Homeland Security Markwayne Mullin disclosed an investment worth as much as $1 million in Botanic Tonics, the company behind Feel Free, which has consistently urged a 7-OH ban. 

The Times also reported that Botanic Tonics donated $1 million to a political committee associated with Health and Human Services Secretary Robert F. Kennedy Jr., and that company founder Jerry W. Ross used access to Vice President JD Vance to urge a 7-OH crackdown.

That is the context in which consumers should read Haddow’s argument. This is about money, market share, and one part of the kratom industry trying to use federal power against another.

Even opponents of 7-OH should be wary of the ramifications of their strategy. Haddow says banning concentrated 7-OH will protect natural kratom leaf, but history gives consumers little reason to trust that prohibition will stop there. 

In 2016, the DEA tried to place both mitragynine and 7-OH into Schedule One before backing down after public backlash. The arguments now being used against 7-OH are the same arguments used against whole-leaf kratom for years, and there can be little doubt that they will resurface again.

That spillover is already happening. The AKA’s campaign against 7-OH has helped create a political environment in which some legislators now see all kratom as a liability. Kansas recently made kratom and 7-OH Schedule One controlled substances, and Tennessee enacted a new criminal law governing kratom.

There is still time to stop this. The DEA should stand down, Congress should hold hearings, and the Trump administration should replace the ban with a responsible adult-use framework for 7-OH. 

Adults should not be abandoned to withdrawal, untreated pain, lost work, and illicit drug markets because one part of the kratom industry decided that protecting its own products mattered more than protecting the consumers it claims to represent. 

Jeff Smith is National Policy Director of the Holistic Alternative Recovery Trust (HART), an advocacy group funded by 7-OH manufacturers.  

Short-Term Opioid Prescribing Should Be Tailored to Patient Needs

By Crystal Lindell

A new study has found something that every pain patient already knows: Opioid prescriptions “should be tailored to address individual patients’ needs.”

The research findings, which were published in JAMA, looked at how well opioids worked for 1,708 patients with short-term acute pain from a wide variety of conditions; from dental procedures and knee replacements to low back pain and cesarean sections.

The findings debunk common myths that many patients quickly become dependent on opioids and are unable to regulate their opioid use.

Overall, most of the patients used opioids for only a short amount of time – about 7 days –  and at low doses (10 MME). Only 10% of patients used opioids for 90 days or more, which is generally considered the threshold for acute pain becoming chronic.  

Overall, opioids were effective at relieving pain, with patients reporting a 55% reduction in pain on average. The median time to pain resolution was 20 days, although patients with low back pain or recovering from surgery took longer than that.

Most patients continued to use non-opioid pain relievers such as acetaminophen or ibuprofen, and also used ice or heat as part of a “multimodal treatment” approach.

About two-thirds of patients had leftover opioids. Interestingly, they were often patients with the longest-lasting pain conditions, which suggests they chose “not to continue using the opioids they had available” even when their pain persisted.   

Current guidelines from the CDC and FDA for acute pain recommend opioids only for severe pain or when non-opioid pain medications are ineffective.

Given the wide variety in outcomes and patient preferences, researchers say their findings demonstrate that guidelines for short-term opioids should be tailored to each patient. Most patients in the study were pretty good about moderating their opioid use. 

“Patients generally reported taking opioids on their worst pain days, in small amounts, for short periods, and in combination with other pharmacologic and nonpharmacologic treatments, with many patients limiting their opioid use to less than the amount prescribed by their clinician,” wrote lead author Molly Moore Jeffery, PhD, of the Mayo Clinic.  

“The findings suggest current guidelines for multimodal treatment and short-duration opioid prescriptions, if needed, will serve many patients but not all and that treatment should be tailored to address individual patients’ needs.” 

A recent study found that opioids are effective for many acute pain conditions and come with little risk. In a review of 59 clinical studies, researchers at the University of Sydney found that opioids were effective for “the vast majority of acute pain conditions,” with no significant risk of serious adverse events.

Inhaled Cannabis More Effective Than Meds for Chronic Low Back Pain

By Pat Anson

Patients with chronic lower back pain who did not respond well to opioids and other pain medications showed “robust improvements” in pain and disability once they switched to inhaled cannabis, according to a new long-term study.

Researchers at Rabin Medical Center in Israel followed 241 patients with chronic lower back pain (CLBP) for five years – a period when they inhaled medical cannabis by smoking (91%) or vaporizing (9%).

Not only did participants report significant and steady improvement in their pain over the course of the study, many were able to stop or significantly reduce their use of opioids, non-steroidal anti-inflammatory drugs (NSAIDs), SSRI/SNRI antidepressants, and gabapentinoids such as pregabalin and gabapentin. 

“In a treatment-refractory CLBP cohort with five-year longitudinal follow-up, inhaled cannabis was associated with large, sustained, and statistically robust improvements in pain, disability, and pain interference, accompanied by near-total displacement of opioids, NSAIDs, antidepressants, and gabapentinoids,” researchers reported in the journal Biomedicines. 

Chronic lower back pain is the leading cause of disability worldwide, affecting about one in five adults at any given time. With so many people suffering, you'd think there would be a consensus on the best ways to treat it, but there isn’t. 

A 2018 review by The Lancet found that low back pain is usually treated with bad advice, inappropriate tests, risky surgeries and injections, and pain medications that provide only temporary relief.

2023 guidelines released by the World Health Organization (WHO) reached similar conclusions, recommending treatments such as exercise, physical therapy, and chiropractic care as alternatives to pain medication..

Neither WHO or The Lancet took a serious look at medical cannabis, so the new Israeli study breaks new ground as a treatment option.

The research team noted that randomized clinical trials are needed before causal claims can be made about cannabis, but the data so far ”support consideration of inhaled cannabis as a potentially clinically meaningful, opioid-sparing option for patients who have failed conventional multimodal therapy.” 

Another sign that inhaled cannabis was effective is that few participants dropped out of the study. After five years, nearly 93% of patients were still involved and only five dropped out due to side effects.

The THC content in the inhaled cannabis ranged from 4 to 22 percent, while the CBD concentration ranged from 2 to 22 percent. Researchers say they chose to study inhaled cannabis because of its rapid onset and patient preference. 

A 2019 survey of medical cannabis users in the U.S. found that smoking cannabis provides more pain relief than ingesting it. Over 3,300 people logged their symptoms on a mobile app while using a variety of cannabis products, including dried flower, edibles, tinctures and ointments. Smoking dried flower provided more pain relief than any other cannabis product.

Banning 7-OH Will Save Lives

(Editor’s Note: Last week the DEA said it would classify concentrated versions of the kratom alkaloid 7-hydroxymitragynine (7-OH) as illegal Schedule One controlled substances. In response, PNN’s Crystal Lindell — a 7-OH consumer — wrote an op/ed sharply critical of the DEA’s decision and the role played by the American Kratom Association (AKA), which lobbied for the move. The column below is the AKA’s response.)  

By Mac Haddow

I do not question the sincerity of Ms. Lindell in her Op-Ed describing her personal experience or the seriousness of the pain she describes. No one should minimize the suffering of chronic pain patients, and no one should dismiss the fear that comes when a person believes the product they rely on may no longer be available.

But that does not change the core issue: the Controlled Substances Act was enacted to protect consumers from dangerous drug products — not to punish consumers. When manufacturers create, market, and sell products that present a significant threat to public safety, federal law exists to intervene. 

That is exactly what has happened with chemically manipulated 7-OH opioid products.

The blame for this situation does not rest with the American Kratom Association, natural kratom leaf consumers, regulators, or anyone advocating for responsible consumer protections. The blame lies entirely at the feet of the 7-OH manufacturers who deliberately bypassed federal law and basic safety requirements in pursuit of profits.

These companies did not follow the required pathways for market entry. They did not submit lawful safety data. They did not comply with the federal requirements that exist to protect consumers from dangerous drug products. 

They took a naturally occurring trace alkaloid found in kratom leaf and chemically manipulated it into highly concentrated 7-OH-dominant opioid products, then pushed those products into the marketplace without the guardrails that would apply to any legitimate opioid drug product.

Worse, they deceived hundreds of thousands of natural kratom leaf consumers into believing they were purchasing ordinary kratom products. They traded on the reputation of natural kratom leaf while selling products that are fundamentally different in formulation, potency, pharmacology, and risk. 

That deception has harmed consumers, undermined legitimate kratom regulation, and placed the entire natural kratom community at risk.

The American Kratom Association does not advocate for the purchase of any kratom product. The AKA advocates for consumer protection. That means support for policies requiring safely formulated natural kratom leaf products, proper labeling, age restrictions, contaminant testing, responsible manufacturing standards, and clear limits that prevent dangerous adulteration or chemical manipulation.

The companies you criticize for supporting the AKA are not being defended because they sell products. They are companies willing to support lobbying efforts to protect consumers through rational regulation. That is very different from the 7-OH manufacturers who chose to evade federal requirements, push chemically manipulated opioid products into gas stations and smoke shops, and then claim that enforcement against them is somehow an attack on personal freedom.

It is not.

No responsible public health policy would support allowing consumers to buy opioids from drug dealers on a street corner simply because some adults may want access to them. The same principle applies here. 

Chemically manipulated 7-OH products are opioids. They should not be easily available to anyone through retail channels with no medical supervision, no lawful drug approval, no verified safety profile, no abuse-liability controls, and no meaningful consumer protections.

This is not a debate over bodily autonomy in the abstract. It is a debate over whether manufacturers can bypass the law, create concentrated opioid products, market them as “kratom,” and sell them broadly to consumers without meeting the same safety standards that apply to other opioid products.

Alcohol and tobacco are not a justification for repeating another public health failure. The existence of dangerous legal products does not mean the government should ignore a new class of chemically manipulated opioid products being sold without adequate oversight. It means policymakers should act before the harm becomes larger.

The most important distinction is this: natural kratom leaf products and chemically manipulated 7-OH opioid products are not the same. The AKA has fought for years to protect access to natural kratom leaf for responsible adult consumers. That work is directly threatened by 7-OH manufacturers who blurred the line between kratom and opioids for profit.

Ms. Lindell's anger should be directed at the companies that created this crisis. They put consumers like her in this position. They entered the market unlawfully. They misled consumers. They ignored safety standards. They gambled with public health. And now they want natural kratom advocates to absorb the blame for the consequences of their own conduct.

The AKA will continue to support access to properly regulated natural kratom leaf products. But it will not defend chemically manipulated opioid products masquerading as kratom. Protecting consumers means drawing that line clearly — and enforcing it.

That is not betrayal.

That is responsible advocacy.

Mac Haddow is a Senior Fellow on Public Policy with the American Kratom Association.

Banning 7-OH Will Ruin My Life

 By Crystal Lindell

When I got the news that 7-OH will likely be illegal in the United States within the next month, I was on a break at the new job I was able to get because of 7-OH.

I opened my texts to see a message from PNN editor Pat Anson:

“7-OH to be banned nationwide in early August according to DEA filings.”

He’s always been great at breaking news. 

When I saw the words though, I wanted to throw up. I started shaking and was overcome by a cold sweat. Then I fought back tears because I had to get back to work.  

I had to get over the shock and dissociate to get through the rest of my shift at the gas station where I work. I spent the next few hours legally selling customers cigarettes, beer, and lottery tickets. 

Then I went into my car and cried.  

7-OH has truly been a life-changing drug for me and many people I know and love.

I have intercostal neuralgia, which is nerve damage in my ribs. When you have the same thing in your face it’s called trigeminal neuralgia – which is colloquially called the “suicide disease” because so many people who have it kill themselves or want to.

As someone with the intercostal variety, I’m here to tell you that having that kind of pain in your ribs doesn’t make it any less horrible. I have long considered suicide as a potential treatment option.

For many years I was able to find some semblance of stability with a cocktail of opioid and OTC pain medications. I know how lucky I am to be among those who can still get an opioid prescription. But while the opioids have kept the suicidal-level pain at bay, they have never allowed me to actually live.

7-OH does that.

It’s not an exaggeration to say that it has given me my life back. It’s been even more effective than hydrocodone or morphine for me. It instantly treats my pain while also combating fatigue. 

Losing access to 7-OH will be devastating for me. 

I am worried I will no longer be able to work full-time, and that I will then lose the health insurance I only just got. Without work and insurance, I will be back to living below the poverty line, and relying on food pantries. 

But none of that has anything to do with why I think 7-OH should remain legal.

7-OH should remain legal because – as an adult – I should have the legal right to put whatever I want into my own body, and it is no one else’s business how I do that.

That’s it. That’s the only reason needed. Anything else is irrelevant.

This is a bodily autonomy issue. I should be the only one who controls my own body, especially my own medical decisions. 

Not to mention the fact that nicotine and alcohol are legal despite the fact that they are both very addictive and sometimes deadly. Why single 7-OH out? Especially considering how safe it is in comparison to those drugs. 

AKA Betrayal

What’s worse is the outright glee from some leaf kratom advocates, who think banning 7-OH will somehow let them be seen as the golden child.

I feel so betrayed by them. The American Kratom Association in particular pushed for this and they have made a deal with the devil. When 7-OH is banned nationwide, it’s likely that leaf kratom is next. It’s already happened in several states.

I will never again use a single kratom product from any of the companies that support the AKA.

For now, I plan to taper down and hopefully get off 7-OH without going into withdrawal. And I am going to look into different substances that may give me a similar effect. 

I’m also hopeful that the 7-OH manufacturers are working on new formulations of kratom alkaloids that will still be available after the ban. 

And I am clinging to the 1% chance that the DEA backtracks on this, as they did in 2016, after initially announcing plans to make mitragynine and 7-hydroxymitragynine illegal Schedule One drugs. 

I know we cannot count on that though.

Honestly, writing this column feels futile. I know it won’t do anything to stop the ban on 7-OH from coming. But I do feel it’s important to at least create a record of my objections. 

I want it plainly stated that a ban on 7-OH will be detrimental to my life, and to the lives of thousands of others who have found relief from this drug.

But how do I convince people to care about my life? Why do I even have to do so? Shouldn’t caring about other people’s well-being be something that comes naturally?

It’s degrading that I have to beg the world for pain relief. That I have to plead for a medication that allows me to live my life, work a job, care for my cats, love my fiancé, and aid my elderly relatives.

It disgusts and depresses me that we live in a country that would deny me those things.

DEA Will Classify 7-OH as Illegal Drug

By Pat Anson  

The Drug Enforcement Administration is moving to ban all concentrated forms of the kratom alkaloid 7-hydroxymitragynine (7-OH) by classifying it as an illegal Schedule One controlled substance, the same classification as heroin and LSD. 

In a notice pre-published in the Federal Register, the DEA said it would enact a temporary scheduling of 7-OH, which will begin 30 days after the notice is formally published on July 6. That would effectively ban the manufacture, sale and possession of 7-OH products nationwide, potentially in early August.

A separate notice applies the same Schedule One classification to the kratom derivatives mitragynine pseudoindoxyl (MP), dihydro-7-hydroxymitragynine (MGM-15), and the 9-fluoro derivative of 7-hydroxymitragynine (MGM-16).

Kratom comes from the leaves of a tropical tree in Southeast Asia, where it has long been used as a natural stimulant and pain reliever. 7-OH occurs naturally in kratom in trace amounts, but when concentrated it becomes more potent and has “opioid-like” effects.

The DEA’s order limits the amount of 7-OH to no more than 0.05% of a product by weight or volume. Virtually all 7-OH products currently on the market are well above that threshold.

Although many pain patients have found 7-OH to be an effective analgesic, concern has risen that repeated use may lead to addiction and overdose. Several states and dozens of cities and counties have banned 7-OH products, which are currently sold as unregulated dietary supplements.  

“7-Hydroxymitragynine has opioidergic activity, sharing a similar pharmacological profile to schedule II opioids like morphine. Preclinical data indicates that 7-hydroxymitragynine carries a high abuse potential with safety risks, including tolerance, dependence, and respiratory depression, which are comparable to those of classic opioid analgesics,” the DEA said.

“While sellers promote these products for their euphoric and opioidergic effects, evidence demonstrates they may also contain other opioid alkaloids, such as mitragynine pseudoindoxyl. These combinations, coupled with a lack of regulatory oversight, pose significant safety risk to unsuspecting consumers by exposing them to high doses of opioids.”

Under the Controlled Substances Act (CSA), the DEA can “temporarily” place a new substance in Schedule One for two years without a public hearing, as long as the Department of Health and Human Services (HHS) has no objection.  

“I commend the DEA for taking decisive action to address these addictive and harmful substances,” HHS Secretary Robert F. Kennedy, Jr. said in a statement.  “7-OH, MP, MGM-15, and MGM-16 are dangerous opioids that fuel addiction and put American lives at risk. HHS reviewed the science and recommended this action.” 

‘More Than We Were Hoping For’

The DEA action was applauded by the American Kratom Association (AKA), an organization of kratom vendors that promotes the use of unadulterated natural leaf kratom. The AKA has been lobbying local governments to ban 7-OH, but keep kratom legal.

“State officials should be very clear about what happened here,” said Mac Haddow, an AKA lobbyist and spokesman. “The 7-OH industry created this crisis. They manufactured or distributed high-potency opioid products, dressed them up as kratom, and then tried to force natural kratom consumers to pay the price for their recklessness.”

Haddow says the DEA’s action will lend weight to arguments that natural leaf kratom is safer than 7-OH.  

“It's more than we were hoping for, in the sense that we got another clear affirmation from HHS about the distinguishing characteristics, because that's important to state legislatures and to state AGs and to boards of pharmacy,” Haddow told PNN. 

“This was all a great set of announcements that clarifies for every state legislator, every attorney general, and every local county elected body to see exactly that they should be in alignment with the federal policy on these issues.”

7-OH advocacy groups are likely to mount a legal challenge to the DEA’s scheduling of 7-OH.

“We understand that this announcement is causing a lot of confusion, fear, and uncertainty throughout the consumer community. First and most importantly, we want to be clear: 7-OH has not been immediately banned or scheduled,” the 7-HOPE Alliance said in a statement.

“While this development is serious, there is still a process ahead, and there is still an opportunity for science, evidence, and consumer voices to be heard. The 7-HOPE Alliance is actively reviewing the announcement and coordinating with legal, scientific, policy, and advocacy partners to determine the strongest path forward.”

Legal options appear to be limited. Under the CSA, DEA and HHS are given wide discretion to classify a new drug as a Schedule One controlled substance if its poses an “imminent hazard to public safety.” In addition to the two-year temporary scheduling of 7-OH, the U.S. Attorney General has the authority to add an additional third year.

In another notice being published in the Federal Register, HHS is opening a 30-day public comment period on the proposed threshold for 7-OH and the other kratom derivatives.

You can leave a comment by clicking here. Comments must be posted by July 31.

It’s important to note HHS is not asking whether 7-OH should be classified as Schedule One, only if the 0.05% threshold set by DEA is appropriate. It is “not soliciting comment on any permanent scheduling decision, the general safety or utility of kratom-derived products.”

Chronic Pain Made Kathie Lee Gifford Suicidal

By Crystal Lindell

Kathie Lee Gifford has revealed to People that while struggling with chronic pain, she wanted to die.

The retired singer and talk show host told the magazine that she remembers praying: "Lord, if this is all you have left for me, I want to go home.”

“I wanted to die a few times. I wasn't going to hurt myself. I wasn't going to kill myself. I just didn't want to be here — as blessed as I am," she said.

The 72-year old Gifford struggled with chronic pain due to a slew of health issues over the last couple years, including a total hip replacement. 

After that procedure, she then had to have another surgery after she fractured her hip again trying to play with her grandchildren.

There’s more. Gifford also broke her arm after rolling over it awkwardly one night. She had yet another bone break when she fell on uneven pavement. Then she realized her depth perception was off, so she had cataract surgery on her eyes.

Based on the types of injuries she had — including multiple broken bones — it sounds like she may have been struggling with accepting her aging body’s limitations.

It is crushing to realize that as our bodies age and deteriorate, we can’t do all the things we used to do when we were healthy.

Gifford said her pain made her self-isolate by staying home more, which made her remember something her late husband, NFL and broadcasting legend Frank Gifford, said before he died at age 84 in 2015.

"Frank said to me before he passed, 'When I go somewhere, I know what people are expecting from me. I want to be Frank Gifford when I go out,'" she recalled. "I want to be Kathie Lee, the person they expect. I don't want to disappoint people. But when you're in pain, it's so debilitating, and everything's a grimace.”

Indeed, as many chronic pain patients can relate, pain will turn you into a different person. It will  chip away at your personality, and all the things that you assumed made you who you were. Deciding it’s easier to just stay home and isolate themselves is an all too common reaction. 

“I've had emotional pain many times in my life, but never this chronic physical pain where you literally want to go home to Jesus," Gifford said about her darkest days.

That comparison of emotional pain to physical pain was especially interesting to read, and something I have definitely thought myself multiple times over the years. There is something about never ending physical pain that will make suicide feel almost welcome.

The way Gifford described her suicidal thoughts as a desire to “go home to Jesus” makes it seem like she gave it serious thought.

Gifford also talked about how chronic pain impacted her ability to be a grandmother, after she welcomed five grandchildren in three years.

"I couldn't carry them, I couldn't love on them, I couldn't run and play with them," she explained. "All I could do was sit there and sing and write silly songs with them."

As a chronic pain sufferer myself, it’s validating to hear that even the rich and famous are no match for the absolute hell that comes with daily pain.

You would think that having a net worth of tens of millions of dollars, as well as access to any treatment possible, would be enough to insulate them. But chronic pain will humble anyone it touches.

Gifford did say she was doing better these days, thanks to her surgeries, 6 days-a-week physical therapy, and stem cell therapy. She’s now able to run "all over the place" with her grandkids.

"They're all fantastic," she says. "I'm hoping, Lord willing, that I have many, many years with them."

Of course, many of us don’t have access to things like stem cells, physical therapy, or joint replacement surgery. Aside from how expensive all of those things are, they also require the ability to take time off work and lots of support from loved ones.

That’s why it is so inhumane for doctors and the government to withhold the one inexpensive treatment that works for many of us: opioids.  

Part of the thought process for refusing to prescribe opioids is basically that pain patients should just suck it up and deal with their pain. But even rich and famous celebrities -- with all the advantages in the world -- struggle with chronic pain.

We need to remember that chronic pain can have life-threatening consequences to our health, and it should be treated with the same urgency as heart disease, cancer or any other potentially fatal condition. 

Gifford is fortunate that she didn’t succumb to suicidal thoughts, but she also had endless resources to help her through it. The rest of us are not so lucky. Which is why we need access to treatments that actually work. 

Melatonin Can Help Reduce Chronic Pain

By Pat Anson

Many chronic pain sufferers know how beneficial a good night’s sleep can be. Restorative sleep reduces pain levels, along with fatigue, anxiety and stress.

A new study in Australia suggests that melatonin not only helps with sleep, but is just as effective at reducing chronic musculoskeletal pain as non-steroidal anti-inflammatory drugs (NSAIDs). 

The study, published in the journal PAIN, looked at health data for over 2,000 patients in 23 controlled trials who took melatonin supplements. Participants included people with low back pain, osteoarthritis and fibromyalgia, as well as those recovering from joint replacements and spinal surgeries. 

“For many patients, pain doesn’t exist in isolation and is closely tied to poor sleep,” said lead author and PhD student Kangchao Wu in the Musculoskeletal Research Hub at the University of Sydney. “Melatonin appears to target both, which makes it particularly useful for people managing chronic pain.

Using a zero to 100 pain scale, researchers say melatonin modestly reduced musculoskeletal pain by about nine points, with the most rigorous studies showing pain levels dropping nearly 10 points, a level similar to those of NSAIDs. Melatonin was not as effective in reducing post-operative pain.

Notably, researchers did not find evidence of a dose-response relationship, meaning no single “best” dose of melatonin can be recommended. 

“The level of pain relief we observed is comparable to some conventional treatments, but this does not mean melatonin should replace them,” Wu said. “Rather, it may offer a safer additional option within a broader pain management plan.”

Melatonin is a natural hormone produced by the pineal gland in the brain. During the day the pineal gland is inactive, but at night it begins to produce melatonin and helps us sleep.

Melatonin supplements are widely promoted as sleep aids. However, their role in reducing inflammation – a major contributor to chronic pain – may be just as important. Melatonin has antioxidant and anti-inflammatory properties, which may reduce the central sensitization and inflammation underlying chronic pain.

In Europe and Australia, melatonin requires a prescription, while in the United States melatonin supplements can be purchased over-the-counter.

“Melatonin is already in people’s homes, it’s inexpensive, and we know it’s safe,” says Wu. “What’s exciting is that melatonin may also help manage chronic pain, opening the door to reducing reliance on medications that come with more risks.”

Melatonin is generally well tolerated, with mild, short-term side effects such as nausea, dizziness and headaches. Melatonin is considered safe for short-term use of less than three months. 

A recent study found that adults with insomnia who used melatonin for at least a year were more likely to be diagnosed with heart failure, be hospitalized, or die from any cause. The study did not establish a cause-and-effect relationship, meaning health conditions raising the risk may have already been present. 

The ‘Skunky’ Smell of Cannabis May Help Treat Fibromyalgia

By Pat Anson

THC and CBD get all the attention, but there’s another compound in cannabis that could someday be harnessed to treat chronic pain: terpenes.

Terpenes are the aromatic compounds that give plants like lavender, sage and eucalyptus their distinctive smells. In cannabis, terpenes give the plant its “skunky” aroma.

Researchers at the University of Arizona Health Sciences have identified four terpenes in cannabis sativa that may offer a new way to treat chronic pain: geraniol, linalool, beta-caryophyllene, and alpha-humulene.

In studies on laboratory mice modeled to simulate fibromyalgia and post-operative pain, all four compounds produced substantial pain-relieving effects. Geraniol delivered the strongest results, followed by linalool, beta-caryophyllene, and alpha-humulene.

The findings, published in Pharmacological Reports, builds on previous research at the U of A that showed the pain-relieving potential of cannabis terpenes in treating inflammation and chemotherapy-induced neuropathic pain. 

“Our research is showing that terpenes are not a good option for reducing acute pain resulting from an injury, such as stubbing your toe or touching a hot stove; however, we are seeing significant reductions in pain when terpenes are used for chronic or pathological pain,” said John Streicher, PhD,  Professor of Neuroscience in the U of A College of Medicine Pharmacology. 

“This study was the first to investigate the impact of terpenes in preclinical models of fibromyalgia and post-operative pain and expand the scope of potential pain-relieving treatments using terpenes.”

Fibromyalgia is a poorly understood musculoskeletal disorder that causes widespread body aches, brain fog, chronic fatigue, and anxiety. There are only four FDA-approved drugs for fibromylagia, which many patients consider ineffective or have too many side effects.. 

“With fibromyalgia, there isn’t much understanding of what the pain state is, and there are not a lot of great options for treating it,” Streicher said. “Our findings show that terpenes may be a viable treatment option for fibromyalgia pain, which could potentially have a large impact and make a difference for an undertreated population.” 

Post-surgical pain straddles the line between short-term acute pain and chronic pain that lasts at least 30 days. When poorly treated, post-operative pain can cause physiological changes that sensitizes the body’s pain signalling system and causes other side effects.

“Opioids do a good job controlling post-surgical pain, but they can cause constipation that can increase the chances of post-surgical complications such as adhesions,” Streicher said. “We are always looking for better options, and this study suggests that terpenes could be a novel therapeutic for post-operative pain.” 

Terpenes are already used in essential oils to promote relaxation or reduce pain and inflammation. Scientists still have much to learn about their therapeutic benefits.

“Nature is incredible at making unique chemical structures, and many of these chemicals are unknowns when it comes to their abilities to aid in human health, diseases and disorders,” said said Todd Vanderah, PhD, director of the U of A’s Comprehensive Center for Pain & Addiction 

“A great current example is medication semaglutide, sold under the brand name Ozempic, which has a chemical structure that was isolated not from a plant, but from an animal that is prevalent in the Southwest, the Gila monster. These discoveries from natural products through research such as Dr. Streicher’s can result in very useful medications.”

Terpenes derived from cannabis are an essential ingredient in Exilby, a cannabis extract developed by a German biopharmaceutical company. Exilby was recently approved by European regulators as a treatment for chronic low back pain. It has also been given a Breakthrough Therapy designation by the FDA, which will speed up its development and review in the U.S.

3 Tips for Surviving Summer Heat with Chronic Pain

By Crystal Lindell

While the official summer season started June 21, here in northern Illinois it has definitely felt like summer for almost three months already.

And with summer weather comes lots of heat, humidity, and thunderstorms – all of which can be tough to deal with when you live with chronic pain.

But there are some things you can do that make surviving the hottest months of the year a little more bearable, even if your body is doing its best to make your life miserable.

1. Learn How Weather Impacts You

I can always feel when a summer thunderstorm is coming. All of my joints hurt more, and the intercostal neuralgia pain in my ribs becomes so intense that it’s difficult for me to stay upright. 

But then, when the rain finally falls, there’s a relief that often envelops my body, as though the swelling is being released.

One thing I have noticed is that when I talk to fellow chronic pain sufferers, many of them don’t even realize that their pain is flaring because storms are coming. The flare may begin when the sky is bright and clear, and the storm itself is still a few hours away.

Learning how weather impacts your body can be very helpful when it comes to predicting and navigating flare ups. Try keeping a diary, either digitally or on paper, of your pain flares. Then compare local weather patterns to the flares to see if they are storm-related. You can look up past weather patterns for your area on Weather Underground. 

When you get really confident in the patterns, you can start to look at the weekly weather forecast as a sort-of pain forecast, which can then help you better plan out your commitments. 

For example, perhaps you’ll schedule your lunch with friends when you know it’s not going to rain for a few days. Or you can reschedule your dentist appointment if you see a storm coming.

2. Embrace Rest on Sunny Days

I’m not sure how things go in the rest of the country, but here in the Midwest everyone feels the need to be as active as possible whenever the weather heats up. It’s because we spend most of the year dealing with freezing temperatures and snow.

There’s a Midwest guilt that comes over us if we ever feel like we are wasting a good weather day. It’s like we are worried that if we don’t show enough appreciation for 80 degrees, we’ll face the punishment of an early winter.

When you have chronic pain though, summer can be especially difficult to deal with. Changes in pressure and humidity can cause inflammation and increased pain, while the heat can be more difficult to tolerate.

So, even if it’s sunny outside, try to remember that rest is both helpful and necessary. It’s good to “waste” a sunny day inside with air conditioning, if that’s what you need to feel your best. 

3. Wear Compression Socks

Personally, I’m a fan of compression socks all year round, but when the temperatures get past about 75 degrees Fahrenheit, they become a staple in my outfits.

Heat is one of the main causes of fluid buildup in your ankles, which in turn causes swelling. It’s more likely to happen if you have certain health conditions, or take medications like gabapentin and NSAIDs.

Compression socks can make a world of difference, by reducing the amount of swelling you’ll experience on the days when you need to be on your feet more or when it’s just especially hot outside.

Plus, keeping your foot and ankle swelling down with compression socks also makes the recovery cycle easier to get ahead of. The less swelling you have, the faster it will go away.

Summertime isn’t always a day at the beach for chronic pain patients, but with a little bit of planning and a few accommodations, it can still offer lots of fun!

What tips do you use to survive the hot summer months? Is your pain better or worse when the weather heats up? We’d love to hear from you in the comments below!