New Medicaid Policy Won't Pay for Costly Sickle Cell Therapies Unless They Work

By Phil Galewitz, KFF Health News

Serenity Cole enjoyed Christmas last month relaxing with her family near her St. Louis home, making crafts and visiting friends.

It was a contrast to how Cole, 18, spent part of the 2024 holiday season. She was in the hospital — a frequent occurrence with sickle cell disease, a genetic condition that damages oxygen-carrying red blood cells and for years caused debilitating pain in her arms and legs. Flare-ups often would force her to cancel plans or miss school.

“With sickle cell it hurts every day,” she said. “It might be more tolerable some days, but it’s a constant thing.”

In May, Cole completed a several-months-long gene therapy treatment that helps reprogram the body’s stem cells to produce healthy red blood cells.

She was one of the first Medicaid enrollees nationally to benefit from a new payment model in which the federal government negotiates the cost of a cell or gene therapy with pharmaceutical companies on behalf of state Medicaid programs — and then holds them accountable for the treatment’s success.

Under the agreement, participating states will receive “discounts and rebates” from the drugmakers if the treatments don’t work as promised, according to the Centers for Medicare & Medicaid Services.

SERENITY COLE

That’s a stark difference from how Medicaid and other health plans typically pay for drugs and therapies — the bill usually gets paid regardless of the treatments’ benefits for patients. But CMS has not disclosed the full terms of the contract, including how much the drug companies will repay if the therapy doesn’t work.

The treatment Cole received offers a potential cure for many of the 100,000 primarily Black Americans with sickle cell disease, which is estimated to shorten lifespans by more than two decades. But the treatment’s cost presents a steep financial challenge for Medicaid, the joint state-federal government insurer for people with low incomes or disabilities. Medicaid covers roughly half of Americans with the condition.

There are two gene therapies approved by the Food and Drug Administration on the market, one costing $2.2 million per patient and the other $3.1 million, with neither cost including the expense of the long hospital stay.

The CMS program is one of the rare health initiatives started under President Joe Biden and continued during the Trump administration. The Biden administration signed the deal with the two manufacturers, Vertex Pharmaceuticals and Bluebird Bio, in December 2024, opening the door for states to join voluntarily.

“This model is a game changer,” Mehmet Oz, the CMS administrator, said in a July statement announcing that 33 states, Washington, D.C., and Puerto Rico had signed onto the initiative.

Asked for further details on the contracts, Catherine Howden, a CMS spokesperson, said in a statement that the terms of the agreements are “confidential and have only been disclosed to state Medicaid agencies.”

“Tackling the high cost of drugs in the United States is a priority of the current administration,” the statement said.

Citing confidentiality, two state Medicaid directors and the two manufacturers declined to reveal the financial terms of agreements.

‘A Worthy Experiment’

The gene therapies, approved in December 2023 for people 12 or older with sickle cell disease, offer a chance to live without pain and complications, which can include strokes and organ damage, and avoid hospitalizations, emergency room visits, and other costly care. The Biden administration estimated that sickle cell care already costs the health system almost $3 billion a year.

With many more expensive gene therapies on the horizon, the cost of the sickle cell therapies presages financial challenges for Medicaid. Hundreds of cell and gene therapies are in clinical trials, and dozens could get federal approval in the next few years.

If the sickle cell payment model works, it will probably lead to similar arrangements for other pricey therapies, particularly for those that treat rare diseases, said Sarah Emond, president and CEO of the Institute for Clinical and Economic Review, an independent research institute that evaluates new medical treatments. “This is a worthy experiment,” she said.

Setting up payment for drugs based on outcomes makes sense when dealing with high treatment costs and uncertainty about their long-term benefits, Emond said.

“The juice has to be worth the squeeze,” she said.

Clinical trials for the gene therapies included fewer than 100 patients and followed them for only two years, leaving some state Medicaid officials eager for reassurance they were getting a good deal.

“What we care about is whether services actually improve health,” said Djinge Lindsay, chief medical officer for the Maryland Department of Health, which runs the state’s Medicaid program. Maryland is expected to begin accepting patients for the new sickle cell program this month.

Medicaid is already required to cover almost all FDA-approved drugs and therapies, but states have leeway to limit access by restricting which patients are eligible, setting up a lengthy prior authorization process, or requiring enrollees to first undergo other treatments.

While the gene therapy treatments are limited to certain hospitals around the country, state Medicaid officials say the federal model means more enrollees will have access to the therapies without other restrictions.

The manufacturers also pay for fertility preservation such as freezing reproductive cells, which could be damaged by chemotherapy during the treatment. Typically, Medicaid doesn’t cover that cost, said Margaret Scott, a principal with the consulting firm Avalere Health.

Emond said pharmaceutical companies were interested in the federal deal because it could lead to quicker acceptance of the therapy by Medicaid, compared with signing individual contracts with each state.

States are attracted to the federal program because it offers help monitoring patients in addition to negotiating the cost, she said. Despite some secrecy around the new model, Emond said she expects a federally funded evaluation will track the number of patients in the program and their results, allowing states to seek rebates if the treatment is not working.

The program could run for as long as 11 years, according to CMS.

“This therapy can benefit many sickle cell patients,” said Edward Donnell Ivy, chief medical officer for the Sickle Cell Disease Association of America.

He said the federal model will help more patients access the treatment, though he noted utilization will depend in part on the limited number of hospitals that offer the multimonth therapy.

Hope for Sickle Cell Patients

Before gene therapy, the only potential cure for sickle cell patients was a bone marrow transplant — an option available only to those who could find a suitable donor, about 25% of patients, Ivy said. For others, lifelong management includes medications to reduce the disease’s effects and manage pain, as well as blood transfusions.

About 30 of Missouri’s 1,000 Medicaid enrollees with sickle cell disease will get the therapy in the first three years, said Josh Moore, director of the state’s Medicaid program. So far, fewer than 10 enrollees have received it since the state began offering it in 2025, he said.

Less than a year into the federal program, Moore said it’s too early to tell its rate of success — defined as an absence of painful episodes that lead to a hospital visit. But he hopes it will be close to the 90% rate seen over the course of a couple of years in clinical trials.

Moore said the federal program based on how well the treatment works was preferred over cutting fees for a new and promising therapy, which would put the manufacturers’ ability to develop new drugs at risk. “We want to be good stewards of taxpayer dollars,” he said.

He declined to comment on how much the state may save from the arrangement or disclose other details, such as how much the drug companies might have to pay back, citing confidentiality of the contracts.

Lately Cole, who underwent gene therapy at St. Louis Children’s Hospital, has been able to focus on her hobbies — playing video games, drawing, and painting – and earning her high school diploma.

She said she was glad to get the treatment. The worst part was the chemotherapy, she said, which left her unable to talk or eat — and entailed getting stuck with needles.

She said that her condition is “way better” and that she has had no pain episodes leading to a hospital stay since completing the therapy last spring. “I’m just grateful I was able to get it.”

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

How Stress Makes Pain Worse

By Crystal Lindell

One of the easiest ways to spot a true chronic pain veteran is that they will be eerily silent during the worst pain of their lives.

That’s because people who endure pain day-in and day-out quickly learn that the worst thing you can do during a pain flare is panic and scream.

In practice, those things only serve to increase your stress levels, which will also increase your pain. The best response to pain is to keep yourself as calm and as quiet as possible.

I did not know this in the beginning. Back when I first started having chronic pain a little over a decade ago, the pain itself would stress me out. I’d end up in a devastating cycle where the pain increased, which made my stress increase, which made my pain increase. Usually, the only way to break the cycle would be to go to the emergency room.

A new study, published in the journal PAIN, offers some data proving this phenomenon. Belgian scientists found that stress heightens acute pain caused by electrical stimulation to the skin, and increases sensitivity to pinpricks.

While pinpricks and electrical stimulation are a far cry from the type of pain most chronic pain sufferers endure, it is still interesting to see data proving what many patients have already figured out: Stress makes pain worse.

The study was conducted on healthy women, using two different experiments. To measure their pain response, participants were asked to rank their pain on a scale of 0-100. 

To induce stress, researchers used the Mannheim Multicomponent Stress Test (MMST), a computer program that causes stress with difficult cognitive tests or disturbing noises and images.

In the first experiment, the researchers induced stress before they started administering electrical stimulation. They followed that up with pinpricks. 

They found that participants ranked their pain after the initial pinpricks as being 10 points higher. But pain decreased back to the normal range as they kept administering the pinpricks.

In the second experiment, stress was induced 20 minutes after they started administering electrical stimulation. They found that pinprick hypersensitivity significantly increased after the stress was induced.

In other words, if someone is stressed before electrical stimulation, it can make that stimulation hurt more. But it doesn't impact whether or not they become more sensitive to pinpricks. 

However, when someone becomes stressed after the electrical stimulation, the stress makes the sensitivity to pinpricks worse. 

While I still hate when people suggest yoga as a treatment for my chronic pain, I will admit that learning to keep myself calm during a flare can go a long way. And research like this helps prove why serenity is so important for pain patients. 

‘No Clear Evidence’ Medical Cannabis Helps With Neuropathic Pain

By Crystal Lindell

A new multi-study analysis is further muddying the water on whether medical cannabis is an effective treatment for neuropathic pain.

The Cochrane review – considered the gold standard in medical research – looked at results from 21 high-quality clinical studies of medical cannabis involving nearly 2,200 participants. German researchers were hoping to find whether THC and/or CBD helped people suffering from neuropathic pain.

They found “no clear evidence” that THC‐dominant medicines, CBD-dominant medicines or THC/CBD‐balanced medicines provided pain relief of 50% or more compared to a placebo. A 50% reduction in pain is generally considered an effective response rate for pain medication.

The new findings contradict a recent U.S. study that found THC more effective in relieving pain than CBD. That review mostly involved patients with chronic neuropathic pain.

The findings also contradict a recent survey of 1,450 medical cannabis users, which found that cannabis works best on neuropathic pain, such as pain caused by diabetic neuropathy, post-herpetic neuralgia, and multiple sclerosis.

As someone with nerve pain in my ribs, these contradictory results are not surprising. I’ve tried both THC and CBD and found them lacking. The most effective class of medications for me remains opioids, with 7-OH a close second.

I fully believe that people should have access to whatever medications work best for them. So, if there are people out there who find that THC works best to alleviate their nerve pain, then by all means they should be allowed to take it. And of course, this new research shouldn’t negate the idea that many people do find cannabis to be very effective at treating other conditions.

The issue is that over the last decade, as cannabis legalization has spread, some doctors have recommended that their patients try medical cannabis, while refusing to prescribe opioids. That is a problem, especially when research shows that cannabis doesn’t work well for most people with nerve pain, and that THC comes with unwanted side effects.

The good news though is that as cannabis has gained more official legal status, research like this is actually happening. So, we can actually have real scientific data, rather than just anecdotal evidence about cannabis.

I’d also really like to see in-depth research about natural leaf kratom and kratom extracts like 7-OH. Perhaps if data showed them as being effective and with few side effects, governments would stop being so quick to ban them.

In the end, every person’s pain is uniquely theirs to endure, and which treatments work will vary from person to person. When doctors and regulators finally accept there is no one treatment that fits all, that we can truly make progress in alleviating pain.  

Scientists May Finally Know Why Statins Cause Muscle Pain

By Pat Anson

Many people stop taking cholesterol-lowering statins because they experience painful muscle cramps, weakness, and fatigue. I know, because I was one of them.

I started taking statins in my 40’s on the advice of our family physician, because of mildly elevated cholesterol and a family history of coronary artery disease. Soon I was having stinging cramps in my legs overnight, which were painful enough to wake me up. 

My doctor was skeptical that statins were the cause, but switched me from Lipitor to Vytorin and finally to Crestor. The muscle cramps continued. Only when I stopped taking statins did the symptoms disappear.

“I’ve had patients who’ve been prescribed statins, and they refused to take them because of the side effects. It’s the most common reason patients quit statins, and it’s a very real problem that needs a solution,” says Andrew Marks, MD, Professor and Chair of the Department of Physiology and Cellular Biophysics at Columbia University.

To find a solution, first you need to identify the cause, and Marks and his colleagues have finally discovered why about 10% of people on statins experience those muscular side effects.

Their research, recently published in The Journal of Clinical Investigation, found that a widely-used statin called simvastatin (Zocor) binds to a protein in muscle cells, which causes a leak of calcium ions inside the cells.

Using an electron microscope, researchers watched simvastatin molecules bind to two locations in a muscle protein called the ryanodine receptor, which opened a channel in the receptor that allowed calcium to flow through. 

Marks says the calcium leak could be weakening the muscle directly or by activating enzymes that degrade muscle tissue.

“It is unlikely that this explanation applies to everyone who experiences muscular side effects with statins, but even if it explains a small subset, that’s a lot of people we could help if we can resolve the issue,” Marks said in a press release.

The electron images suggest that statins could be redesigned so they don’t bind to the ryanodine receptor, but retain their cholesterol-lowering ability. 

Marks is now collaborating with chemists to create such a statin. He owns stock in RyCarma Therapeutics, a company developing compounds that target the ryanodine receptor.

Plugging the calcium leak could be another option: Statin-induced calcium leaks in laboratory mice can be closed with an experimental drug developed by Marks for other muscle conditions involving calcium leaks.

“These drugs are currently being tested in people with rare muscle diseases. If it shows efficacy in those patients, we can test it in statin-induced myopathies,” Marks says.

The first statin was approved by the FDA in 1987, but it took the agency nearly three decades to listen to patients like me and update warning labels on statins in 2014, cautioning that statins can cause myopathy. In rare instances, the FDA says statins can also cause liver injury, diabetes and memory loss.   

Prohibition Medicine and the Collapse of Patient Safety

By Michelle Wyrick

For more than a decade, the United States has been running a vast, uncontrolled policy experiment in medical care. Under the banner of “opioid reduction” and “overdose prevention,” regulators have steadily restricted, stigmatized, and in many cases effectively eliminated access to stable, physician-supervised treatment for pain, anxiety, and other chronic disabling conditions.

The results of this experiment are now visible everywhere, and they are not subtle. Patients are sicker, more desperate, more marginalized, and more exposed to dangerous unregulated substances than at any point in modern medical history.

This outcome should not surprise anyone. It is not an accident. It is the predictable result of applying prohibition logic to medicine.

When legitimate patients are cut off from stable, supervised, pharmaceutical-grade treatment, they do not stop having pain. They do not stop having anxiety, severe depression, neurological disease, connective tissue disorders, autoimmune conditions, or the many other illnesses that produce chronic suffering.

They look for substitutes. And there will always be substitutes.

This is not a moral statement. It is a basic fact of human biology and behavior.

Demand for relief from suffering is not eliminated by supply restrictions. It is merely displaced into less safe, less predictable, and less medically supervised channels.

This dynamic is not unique to opioids. It is a universal feature of prohibition systems. Alcohol prohibition in the early 20th century did not end drinking. It drove production into unregulated, often toxic forms and empowered criminal supply chains. Modern drug prohibition has not eliminated drug use. Instead, it has ensured that the drugs people do use are increasingly potent, adulterated, and dangerous.

The same pattern is now playing out inside medicine itself.

For decades, physicians used opioid analgesics, benzodiazepines, and other controlled medications in a personalized, risk-benefit framework. This was not perfect medicine, but it was recognizable medicine. Doctors assessed individual patients, monitored them, adjusted doses, and discontinued treatment when risks outweighed benefits. The vast majority of stable patients used these medications without chaos, without dose escalation, and without the kinds of outcomes now routinely attributed to the “opioid crisis.”

Beginning in the mid-2010s, this model was replaced with something very different. Guidelines were transformed into rigid limits. Clinical judgment was replaced by fear of regulators. Medical boards, insurers, pharmacies, and hospital systems began enforcing population-level dose ceilings and forced tapering policies that took little or no account of individual patient physiology, genetics, or clinical history.

This shift was justified using public health language, but it was not actually evidence-based medicine. It was administrative medicine.

The core assumption behind this approach was simple and deeply flawed. If you reduce access to prescription opioids, you reduce addiction and overdose.

In the real world, the opposite happened.

As prescription access fell, overdose deaths rose. Not slowly. Not ambiguously. They rose sharply and continuously, driven almost entirely by illicit synthetic opioids such as fentanyl and its analogues. This is not a coincidence. It is substitution.

When patients and non-patients alike lose access to regulated, dosed, known substances, the market does not disappear. It mutates. It becomes more concentrated, more dangerous, and more lethal.

From a pharmacological standpoint, this is exactly what one would predict. When supply is restricted, traffickers move to higher potency products that are easier to transport and conceal. This is why fentanyl replaced heroin, and why heroin replaced opium, and why alcohol prohibition favored spirits over beer. The same pressure operates everywhere prohibition is applied.

In medicine, this has produced a grotesque paradox. The very policies sold as “harm reduction” have forced more people into the most dangerous drug environment in history.

But the harm does not stop with overdose statistics.

For millions of legitimate patients, the new regime has meant something quieter but equally devastating. Forced tapers. Sudden discontinuations. Blacklisting by pharmacies. Doctors who will not treat pain at all. Clinics that advertise only “non-opioid” care, regardless of diagnosis, severity, or prior response.

These patients are often described in policy discussions as if they were abstractions. In reality, they are people with connective tissue disorders, spinal injuries, advanced arthritis, neuropathies, autoimmune diseases, post-surgical damage, and complex multi-system conditions. Many were stable for years or decades. Many were functional. Many worked, raised families, and lived ordinary lives.

When their treatment is removed, they do not return to some baseline healthy state. They collapse.

Some become housebound. Some lose the ability to work. Some develop severe depression and suicidality. Some are driven, reluctantly and fearfully, to seek relief outside the medical system.

This is the part of the story that is still not being honestly confronted.

People do not seek unregulated substances because they want to. They seek them because the medical system has left them with no humane alternative.

This is not “addiction” in the simplistic, moralized sense that is often implied. It is survival behavior in the context of untreated suffering.

From a systems perspective, the current policy framework violates one of the most basic principles of risk management. If you remove a safer, regulated option while demand remains constant, you do not eliminate risk. You increase it.

Pharmaceutical-grade medications have known dosages, known purity, known pharmacokinetics, and some degree of medical oversight. Gray and black market substances do not. They vary wildly in potency. They are often contaminated. They are frequently misrepresented. The margin for error is small, and the consequences of error are fatal.

This is why the shift from prescription opioids to illicit fentanyl has been so deadly. It is not because fentanyl is uniquely evil. It is because unregulated supply chains, extreme potency, and unpredictable dosing is a perfect storm.

A rational harm-reduction strategy would aim to pull people into safer, supervised, medically controlled channels. Instead, current policy does the opposite.

It pushes people out.

There is also a deeper scientific problem with the one-size-fits-all approach that now dominates pain and psychiatric care. Human beings do not respond to drugs uniformly. Genetics, metabolism, receptor expression, enzyme function, comorbid conditions, and prior exposure all profoundly shape both benefit and risk. Pharmacogenetics has made this increasingly obvious, yet policy continues to pretend that a single dosage threshold can define safety for everyone.

This is not medicine. It is bureaucratic simplification masquerading as science.

Some patients tolerate and benefit from opioid therapy at doses that would be excessive for others. Some cannot tolerate even low doses. Some respond better to one class of medication than another. The same is true for benzodiazepines, antidepressants, stimulants, and nearly every drug class in existence.

The proper response to this variability is individualized care, not blanket restriction.

Instead, clinicians are now taught, implicitly and explicitly, that avoiding regulatory risk matters more than relieving suffering. The result is widespread medical abandonment.

From an ethical standpoint, this should be alarming. Medicine is supposed to be organized around the care of the patient in front of the clinician, not the appeasement of distant agencies.

From a public health standpoint, it is also failing by its own stated metrics. Overdose deaths continue. Illicit markets continue to grow. Patients continue to be driven out of care.

This is not because the problem is unsolvable. It is because the framing is wrong.

We are not dealing with a battle between “medicine” and “drugs.” We are dealing with a battle between regulated, supervised, accountable systems and unregulated, chaotic, lethal ones.

History has already shown us how this ends. Every time.

Prohibition logic has never worked in any domain. Not alcohol. Not drugs. Not sex work. Not abortion. Not gambling. It does not eliminate demand. It ensures that demand is met in more dangerous ways.

If policymakers actually cared about safety and harm reduction, they would reverse course.

They would restore rational, individualized medical prescribing. They would protect clinicians who practice careful, documented, patient-centered care. They would stop forcing stable patients into destabilizing tapers. They would bring people back into the healthcare system instead of pushing them into gray and black markets.

They would also start telling the truth about what has happened.

The current crisis is not the result of doctors prescribing too compassionately. It is the result of a system that replaced medicine with fear, and then called the outcome “public health.”

We can continue down this path, and watch the death toll and human suffering rise year after year. Or we can admit what history, pharmacology, and basic systems theory already tell us.

You cannot ban your way to safety.

You can only regulate, supervise, and care your way there.

And right now, we are doing the opposite.

Michelle Wyrick is a Board Certified Psychiatric Registered Nurse and a Clinical Hypnotist in Gatlinburg, Tennessee.

There’s Still Plenty of Stigma About Opioid Addiction

By Crystal Lindell

Many Americans still view opioid addiction as a stigmatized condition – with over half (58%) saying they wouldn’t want someone with an opioid use disorder marrying into their family. And over a third (38%) don’t want to be neighbors with someone with opioid addiction.

That’s according to an online survey of over 1,550 U.S. adults by researchers at Cornell University, who published their findings in JAMA. 

The goal of the survey was to see how Americans view opioid overdose deaths, people with opioid addiction, and who is responsible for solving the opioid crisis. They also measured if views differed by political ideology.

Notably, the survey did not define “addiction” before asking questions about it, leaving it up to each respondent to rely on their own personal perception of what addiction is. There are issues with that approach, as many people don’t know the difference between addiction and dependence, which is a reliance on medication to treat a health condition.

The survey also didn’t distinguish between people addicted to prescription opioids and those addicted to illicit opioids such as fentanyl or heroin. Most U.S. overdoses involve illicit fentanyl.  

That said, the responses indicate that many people view opioid addiction through an ideological lens.

There was broad agreement among conservatives, moderates and liberals that opioid overdose deaths are a serious problem. Overall, 88% rated it as a very serious problem. 

But when it comes to responsibility for reducing overdose deaths, conservatives were more likely than liberals to say people who use opioids and their family members bear a personal responsibility for reducing the number of deaths.

Liberals, on the other hand, were more likely than conservatives to say pharmaceutical companies, as well as federal, state and local governments, were responsible for fixing the problem.

Only about one in four thought that nonprofit organizations were responsible for the opioid crisis.  

Perceived Responsibility for Reducing Opioid Overdose Deaths

SOURCE: jama

Conservatives were also more likely to have a stigmatized view of people with opioid use disorder. Over half of conservatives (52%) said they were unwilling to have a neighbor with an opioid addiction (compared to 27% of liberals), and 71% of conservatives said they would not want someone with an opioid addiction to marry into their family (compared to 48% of liberals).

Attitudes About People With Opioid Addiction

SOURCE: jama

The findings highlight just how widespread the stigma still is when it comes to opioid use.

"It remains striking that nearly one-half of self-described liberals indicated unwillingness to have a person with opioid addiction marry into their family," wrote Harold Pollack, PhD, a Professor of Public Health at the University of Chicago, in a commentary also published in JAMA. "The stigma of current opioid addiction crosses political lines."

Respondents who have a personal experience with opioids — who experienced opioid addiction themselves, had a family member or close friend with addiction, or knew someone who died from overdose — showed a greater willingness to have a person with opioid addiction as a neighbor or in-law.

Interestingly, people with that lived experience were slightly more likely than others (82.2% vs 79.3%) to state that people who use opioids are responsible for reducing opioid overdose deaths.

In his commentary, Pollack said the findings carry important implications for public health messaging regarding harm reduction programs such as free syringes, naloxone distribution, and fentanyl test strips. 

"These evidence-informed interventions face continued resistance, most notably from communities and families that experience direct harms arising from the opioid epidemic, who are understandably drawn to abstinence-based approaches rather than to approaches that some perceive as encouraging continued drug use or as replacing one addiction with another," Pollack said.

The survey findings are a subset of data drawn from a much larger survey designed to test public messaging campaigns about Medicaid programs that treat substance use disorder.

Taking Tylenol During Pregnancy Does Not Increase Baby’s Risk of Autism or ADHD

By Anya Arthurs

If you’ve been pregnant in the past few months, you may have faced a dilemma. You wake up with a fever, a pounding headache or back pain – and then pause. Is it safe to take paracetamol?

That hesitation isn’t surprising. In September last year, the United States government sowed widespread doubt and anxiety by linking paracetamol use in pregnancy to autism and attention-deficit hyperactivity (ADHD).

But now a major new international study, published in The Lancet, provides some much-needed clarity.

The research confirms that taking paracetamol – also known as acetaminophen, or by brand names such as Panadol and Tylenol – does not increase a baby’s risk of autism, ADHD or intellectual disability when used in pregnancy.

Paracetamol remains a safe and effective way to treat fever and pain at any stage of pregnancy.

Large Review of Studies

The researchers carried out a large systematic review and meta-analysis, meaning they didn’t just study one group of people. Instead, they pulled together results from many previous studies.

In total, they reviewed 43 studies that focused on whether children exposed to paracetamol in the womb were more likely to later be diagnosed with autism, ADHD or intellectual disability.

Crucially, the authors prioritised sibling-comparison studies. Sibling studies compare siblings from the same family, where one used paracetamol during pregnancy and another didn’t.

This approach produces higher-quality results for comparison. It helps researchers isolate what they’re studying – in this case, paracetamol.

Siblings’ shared genetics, home environment and family background mean there won’t be differences in these factors, which could distort results (known as “confounding factors”).

The authors used extensive statistical methods to ensure their results were accurate.

What They Found

Across these higher-quality studies, the researchers found no meaningful increase in the risk of autism, ADHD, or intellectual disability in children whose mothers used paracetamol during pregnancy.

This was true when the authors (a) looked only at sibling studies, (b) focused on studies with low risk of bias and (c) examined children followed for more than five years.

In other words, when the strongest methods were used, the earlier alarming links simply didn’t hold up. The study concludes that paracetamol, when used as directed, remains safe during pregnancy.

These results echo those of another landmark study in 2024, conducted in Sweden and including almost 2.5 million children (born between 1995 and 2019).

This Swedish study illuminated the need for good controls in scientific research.

It showed when studies didn’t use sibling comparison as a way to control confounding factors, there appeared to be a small increased risk of autism and ADHD associated with using paracetamol while pregnancy.

However, when the researchers used rigorous statistical methodology in sibling studies to account for the confounding factors between people – differences such as genetics or living conditions – these associations disappeared.

The Swedish study, just like the current Lancet study, also concluded there was absolutely no evidence of increased risk of autism, ADHD or neurodevelopmental disability with paracetamol use in pregnancy.

Why It’s Important

Paracetamol isn’t just another medication. It’s often the only recommended option for treating pain and fever in pregnancy.

The Therapeutics Goods Administration, responsible for regulating medication safety and quality in Australia, maintains that paracetamol remains a pregnancy “Category A” drug. This means it is safe for use in pregnancy when used according to directions.

Being able to rely on a safe drug to reduce fever is really important for pregnant people.

Leaving fever untreated during pregnancy can be harmful for both the fetus and the mother. Fever in pregnancy has been linked to miscarriage, pre-term birth and birth complications.

So avoiding paracetamol “just in case” in fact isn’t a cautious choice. The risks of not treating pain or fever may be greater than the risks of the medication itself.

For pregnant people weighing up whether to take a tablet for a feverish night or pregnancy aches, this study should help reassure them taking paracetamol is safe and evidence-based.

Paracetamol remains, as it has for decades, the first-line option.

If you have concerns, speak to your health-care provider.

Anya Arthurs, PhD, is a Research Fellow in Cell and Molecular Biology in the College of Medicine and Public Health at Flinders University in Australia. 

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

CRPS: When Pain Becomes a Disease

By Madora Pennington

For Pattie Christensen, Complex Regional Pain Syndrome (CRPS) started after she had surgery for carpal tunnel syndrome in 2022. She opted for a local anesthetic, since it was a simple procedure.

Everything seemed fine until a month passed after her second hand surgery. Christensen felt something was wrong — very wrong. The outside of her hand started to hurt terribly. When she talked to her surgeon, he pointed out that the area now hurting had not even been involved in the surgery. The region that was operated on had healed well.

Things got worse. Soon her hand swelled to where her fingers looked like raw, discolored sausage. That’s when she got the bad news: Christensen had CRPS, a debilitating chronic pain condition that can be ignited by a simple fracture, sprain, surgery, or even a cardiovascular event.

CRPS causes dysfunction and confusion in the nervous system, amping up pain in an injured area. The pain then migrates to other nerves in non-injured areas. Most commonly, the CRPS pain settles and remains in a hand. Early treatment is the best chance to stop the progression of CRPS, but for many it becomes a long-term or even lifelong problem.

Christensen now makes videos about her life with CRPS on YouTube from her home in Salt Lake City, runs a Facebook support group, and tries to remain optimistic. Unfortunately, like most people with CRPS, she suffers from migraines.

According to a new study of 88 patients with CRPS in Australia, two out of three started having migraines or a worsening of their migraines after CRPS took hold.

“We found that migraine headaches often began or got worse after the injury that triggered CRPS. There seemed to be a direct connection between the limb injury and the headaches as they were often on the same side of the body and symptoms overlapped. That is, one condition may feed the other,” says lead author Peter Drummond, PhD, a Psychology Professor at Murdoch University.

“Unfortunately, many people with CRPS face the prospect of enduring a lifetime of pain because understanding is poor and treatment options are limited.”

One in every five people in the study has headaches almost every day, something Christensen can relate to.

“I never know if I’m going to have a bad migraine,” she says.

One of her migraine relief medications costs Christensen $150 per pill. She only takes that when it gets very bad.

She describes a recent episode: “I had dry heaves. I was crying.” She started with half of her expensive pills and felt nothing. It took $300 of medication and a period of lying down to get any relief. “I can’t say I felt great, I just felt okay and was able to work.”

CRPS is a disease of pain signaling gone wrong. People with CRPS tend to have extreme light sensitivity, foreheads painful to touch, and hyperalgesia (feeling pain from non-painful stimuli).

In the Australian study, participants with worse limb pain and hyperalgesia were more headache-prone. And the patients who were younger when their pain started were more likely to end up with headaches.

“We hope that greater recognition of the link between CRPS and migraine will clarify understanding of both conditions and will result in more effective treatment of headaches and a better quality of life for people with CRPS,” says Drummond.

CRPS seems to result from an overactive inflammatory response in the brain and spinal cord (neuroinflammation), a hyperactive nervous system (central sensitization), and problems with the body’s natural pain dampening signals.

Researchers say this heightened pain feedback creates a positive loop where pain increases. The mechanisms behind migraines and CRPS, both quite disabling on their own, fuel each other.

Those who never had migraines before the start of CRPS are likely to get them. And those who already had migraines will get more of them.  Although it may sound like it, CRPS is not psychosomatic. There are very real internal body processes that have gone wrong.  

Federal and State Warnings May Be Increasing 7-OH Sales

By Pat Anson

Federal and state efforts to ban the sale of 7-hydroxymitragynine (7-OH) products may be having the unintended effect of increasing sales of the kratom extract, which is a potent pain reliever.

The owner of Kansas City-based American Shaman, the largest U.S. producer and seller of 7-OH products, says sales have increased since the FDA sent a warning letter to his company in July alleging its 7-OH tablets were being sold illegally as adulterated dietary supplements.

“We’re busier than ever,” says Vince Sanders, who estimates that millions of Americans are using 7-OH for pain relief and as a mood enhancer. “More people are familiar with it now than there were a year ago. All this press just makes more and more people educated about it, and more people go out and try it.”

7-hydroxymitragynine is a naturally occurring alkaloid found in kratom, an herbal supplement used in southeast Asia for centuries as a stimulant and pain reliever. Kratom contains only trace amounts of 7-OH, but Sanders has developed a process that makes it more concentrated and potent. 

Although technically not an opioid, 7-OH has opioid-like effects. Last summer, the FDA asked the DEA to classify 7-OH as an illegal Schedule One controlled substance, claiming it was a dangerous and addictive substance “more potent than morphine.” While the DEA has yet to act on that request, Florida, Ohio, California, and several other states and municipalities have recently moved to ban 7-OH sales.  

‘This Isn’t Some Party Drug’

While there are anecdotal reports that 7-OH is addictive, there is little solid evidence that people are overdosing or being harmed by it. And American Shaman continues to sell it, even though thousands of its tablets have been seized by the FDA.

Sanders believes 7-OH may be at least partially responsible for the recent decline in drug overdoses, because it keeps pain sufferers from turning to more dangerous substances like illicit fentanyl and other street drugs. Some use it as an alternative to Suboxone to treat opioid withdrawal symptoms. 

“There's probably roughly 75,000 people walking the earth today that wouldn't be here, and hundreds of thousands of others that have used 7-OH to completely stop taking a street drug,” Sanders told PNN..

“This isn't some party drug. It's not like, ‘Oh my gosh, I feel so high. This is incredible.’ That's not what 7-OH does. 7-OH is tremendous for pain and it definitely is a mood enhancer. It puts you in a better mood, but it doesn't make you high, like alcohol, marijuana or a traditional opioid. It doesn’t have that effect.”

7-OH is so effective that Sanders advises pain sufferers to use it sparingly in small amounts, and to take a break from it at least once a week to avoid building a tolerance that requires higher doses.  

“If you take it appropriately, you won't build a tolerance. You're not going to build an addiction to it. My 82 year old mother has been using it for nearly two years now. She needed a dual hip replacement, but refused to get it. She was almost to the point of not being mobile, she was in so much pain. But now she gets along like normal. It's amazing. Just takes her pain away.”

Are pain patients using 7-OH? We posed that question to PNN readers on our Facebook page and got some mixed responses.

“It absolutely works! Gets me through an eight hour shift every single day,” said one poster.   

“Best pain relief I ever had,” said another.

“Very effective, but it is addictive. It’s helped a lot of people, but it’s hurt some people as well,” warned one poster.

“Can’t stop taking them. It’s been over a year (and) trying to get down to below 100 mg a day is tough. I cannot have a normal digestion process anymore. Sucks and costs a lot of money,” warned another 7-OH user.

Some drug testing companies have started looking for 7-OH in blood and urine samples. Clinical Reference Laboratory in Kansas tested for it in a random batch of 1,000 samples from across the country. Surprisingly, 7-OH was detected more often than fentanyl and prescription opioids like oxycodone and morphine.

“We found a 1.09% positive rate, which is, depending on the population, higher than all the other opiates we test for combined,” CEO Robert Thompson told the Kansas City Star. “That was pretty concerning to me.”

As perplexing as 7-OH may be to health officials and drug regulators, there’s another kratom extract called pseudoindoxyl that’s even more potent and gaining in popularity. Derived from the alkaloid mitragynine, pseudoindoxyl also has opioid-like effects, but without the respiratory depression and risk of overdose that comes with traditional opioids.  

“For pain relief, it's better than 7-OH. The science would indicate that it's probably five times more potent for pain than 7-OH,” says Sanders, who sells pseudoindoxyl chewable tablets on American Shaman’s website.

He has yet to get any warning letters telling him to stop.

Medicare Plans to End Most Telehealth Coverage Soon

By Crystal Lindell

Telehealth access was greatly expanded during the COVID-19 pandemic, but that expansion is slated to end this month for many older patients. Medicare is planning to end most coverage for telehealth appointments as of January 31, 2026.

There are some exceptions to the new policy. Telehealth appointments for those living in a rural area or seeking care in a rural area will still be covered. So will appointments for monthly home dialysis for end-stage renal disease; appointments for acute stroke; and appointments for behavioral health disorders.

The new policy only applies to Original Medicare plans. Medicare Advantage Plans may still cover telehealth appointments.

It’s baffling that this type of policy is being implemented for Medicare patients at all, seeing as how most people on Medicare are senior citizens — a demographic that is more likely to have mobility issues as well as a higher risk of falls.

The American Medical Association is calling on the federal government to make telehealth coverage permanent ahead of this month’s deadline. Congress has repeatedly extended the telehealth flexibilities for Medicare patients, but often at the last moment. The AMA says the constant procrastination creates uncertainty for millions of patients and their physicians.

“As the current waiver deadline approaches, Congress must finally act decisively to prevent a disruptive and abrupt halt to the expanded telehealth services that have improved care continuity, chronic disease management, and access for rural and underserved communities,” said AMA President Bobby Mukkamala, MD.

The AMA says telehealth offers the potential for long-term savings through early medical intervention, improved chronic disease management, and reduced use of expensive emergency care and inpatient services. Telehealth also has higher appointment completion rates and reduces hospital readmissions. In short, it helps our complex healthcare system work more efficiently and at a lower cost. 

“Now is the time for lawmakers to secure innovation, modernize care delivery, and protect access to telehealth for all Medicare beneficiaries by passing comprehensive, forward-looking reform,” the AMA said.

Speaking from personal experience, I am reminded of the time my grandma fell on the ice in front of her home a few years ago and broke her hip. The injury led to a months-long recovery process that included an extended stay at a rehabilitation facility. Aside from how inconvenient the entire episode was, it was also an extremely painful injury for her to endure.

Today, we limit how often she leaves the house to reduce the risk of her falling again. And we are especially cautious whenever the temperatures drop low enough to create icy patches on the ground.

Thus, whenever possible, we opt for telehealth appointments to keep grandma safe. Aside from reducing her fall risk, they also lower the risk of her being exposed to viruses at an in-person doctor’s office.

It seems like common sense that seniors in particular would have easy access to telehealth services, and my hope is that Congress will act and extend that access before the deadline. 

Treating Pain Cost an Addiction Medicine Doctor Her Job

By Aneri Pattani, KFF Health News

Elyse Stevens had a reputation for taking on complex medical cases. People who’d been battling addiction for decades. Chronic-pain patients on high doses of opioids. Sex workers and people living on the street.

“Many of my patients are messy, the ones that don’t know if they want to stop using drugs or not,” said Stevens, a primary care and addiction medicine doctor.

While other doctors avoided these patients, Stevens — who was familiar with the city from her time in medical school at Tulane University — sought them out.

She regularly attended 6 a.m. breakfasts for homeless people, volunteered at a homeless shelter clinic on Saturdays, and on Monday evenings, visited an abandoned Family Dollar store where advocates distributed supplies to people who use drugs.

One such evening about four years ago, Charmyra Harrell arrived there limping, her right leg swollen and covered in sores. Emergency room doctors had repeatedly dismissed her, so she eased the pain with street drugs, Harrell said.

Stevens cleaned her sores on Mondays for months until finally persuading Harrell to visit the clinic at University Medical Center New Orleans. There, Stevens discovered Harrell had diabetes and cancer.

She agreed to prescribe Harrell pain medication — an option many doctors would automatically dismiss for fear that a patient with a history of addiction would misuse it.

ELYSE STEVENS

But Stevens was confident Harrell could hold up her end of the deal.

“She told me, ‘You cannot do drugs and do your pain meds,’” Harrell recounted on a Monday evening in October. So, “I’m no longer on cocaine.”

Stevens’ approach to patient care has won her awards and nominations in medicine, community service, and humanism. Instead of seeing patients in binaries — addicted or sober, with a positive or negative drug test — she measures progress on a spectrum. Are they showering daily, cooking with their families, using less fentanyl than the day before?

But not everyone agrees with this flexible approach that prioritizes working with patients on their goals, even if abstinence isn’t one of them. And it came to a head in the summer of 2024.

“The same things I was high-fived for thousands of times — suddenly that was bad,” Stevens said.

Flexible Care or Zero Tolerance?

More than 80% of Americans who need substance use treatment don’t receive it, national data shows. Barriers abound: high costs, lack of transportation, clinic hours that are incompatible with jobs, fear of being mistreated.

Some doctors had been trying to ease the process for years. Covid-19 accelerated that trend. Telehealth appointments, fewer urine drug tests, and medication refills that last longer became the norm.

The result?

“Patients did OK and we actually reached more people,” said Brian Hurley, immediate past president of the American Society of Addiction Medicine. The organization supports continuing flexible practices, such as helping patients avoid withdrawal symptoms by prescribing higher-than-traditional doses of addiction medication and focusing on recovery goals other than abstinence.

But some doctors prefer traditional approaches that range from zero tolerance for patients using illegal drugs to setting stiff consequences for those who don’t meet their doctors’ expectations. For example, a patient who tests positive for street drugs while getting outpatient care would be discharged and told to go to residential rehab.

Proponents of this method fear loosening restrictions could be a slippery slope that ultimately harms patients. They say continuing to prescribe painkillers, for example, to people using illicit substances long-term could normalize drug use and hamper the goal of getting people off illegal drugs.

Progress should be more than keeping patients in care, said Keith Humphreys, a Stanford psychologist, who has treated and researched addiction for decades and supports involuntary treatment.

“If you give addicted people lots of drugs, they like it, and they may come back,” he said. “But that doesn’t mean that that is promoting their health over time.”

Flexible practices also tend to align with harm reduction, a divisive approach that proponents say keeps people who use drugs safe and that critics — including the Trump administration — say enables illegal drug use.

The debate is not just philosophical. For Stevens and her patients, it came to bear on the streets of New Orleans.

‘Unconventional’ Prescribing

In the summer of 2024, supervisors started questioning Stevens’ approach.

In emails reviewed by KFF Health News, they expressed concerns about her prescribing too many pain pills, a mix of opioids and other controlled substances to the same patients, and high doses of buprenorphine, a medication considered the gold standard to treat opioid addiction.

Supervisors worried Stevens wasn’t doing enough urine drug tests and kept treating patients who used illicit drugs instead of referring them to higher levels of care.

“Her prescribing pattern appears unconventional compared to the local standard of care,” the hospital’s chief medical officer at the time wrote to Stevens’ supervisor, Benjamin Springgate. “Note that this is the only standard of care which would likely be considered should a legal concern arise.”

Springgate forwarded that email to Stevens and encouraged her to refer more patients to methadone clinics, intensive outpatient care, and inpatient rehab.

Stevens understood the general practice but couldn’t reconcile it with the reality her patients faced. How would someone living in a tent, fearful of losing their possessions, trek to a methadone clinic daily?

Stevens sent her supervisors dozens of research studies and national treatment guidelines backing her flexible approach. She explained that if she stopped prescribing the medications of concern, patients might leave the health system, but they wouldn’t disappear.

“They just wouldn’t be getting care and perhaps they’d be dead,” she said in an interview with KFF Health News.

Both University Medical Center and LSU Health New Orleans, which employs physicians at the hospital, declined repeated requests for interviews. They did not respond to detailed questions about addiction treatment or Stevens’ practices.

Instead, they provided a joint statement from Richard DiCarlo, dean of the LSU Health New Orleans School of Medicine, and Jeffrey Elder, chief medical officer of University Medical Center New Orleans.

“We are not at liberty to comment publicly on internal personnel issues,” they wrote.

“We recognize that addiction is a serious public health problem, and that addiction treatment is a challenge for the healthcare industry,” they said. “We remain dedicated to expanding access to treatment, while upholding the highest standard of care and safety for all patients.”

Not Black-and-White

KFF Health News shared the complaints against Stevens and the responses she’d written for supervisors with two addiction medicine doctors outside of Louisiana, who had no affiliation with Stevens. Both found her practices to be within the bounds of normal addiction care, especially for complex patients.

Stephen Loyd, an addiction medicine doctor and the president of Tennessee’s medical licensing board, said doctors running pill mills typically have sparse patient notes that list a chief complaint of pain. But Stevens’ notes detailed patients’ life circumstances and the intricate decisions she was making with them.

“To me, that’s the big difference,” Loyd said.

Some people think the “only good answer is no opioids,” such as oxycodone or hydrocodone, for any patients, said Cara Poland, an addiction medicine doctor and associate professor at Michigan State University. But patients may need them — sometimes for things like cancer pain — or require months to lower their doses safely, she said. “It’s not as black-and-white as people outside our field want it to be.”

Humphreys, the Stanford psychologist, had a different take. He did not review Stevens’ case but said, as a general practice, there are risks to prescribing painkillers long-term, especially for patients using today’s lethal street drugs too.

Overprescribing fueled the opioid crisis, he said. “It’s not going to go away if we do that again.”

‘The Thing That Kills People’

After months of tension, Stevens’ supervisors told her on March 10 to stop coming to work. The hospital was conducting a review of her practices, they said in an email viewed by KFF Health News.

Overnight, hundreds of her patients were moved to other providers.

Luka Bair had been seeing Stevens for three years and was stable on daily buprenorphine.

After Stevens’ departure, Bair was left without medication for three days. The withdrawal symptoms were severe — headache, nausea, muscle cramps.

“I was just in physical hell,” said Bair, who works for the National Harm Reduction Coalition and uses they/them pronouns.

Although Bair eventually got a refill, Springgate, Stevens’ supervisor, didn’t want to continue the regimen long-term. Instead, Springgate referred Bair to more intensive and residential programs, citing Bair’s intermittent use of other drugs, including benzodiazepines and cocaine, as markers of high risk. Bair “requires a higher level of care than our clinic reasonably can offer,” Springgate wrote in patient portal notes reviewed by KFF Health News.

But Bair said daily attendance at those programs was incompatible with their full-time job. They left the clinic, with 30 days to find a new doctor or run out of medication again.

“This is the thing that kills people,” said Bair, who eventually found another doctor willing to prescribe.

Springgate did not respond to repeated calls and emails requesting comment.

University Medical Center and LSU Health New Orleans did not answer questions about discharging Stevens’ patients.

‘Patients Will Die Without Her’

About a month after Stevens was told to stay home, Haley Beavers Khoury, a medical student who worked with her, had collected nearly 100 letters from other students, doctors, patients, and homelessness service providers calling for Stevens’ return.

One student wrote, “Make no mistake — some of her patients will die without her.” A nun from the Daughters of Charity, which ran the hospital’s previous incarnation, called Stevens a “lifeline” for vulnerable patients.

Beavers Khoury said she sent the letters to about 10 people in hospital and medical school leadership. Most did not respond.

In May, the hospital’s review committee determined Stevens’ practices fell “outside of the acceptable community standards” and constituted “reckless behavior,” according to a letter sent to Stevens.

The hospital did not answer KFF Health News’ questions about how it reached this conclusion or if it identified any patient harm.

Meanwhile, Stevens had secured a job at another New Orleans hospital. But because her resignation came amid the ongoing investigation, University Medical Center said it was required to inform the state’s medical licensing board.

The medical board began its own investigation — a development that eventually cost Stevens the other job offer.

In presenting her side to the medical board, Stevens repeated many arguments she’d made before. Yes, she was prescribing powerful medications. No, she wasn’t making clinical decisions based on urine drug tests. But national addiction organizations supported such practices and promoted tailoring care to patients’ circumstances, she said. Her response included a 10-page bibliography with 98 citations.

Abandoning People

The board’s investigation into Stevens is ongoing. Its website shows no action taken against her license as of late December.

The board declined to comment on both Stevens’ case and its definition of appropriate addiction treatment.

In October, Stevens moved to the Virgin Islands to work in internal medicine at a local hospital. She said she’s grateful for the welcoming locals and the financial stability to support herself and her parents.

But it hurts to think of her former patients in New Orleans.

Before leaving, Stevens packed away handwritten letters from several of them — one was 15 pages long, written in alternating green and purple marker — in which they shared childhood traumas and small successes they had while in treatment with her.

Stevens doesn’t know what happened to those patients after she left.

She believes the scrutiny of her practice centers on liability more than patient safety.

But, she said, “liability is in abandoning people too.”

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

Medical Cannabis Helps Relieve Fibromyalgia Symptoms

By Pat Anson

Medical cannabis products help relieve pain and anxiety caused by fibromyalgia, and improve sleep and quality of life, according to a new study of patients enrolled in the UK’s Medical Cannabis Registry.

Fibromyalgia is a poorly understood and difficult-to-treat condition that causes widespread body pain, fatigue, insomnia, mood disorders and brain fog. 

The UK study of nearly 500 fibromyalgia patients found the greatest improvement in symptoms when participants took higher doses of cannabidiol (CBD) daily over an 18-month period. Higher CBD doses were associated with better outcomes compared to lower doses, and current cannabis users saw better results than those who had never tried it before. 

Participants were initially prescribed a cannabis oil, but as the study progressed, most began to use a mixture of oils taken orally and dried flowers inhaled through a vaporizer. The median CBD dosage increased during the study, from 20mg a day at the start to 25mg at the end, which is considered a moderate to strong dose. 

Tetrahydrocannabinol (THC) content also increased, from a median of 2mg a day at the start of the study to 112.5mg at the end – a high dose likely to cause a strong buzz. But high THC doses were not associated with an improvement in symptoms.

The UK study contradicts a recent U.S. study that found THC more effective in relieving pain than CBD. However, that study primarily involved synthetic FDA approved cannabis-based medicines, such as dronabinol and nabilone, which are approved to reduce nausea and increase appetite – not for pain relief. The UK study involved products that cannabis consumers are much more likely to use.

In the UK, fibromyalgia patients are only eligible to be prescribed “unlicensed” medical cannabis if they have failed to gain improvement in symptoms from licensed pharmaceutical medicines. 

Nearly half of the participants reported mild to moderate side effects, with fatigue and dry mouth being the most common. Researchers believe the high rate of adverse events (AEs) stem from fibromyalgia’s central sensitization effects, which increase the nervous system’s sensitivity to new stimuli. 

“This study found treatment with CBMPs (cannabis-based medicinal products) in fibromyalgia was associated with short to medium-term improvements in pain, anxiety, sleep, and general quality of life. There was a high incidence of AEs, perhaps due to its central sensitisation mechanism, associated with an increased susceptibility to AEs,” the authors reported in the journal Clinical Rheumatology.

Researchers say the improvement in fibromyalgia symptoms had a waning effect as the study progressed, with peak improvement at 1 month and the lowest after 18 months.

Previous studies in Israel and Brazil have also found that cannabis products improve fibromyalgia symptoms.

The amount of THC – the psychoactive ingredient in cannabis – consumed in the UK study was unusually high. After 18 months, the median dose was 112mg of THC a day, with some participants taking nearly 217mg daily.

Another team of UK researchers recently recommended that adults not consume more than 40mg of THC a week – or about 5.7mg a day. Higher THC doses are associated with increased rates of cannabis use disorder.

In More Pain? Blame the Weather – and Climate Change

By Crystal Lindell

On Wednesday, three people I know all had a migraine. My mom also told me that her hip joint was suddenly much more painful than normal. And the intercostal neuralgia in my ribs hurt so bad that I spent most of the day in bed.

The next day, the temperature here in northern Illinois suddenly spiked to 53 degrees Fahrenheit – an unusual occurrence for Januar. Then the rain started and never really stopped.

The random spike to 50 degree weather – when most people here still have their Christmas lights up – felt almost ominous. And it seems our bodies agreed.   

If we lived in the 1800s, all of us could have served as our town’s meteorologist, accurately predicting both temperature changes and precipitation.

But here in 2026, many people still don’t even connect their pain flares to weather changes. And I still hear doctors dismiss the idea that weather can impact pain.

As someone who lives with chronic pain, I think the connection is obvious. I can tell you almost down to the hour when it’s going to snow. I have learned to plan my rest days around rapid temperature changes in the forecast. And when it’s sunny and clear, I sometimes find myself wondering if I have somehow been cured – because I feel so little pain!

The thing is, the reason we had a 53 degree temperature spike in the middle of winter in northern Illinois is likely due to climate change. While the warm front may have come in regardless, just how warm it got was likely amplified by global warming.

In fact, the shifting global climate means we are all experiencing weather fluctuations and temperatures that had previously been considered rare.

And our bodies have noticed.

A recent story by Inside Climate News discusses the link.

"Global warming is bringing more heatwaves and an atmosphere that sucks up more moisture to feed storms. Those thermodynamic effects of climate change often have more clear ties to pain," wrote Chad Small, a PhD student in Atmospheric and Climate Science at the University of Washington. 

“For example, gout sufferers living in Arizona—which will continue to get hotter and dryer as global temperatures increase—will likely experience worse pain due to more frequent and severe instances of dehydration driven by the increasing temperatures and aridity. That’s on top of the exacerbation of the pain by the heat itself.” 

In 2023, The University of Pennsylvania published an article titled, "Why climate change might be affecting your headaches" in Penn Medicine News.

“Rising global average temperature and extreme weather events are likely to become more frequent or more intense,” they wrote. “Experts suggest that the stress of these events can trigger headaches.”

Society at large seems to still be in denial about all of this though, at least in my experience.

For example, when the weather changes, people who get migraines don’t get more sick days or easier access to government assistance.

And while weather changes are causing more pain flares, government regulators and health officials still limit access to opioid pain medication.

Not to mention the lack of social accommodation. Friends and family aren’t more understanding about the increase in pain because of climate change. In fact, most people aren’t even more forgiving of their own bodies in that situation.

The ableism at the root of our culture in the United States still expects people to push through the pain and show up anyway – and that social pressure only increases when someone’s pain flares get more frequent.

In other words, the more climate change increases pain, the less accepting people are of it. Perhaps that’s because many are still in denial that climate change even exists.

Unfortunately, all indications are that climate change is only going to continue getting worse, which means the pain it causes will do the same.

If we are going to endure it, we are going to have to offer grace to others and ourselves when that pain shows up in our bodies.

We can’t control the weather, but we can control how we endure it.  

Chronic Pain and Complications Common After Outpatient Surgery

By Pat Anson

Outpatient surgeries are often touted for their convenience and cost savings. The surgeries are often minimally invasive, less painful, reduce trauma and recovery time, and save patients (and insurers) thousands of dollars because they don’t have to spend a night or two in the hospital in post-op care. 

But two new studies in the UK – where outpatient procedures are called “day-case” surgeries – show the benefits of outpatient surgery are not universal and often make pre-existing pain conditions worse.

The studies, published here and here in the journal Anaesthesia, involved nearly 17,500 patients, and were conducted by a team of researchers at the NHS Foundation Trust and University Hospitals Plymouth. 

In the first study, researchers found that 1 in 8 patients (11.8%) who had day-case surgery did not go home the same day and were admitted to hospital for various complications. For some patients who had prostate procedures (including those for cancer and benign prostate growth), the hospital admission rate was higher than 50%.

In the second study, one in 14 patients (7.2%) developed chronic pain or had their pain worsen at the surgery site. Some procedures had higher rates of chronic pain after 3 months, including orthopaedic (13.4%) and breast (10%) surgeries. Patients with chronic post-surgical pain also had lower quality of life scores than they did before the surgeries.

To be fair, many of the patients in the studies had chronic pain before their surgeries. Pain was already present at the surgery site in 39% of patients and was moderately severe. Chronic pain elsewhere in the body was also common. About one in four patients had opioid prescriptions prior to their surgeries, and a little over one in 10 used opioids daily. 

These were the first studies of their kind in the UK, and fill an important gap in information about the outcomes of outpatient surgery. Because the UK’s National Health Service seeks to have 85% of eligible elective operations be done as day-case surgeries, researchers expect the outpatient workload to increase and the numbers of patients with chronic post-surgical pain to also grow..

“In summary, this large multicentre UK observational study on day-case surgery provides valuable new insights into a key patient group. We have shown that chronic pain is prevalent within this cohort, with a significantly higher burden than the general population,” the authors found.

“While most patients undergoing day-case surgery were discharged on the same day, the rate of unplanned inpatient admissions was unacceptably high, at twice the national target. This finding underscores a critical area for improvement, as reducing unplanned admissions would enhance the efficiency of day-case surgery and improve outcomes for patients. We highlight the complexity of day-case surgery, where even procedures that are generally seen as straightforward can still carry potential risks, especially for certain patient groups.”

Previous studies have found that female patients had higher rates of chronic post-surgical pain. The new studies found no difference in outcomes between males and females overall, but did show that gynaecological and breast surgeries (almost all female patients) had higher rates of chronic post-surgical pain. This suggests that medical specialties –  rather than being female –- were behind the increased risk.

The studies also found that wealthier patients were less likely to have chronic post-surgical pain compared to the poorest ones. Patients of Asian, Black and mixed ethnicity were also more likely to report chronic post-surgical pain, which may be due to healthcare inequities and cultural difference in pain perception.

Utah Launches AI-Powered Prescription Refills

By Crystal Lindell

Utah is testing a new AI-powered prescription drug service that allows people to skip seeing the doctor if they need a medication refilled for some chronic conditions.

The program is powered by Doctronic, a telehealth service that uses artificial intelligence to act in the role of a doctor, asking patients questions that are typically asked during a refill appointment.

The renewal process will take less than five minutes and Doctronic will charge just $4 for the service.

“If you’re in the state of Utah and you need let’s say a statin renewed because you have high cholesterol and you don’t have any more renewals left on your prescription, but you’ve already been taking that statin, you can talk to our AI,” Matt Pavelle, Co-CEO of Doctronic, told ABC4 in Salt Lake City. 

“It’s going to lead you through the process as a human doctor would, ask all of the right questions, look up all the right interactions, make sure that it’s safe for you…to receive that renewal. It will approve that and send it to a pharmacy in Utah for you.”

The list of medications that Doctronic will refill is limited. The strongest pain relievers you can get are prescription strength acetaminophen and NSAIDs. Other medications used by people with chronic conditions like diabetes are also unavailable.

“The program does not fill prescriptions for controlled substances, such as opioids or ADHD medications, nor are injectables eligible, such as insulin or semaglutide/weight-loss drugs,” a spokesperson for the Utah Department of Commerce told PNN.

Maybe Utah’s program will work as they claim and using it will be even better than talking or seeing a human doctor. But I’m skeptical.

A program like this has the potential to help patients, but it comes with a lot of questions about how it will work in practice – especially given how horrible customer service AI bots have been in general. From personal experience, I can tell you that they are often impossible to communicate with.

I also worry about how accurate Doctronic is, given that other AI bots like ChatGPT can have an error rate of 52%. When it comes to medical decisions, that kind of error rate can be deadly. 

In case of a problem or error with a prescription, Doctronic could be held liable. According to ABC4, Doctronic is covered by a malpractice insurance policy

AI prescription refills could save patients from the cost and hassle of a doctor’s appointment, but if a program like this really takes off, I am certain that the companies running them will then increase the price of each AI appointment. 

In the end, if it was safe to continue prescribing a medication without checking in with a human doctor, the human doctor could easily allow for multiple refills..

And if a human doctor is not needed as part of the equation, why is an AI doctor even needed?

Theoretically, if human doctors are not needed, commonly renewed medications could just have a check-in questionnaire that patients fill out when they need more refills. A doctor would only get involved if any of the responses warranted it.

I would wager such a program would be significantly more accurate, but also significantly more difficult to launch. The lack of a buzzy AI angle would probably be a turn off for both lawmakers and medical professionals.  

There’s also the issue of losing the patient-to-doctor interaction, where other health issues are often flagged and treated. This program all but eliminates that possibility. 

It will be interesting to see how patients and doctors respond to the Doctronic program, and whether they like actually using it. I fully support making healthcare and prescriptions more affordable and accessible. I am just not convinced that an AI chatbot is the best way to achieve either of those goals.