The Two Most Common Causes of Adhesive Arachnoiditis

By Dr. Forest Tennant

Adhesive arachnoiditis (AA) doesn’t just happen out-of-the-blue or overnight. It is the tragic end result of sequential pathologic damage, over time, to multiple spinal tissues.

There are two common pathologies that can cause this, resulting in early symptoms that precede AA itself:

Pathology #1: Spinal Trauma

The first pathologic journey is accidental spine trauma or a medical procedure that damages the spinal canal cover, which consists of an outer layer (dura) and an inner layer (arachnoid).

The arachnoid becomes inflamed after trauma, just like a finger that has been hit with a hammer. The inflammation may progress and then spread.

Eventually, the inflammation will contact cauda equina nerve roots and spread into them. After a time ranging from weeks to months, the inflammatory adhesions glue cauda equina nerve roots to the arachnoid, forming the disease called adhesive arachnoiditis.

Pathology #2: Degenerative Discs

Spinal discs degenerate when they become inflamed, due to a pathologic generator such as an infection, autoimmunity or trauma.

Persons who have a genetic connective tissue disease like Ehlers-Danlos, a spine anatomic abnormality, or an autoimmune disease are at high risk to develop degenerative disc disease. Once inflammation sets in, the disc softens, shrinks and slips out of its space, pressing against the spinal canal cover (dura and arachnoid layers).

The inflammation in the disc may spread to the arachnoid membrane and cauda equina nerve roots. As stated in Pathology #1, when inflammation produces sticky adhesions in the cauda equina nerve roots and arachnoid, they may glue together forming AA.

Early Symptoms

If the arachnoid becomes inflamed after trauma, epidural injection, spinal puncture or surgical procedure, there will be headaches, localized back pain, feverishness and dysphoria (a state of unease, depression and fatigue). This usually starts 7 to 10 days after the procedure or trauma.

When the cauda equina also becomes inflamed, the first early symptoms are shooting pains into the buttocks and legs, burning feet, and the tingling sensation of water or insects on the buttocks or legs.

Prevention of AA may be possible in these circumstances by use of one or more anti-inflammatory drugs that are effective inside the spinal canal. You can learn more about the symptoms and treatments for AA on our website.

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

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

Are 1 in 10 Americans Really Using Illicit Opioids?

By Crystal Lindell

A new study claims to have found that nearly 11% of Americans reported using illicit opioids in 2024, with 7.5% of them using illicit fentanyl.

It's a startling claim, in large part because those numbers are significantly higher than what's been reported in previous research. When the National Survey on Drug Use and Health asked about illicit fentanyl use in 2022, they found that just 0.3% of American adults used it in the past year

The study by researchers at the RAND corporation and USC led to a number of splashy headlines, including one in U.S. News and World Report reading: "U.S. Illicit Opioid Use Could Be 20 Times Higher Than Previously Estimated"

That is indeed a pretty striking claim – which is a large reason I am so skeptical of the research.

How did the study authors arrive at those figures? They developed and fielded a survey with Respondi, an online platform often used in academic research. So essentially, they did an online survey of 1,515 adults.

Participants were asked about their use of nonprescription opioids within the past 12 months, with heroin and illicitly manufactured fentanyl given as examples.

Among the respondents, they found that 166 (10.96%) reported illicit opioid use and 114 (7.5%) said they used illicit fentanyl. 

While I understand that population data is often collected with a relatively small sample size, it feels rushed to claim that 7.5% of adults used illicit fentanyl based on responses from 114 people in an online survey.

It feels equally rushed to claim that because 166 people reported illicit opioid use, that must mean that 11% of the population did so. 

There are about 262 million adults in the United States. If those survey numbers are accurate, that would mean 19.7 million Americans are using illicit fentanyl. And 28.8 million are using illicit opioids. That’s a lot of people. 

Overdose Deaths Declining

Keep in mind that the CDC just reported that U.S. overdose deaths fell by nearly 27% in 2024, the largest annual decline since they started tracking overdoses 45 years ago. 

Of the 80,391 drug deaths reported in 2024, the CDC estimates that 48,422 of those deaths involved synthetic opioids, primarily fentanyl. That’s nearly 28,000 fewer fentanyl deaths than the year before.

How can fentanyl deaths be declining when so many Americans claim they used the potent and often deadly street drug?     

The numbers just don’t add up. They suggest that illicit fentanyl isn’t nearly as dangerous as we’ve been led to believe, although I doubt that that’s the point the study authors were hoping to make. 

The RAND and USC researchers say their findings add to evidence that the CDC may significantly underestimate illicit drug use and that new methods are necessary to keep better track of them.  

“Estimates of illicit opioid use are rare and typically are available only years after the information is collected, limiting our ability to monitor trends on a near-term basis,” says lead author David Powell, PhD, a senior economist and Professor of Policy Analysis at RAND. “Our study offers a method to quickly and repeatedly monitor illicit opioid prevalence at low cost.”

All of this matters because studies like this are often used to punish people who use any opioids – both legal and illegal. 

For example, if 11% of the population truly is using illicit opioids, then the medical community may use that statistic to claim that opioid prescribing is still too high and that too many prescription opioids are finding their way onto the black market. 

They might also claim more public funding is needed for the addiction treatment industry. Or that the overdose reversal drug naloxone should be required for anyone getting an opioid prescription. 

There’s also the prevailing myth that prescription opioids are what lead people to use fentanyl and other street drugs, a claim that the RAND/USC researchers believe is true.

“As the opioid crisis has evolved, attention to the role of prescription opioids has waned, even though overdose deaths from prescription opioids remain high and prescription opioids may operate as critical pathways to illicit opioid use,” they reported.  

That’s why it is so important for researchers to be more cautious in how they frame their results, and it’s also important for the media to be skeptical of research that shows extreme outlier data. 

Maybe 11% of people are using illicit opioids, and 7.5% are using illicit fentanyl. Both of those things could very well be true. But I think additional research replicating those results is needed before regulators and opioid prohibitionists act on them – especially if that means further restricting access to pain medication. 

Pain Clinic CEO Faced 20 Years for Fraud. He Got 18 Months.

By Brett Kelman, KFF Health News

Federal prosecutors sought a maximum prison sentence of nearly 20 years for the CEO of Pain MD, a company found to have given hundreds of thousands of questionable injections to patients, many reliant on opioids. It would have been among the longest sentences for a health care executive convicted of fraud in recent years.

Instead, he got 18 months.

Michael Kestner, 73, who was convicted of 13 fraud felonies last year, faced at least a decade behind bars based on federal sentencing guidelines.

He was granted the substantially lightened sentence due to his age and health Wednesday during a federal court hearing in Nashville.

U.S. District Judge Aleta Trauger described Kestner as a “ruthless businessman” who funded a “lavish lifestyle” by turning medical professionals into “puppets” who pressured patients into injections that did not help their pain and sometimes made it worse.

“In the court’s eyes, he knew it was wrong, and he didn’t really care if it was doing anyone any good,” Trauger said.

MICHAEL KESTNER

But Trauger also said she was swayed by defense arguments that Kestner would struggle in federal prison due to his age and medical conditions, including the blood disorder hemochromatosis. Trauger said she had concerns about prison health care after considering about 200 requests for compassionate release in other court cases.

“The medical care at these facilities,” defense attorney Peter Strianse said, “has always been dodgy and suspect.”

Kestner did not speak at the court hearing, other than to detail his medical conditions. He did not respond to questions as he left the courthouse.

‘Human Pin Cushions’

Pain MD ran as many as 20 clinics in Tennessee, Virginia, and North Carolina throughout much of the 2010s. While many doctors were scaling back their use of prescription painkillers due to the opioid crisis, Pain MD paired opioids with monthly injections into patients’ backs, claiming the shots could ease pain and potentially lessen reliance on pills, according to federal court documents.

During Kestner’s October trial, the Department of Justice proved that the injections were part of a decade-long scheme that defrauded Medicare and other insurance programs of millions of dollars by capitalizing on patients’ dependence on opioids.

The DOJ successfully argued at trial that Pain MD’s “unnecessary and expensive injections” were largely ineffective because they targeted the wrong body part, contained short-lived numbing medications but no steroids, and appeared to be based on test shots given to cadavers — people who felt neither pain nor relief because they were dead. During closing arguments, the DOJ argued Pain MD had turned some patients into “human pin cushions.”

“They were leaned over a table and repeatedly injected in their spine,” federal prosecutor Katherine Payerle said during the May 14 sentencing hearing. “Over and over, month after month, at the direction of Mr. Kestner.”

At last year’s trial, witnesses testified that Kestner was the driving force behind the injections, which amounted to roughly 700,000 shots over about eight years, with some patients receiving up to 24 at once.

Four former patients testified that they tolerated the shots out of fear that Pain MD otherwise would have cut off their painkiller prescriptions, without which they might have spiraled into withdrawal.

One of those patients, Michelle Shaw, told KFF Health News that the injections sometimes left her in so much pain she had to use a wheelchair. She was outraged by Kestner’s sentence.

“I’m disgusted that all they got was a slap on the wrist as far as I’m concerned,” Shaw said May 14. “I hope karma comes back to him. That he suffers to his last breath.”

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

Banning Kratom is Foolish. Governments Should Avoid Hysteria

By Crystal Lindell

I always say the way you know that kratom is among the rare herbal supplements that actually relieves pain is that everyone is always trying to ban it. 

Unfortunately, two towns in my state - Illinois - have done just that. City councils in Marion and Herrin voted this week to ban the sale and delivery of kratom. 

The reported justifications for the bans are naive at best and outright dishonest at worst. 

According to an article about the bans, the Marion city council acted after hearing from the widow of 41-year old Blake Pieroni, who died two months ago. She blames kratom for his death.

“He initially believed, as many do, that kratom was a safe natural supplement,” said Emily Pieroni. “The first time he tried kratom was when the owner of a gas station here in Marion offered Blake kratom as an energy shot. He told him it was like a 5-Hour Energy, but safer and more natural.”

I was especially interested in this anecdote because it would indeed be quite noteworthy if kratom alone had directly caused someone's death. Such cases are incredibly rare. However, when I looked into it, I quickly found that this was not the case. 

In fact, Emily Pieroni has written publicly that her husband died by suicide. She even includes this information in her Change.org petition asking for kratom to be banned:

“At first, it seemed harmless — just a boost of energy. But it quickly became an addiction. He tried to quit three times in seven months. The withdrawal was unbearable. Eventually, the emotional toll was too much, and kratom addiction led my husband to take his own life.”

Someone committing suicide is not the same thing as someone accidentally overdosing on a substance. If her husband had been trying to avoid coffee when he died, would that be enough to blame caffeine for his death? No. 

While I’m sympathetic to the immense grief Emily Pieroni is no doubt going through, especially as someone who has lost a loved one to suicide myself, her advocacy to have kratom banned is going to cause more harm. 

In fact, it is because she is still dealing with such raw grief that the Marion and Herrin city councils should have acted with clearer heads. 

Instead, they embraced kratom hysteria, with Marion Mayor Mike Absher even calling it “gas station heroin.” 

I want to be very clear here: Kratom is not gas station heroin. It’s an incredibly mild supplement similar to coffee. In fact, kratom comes from the leaves of the Mitragyna speciosa tree, which is literally part of the coffee family.

I could also call coffee “gas station meth” but that doesn’t make it true. And it would actually be more accurate to describe kratom as “herbal coffee.”

Because in reality, kratom helps countless people, including me. I have taken kratom for years for chronic pain. It is the only thing sold over the counter that actually helps me. 

For me, kratom withdrawal symptoms are as mild as withdrawing from coffee. Yes, some people may struggle to stop drinking coffee completely, but we as a society have decided that does not mean coffee should be illegal.

I also want to note that the Herrin city ordinance bans “possession” specifically, which means police can now use it to cite or even arrest people who bought kratom elsewhere, ensnaring them in the legal system and all its ill effects. 

Many kratom users are just people with chronic pain or other health issues looking for relief. We should let them use kratom in peace. Kratom is legal in most states and the vast majority of people use it safely. About 100 deaths have been linked to kratom use, but other drugs and illicit substances were usually involved. 

I hope that other towns and municipalities considering kratom bans will also consider the immense harm those bans will cause. 

Kratom is a very mild alternative to other drugs that treat chronic pain and other health issues. That should be celebrated, not demonized. 

Instead of trying to falsely claim that kratom is the same as heroin, we should be lauding the fact that it’s nowhere near as strong as heroin, and yet it is still quite effective at treating pain.

A Pained Life: Riding the Medical Merry-Go-Round

By Carol Levy

I recently went to an Urgent Care clinic because the left side of my face -- the side with the trigeminal neuralgia and phantom pain -- was swollen.

Had it been the right side of my face, I have no doubt they would have prescribed antibiotics and sent me home. Instead, because it was the left side, it became a major issue of “What is it?”

That earned me another ride on the medical merry-go-round.

Urgent care recommended I see an otolaryngologist; an ear, nose and throat specialist. He did nothing for me, but did pronounce, “Yep, it's swollen.”

My family doctor prescribed steroids, ordered blood tests, and a CAT scan of my facial bones. That was no help.

Next came a dermatologist who said, “No idea. See your neurologist.”

So I did. She ordered an MRI of my facial bones and more blood work. Again, all negative.

My GP suggested another otolaryngologist. The second one said she didn’t know what was causing my face to swell, but prescribed an antibiotic anyway.

At the next appointment, I was floored when she asked, “Has anyone else told you your face is swollen?”

That implied I was making it all up. Even though the swelling was obvious. 

Pain is not obvious.  Articles tell us not to exaggerate our pain or to pretend that we’re not in pain. The lesson seems to be to avoid stigma or judgement by not indicating one way or another if we have pain.

Is it any wonder then that we're asked, “Are you sure it's really that bad?” Or it’s suggested that we’re not really hurting, and could work or get out of bed if we really wanted to.

Being questioned about the reality of our pain is an awful discussion to have. We say we have it. That should be enough. And to some doctors, very few it seems, it is.  We say we have pain and they accept it.

Then, of course, there are the doctors whose philosophy is “seeing is believing.” Because our pain is often invisible to the eye, they refuse to believe us.

Until now, it never occurred to me that also applies when we go to a doctor with a normal everyday complaint. They still didn’t believe me, even when the swelling was plainly visible.

I still have the swelling. No one has figured it out. It’s just one more instance where a chronic pain condition interferes with getting the medical care that we need. And send us for another ride on the merry-go-round.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here. 

Anti-Inflammatory Drugs May Increase Risk of Pain Becoming Chronic

By Pat Anson

Aspirin, ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) have long been used to relieve back pain, muscle aches and other types of acute, short-term pain. The medications work by reducing inflammation, and are consider safer than stronger analgesics like opioids.

It turns out NSAIDs may do more harm than good by increasing the risk of acute pain becoming chronic.

In a series of studies on lab animals and humans, a team of researchers at McGill University found the NSAIDs, steroids, and other drugs that block inflammation may inhibit the body’s natural healing process. That can make the pain last longer than it should, according to research findings published in Science Translational Medicine.

“Clinical data showed that the use of anti-inflammatory drugs was associated with increased risk of persistent pain, suggesting that anti-inflammatory treatments might have negative effects on pain duration,” wrote lead author Jeffrey Mogil, PhD, a Professor of Pain Research at McGill University.

Mogill and his colleagues studied the transition from acute to chronic low back pain (LBP) in 98 adults by analyzing their immune cells. They focused on neutrophils, a type of white blood cell that is attracted to sites of inflammation and releases chemicals that promote an immune response to fight infection and heal tissue.

In participants whose lower back pain resolved and did not become chronic, researchers found evidence that their neutrophils and other natural biological processes performed normally, protecting them from transitioning to chronic pain.

Participants whose pain turned chronic showed signs that the healing process and neutrophils were impaired. This suggests that anti-inflammatory drugs that block neutrophils may interfere with the healing process by reducing inflammation too soon.

To test their theory, researchers analyzed health data from 500,000 people in the UK Biobank project, a long-term research study, to see if the medications they took for acute back pain had any negative consequences. They found that people who took NSAIDs had a higher risk of reporting chronic back pain 2 to 6 years later. Those who took antidepressants, which do not interfere with inflammation, did not have a higher risk of chronic pain.   

In animal studies, the McGill researchers found that laboratory mice given anti-inflammatory drugs had pain that lasted up to ten times longer than normal. Interestingly, mice given gabapentin, morphine or lidocaine – analgesics that do not have anti-inflammatory properties – did not experience longer pain episodes.

None of this proves anything – correlation is not causation – but it suggests that anti-inflammatory drugs may not be good for long-term pain management. They may be effective for short-term pain relief, but have the unintended effect of making pain last longer. If confirmed in future studies, researchers say their findings could have a substantial impact in how we manage pain.

“Together, our results suggest that active immune processes confer adaptation at the acute pain stage, and impairment of such inflammatory responses in subjects with acute LBP increases the risk of developing chronic pain,” researchers said. “Specifically, our data suggest that the long-term effects of anti-inflammatory drugs should be further investigated in the treatment of acute LBP and likely other pain conditions.”     

FDA Warns Again About ‘Gas Station Heroin’

By Pat Anson

The Food and Drug Administration is once again warning Americans about the harmful effects of tianeptine, an antidepressant found in supplements sold online and in convenience stores to help with energy, mood, pain and sexual performance.

Tianeptine is essentially an unregulated drug in the United States. It is not currently scheduled under the Controlled Substances Act, but is also not approved by the FDA for any medical use. It is, however, approved in low doses as a treatment for depression and anxiety in several European, Asian and Latin American counties.

The problem in the U.S. is that tianeptine is being sold in supplements without a prescription at doses up to 250 times higher than what is typically recommended in foreign drug products. At high doses, tianeptine can cause confusion, agitation and euphoria – which has led some to call it “gas station heroin.”

“I am very concerned. I want the public to be especially aware of this dangerous product and the serious and continuing risk it poses to America’s youth,” FDA Commissioner Dr. Martin Makary said in a “Dear Colleagues” letter to healthcare professionals.

“While the FDA is closely following the distribution and sale of these products, it is critical that you appreciate the magnitude of the underlying danger of these products, and disseminate information about it.”

This isn’t the first time the FDA has warned about tianeptine. In 2023, the agency warned consumers not to purchase or consume tianeptine products sold under the brand name Neptune’s Fix, which it blamed for “severe adverse events” such as seizures and loss of consciousness. A few months later, the FDA sent a warning letter to retailers telling them to stop selling Neptune’s Fix and any other products containing tianeptine.

Makary’s letter does not make clear why another warning about tianeptine is needed. It implies the drug is increasingly used by young people, but provides no statistics or examples of it harming users.

Since 2023, the FDA’s Adverse Events Reporting System has recorded less than a hundred cases of adverse health events involving tianeptine, most of them involving “persistent genital arousal disorder.”

Like other antidepressants, tianeptine can be used to relieve pain. A 2023 study on laboratory mice found tianeptine to be a fast-acting pain reliever, with low risk of addiction.

“We hope this revives the potential of using tianeptine for the treatment of chronic pain and associated conditions, such as anxiety and depression,” said lead author Venetia Zachariou, PhD, Chair of Pharmacology at Boston University’s School of Medicine. “By further refining this molecule, we could arrive at a pain treatment that is more effective, fast acting, and has a mild side effect profile.”

Other studies have show tianeptine may be effective as a treatment for asthma, irritable bowel syndrome, fibromyalgia, and ADHD. Like any drug, however, tianeptine can be harmful when its abused, taken in high doses, or combined with other drugs.

“Tianeptine is often taken recreationally, but it has also been used to self-treat a variety of ailments. It is frequently used chronically and, if stopped abruptly, users may experience withdrawal symptoms,” Makary said in his letter. “Historically, there has been a delayed recognition of fast-growing trends, such as opioid abuse and vaping addiction in youth. Let’s be proactive in understanding and addressing the use of tianeptine products.”

Pelvic Pain Patients Often Face Medical Gaslighting

By Crystal Lindell

Doctors are telling women with pelvic pain disorders to drink alcohol, learn how to relax, or get psychiatric care to treat their symptoms, according to a new study in JAMA Network Open. 

Researchers at The Centers for Vulvovaginal Disorders surveyed 447 patients pelvic pain, and found that medical gaslighting is common among doctors treating women with vulvodynia, endometriosis, interstitial cystitis and other pelvic conditions. 

The gaslighting was so disheartening that over half of the patients (52.8%) considered ceasing care because their concerns were not being addressed. Nearly 40% of the women said they were made to feel crazy, and one in five were referred to psychiatry without any medical treatment. 

Additionally, 16.8% of the patients surveyed felt unsafe during a medical exam. About a quarter of the doctors were belittling (26.6%) or did not believe the patient (20.5%). Many of the patients said their doctors lacked clinical knowledge about pelvic pain and were dismissive. 

The research also included quotes from patients who were surveyed, including one from a woman about a doctor who neglected her: 

"[I’ve been] told that they don't see anything or there is nothing there, despite that I was in severe pain and crying and had been in that provider's office almost every day for a week for these burning symptoms.”

As a pain patient myself, I have had the same experience. It’s difficult to explain to people who have never dealt with a long-term, complex health issue because most people still buy into the myth that doctors will do everything possible to help you. Unfortunately, that’s often not the case when it’s an ailment that’s difficult to treat or involves awkward topics like sex. 

One doctor dismissed the concerns of a patient about having sex, telling her that “intercourse is overrated anyway.”

I have to confess I was shocked to read that a doctor would ever say anything as ignorant as “intercourse is overrated.” It just proves that some doctors lack empathy, because there is no way a doctor would accept that response if an ailment was impacting their own sex life.

The same patient also complained about a doctor saying her discomfort was a normal part of growing older. 

“Providers that say 'it's just part of aging' don't address why it's not part of aging for my peers and even friends who are significantly older,” she said.

Which brings us to a common excuse that doctors use to dismiss patients of every age: You’re either “too young” to have a serious problem, or so old that whatever you’re experiencing must be “a normal part of aging.” 

This is evidenced by another respondent, who wrote: "I have had providers simply refuse to do tests on me because they said that I'm too young to worry about reproductive issues or that my pain is 'normal for young women' or that my pain is 'probably just stress.'"

One of the best ways to combat medical gaslighting and dismissive doctors is to spread awareness about it happening in the first place.

Those abusive tactics work because patients are often made to feel like they are crazy and stay silent. However, once they see that a doctor is talking to other patients the same way, it becomes clear that the patient is not the problem – the doctor is.

Researchers said their findings show “an urgent need for education supporting a biopsychosocial, trauma-informed approach to vulvovaginal pain and continued development of validated instruments to quantify patient experiences.”

In other words, the doctors need better training. And I couldn’t agree more. 

Patients don’t have the power to fix this problem on their own. It’s going to have to be the medical community that addresses it. And they can start by believing patients and showing some basic empathy.

Can Gut Bacteria Help Diagnose CRPS?

By Pat Anson

In what’s being called a breakthrough discovery, an international team of researchers has identified patterns in gut bacteria that appear to be associated with Chronic Regional Pain Syndrome (CRPS), a disabling nerve disease that causes severe pain. The discovery could lead to easier diagnosis of CRPS and potential new treatments.

Researchers at McGill University in Canada, working with colleagues in Israel and Ireland, used artificial intelligence (AI) to identify significant differences in the gut bacteria of CRPS patients and those of pain-free individuals. The findings were based on an analysis of stool and plasma samples from 53 CRPS patients and 52 healthy volunteers, which confirmed differences in fecal and plasma short-chain fatty acid levels.

The study, published in the journal Anesthesiology, adds to a growing body of evidence that gut microbiome — the population of microorganisms that live in the gastrointestinal tract —.plays a role in some chronic pain conditions.

“What’s remarkable about this study is that we trained our machine learning algorithms on high quality microbiome data from patients in Israel and successfully predicted CRPS in Canadian patients with over 90-per-cent accuracy,” said lead author Emmanuel Gonzalez, PhD, from the McGill Centre for Microbiome Research and Canadian Centre for Computational Genomics.

“This is extraordinary because factors like geography, climate, diet and natural variation between people typically create large microbiome differences. Yet, our AI approach seems to have identified a common ‘microbiome signature’ of CRPS, suggesting microbiome-based diagnostics could work across populations in different countries.”

CRPS is a nerve disorder that often starts with an injury to an arm or leg, with the skin in the affected area becoming warm, red and painful to touch. Most cases are mild and people recover, but in rare cases it gets worse, resulting in chronic nerve pain that spreads throughout the body.  

Also known as Reflex Sympathetic Dystrophy (RSD), CRPS affects between 400,000 and 2.1 million people worldwide. The disease is poorly understood, making it difficult to diagnose and treat.

“CRPS remains challenging to treat, with patients often experiencing prolonged suffering before receiving appropriate care,” said senior author Amir Minerbi, MD, Director of the Institute for Pain Medicine at Rambam Health Campus in Haifa, Israel.

With no known cure and few ways to manage symptoms, some CRPS patients become so desperate they resort to amputation. Researchers found that three male patients whose symptoms disappeared after limb amputation still had the same gut bacteria pattern that was linked to CRPS.   

“This persistent signature suggests the gut microbiome might make some people more prone to developing CRPS, with an injury or other event triggering the condition,” said Yoram Shir, MD, a Professor of Anesthesia and Director at McGill’s Alan Edwards Pain Management Unit.

“The identification of a gut microbiome signature for CRPS, paired with AI’s remarkable diagnostic accuracy, brings hope for earlier detection and tailored treatments,” says Barby Ingle, the founder and past president of the International Pain Foundation (iPain), who has lived with CRPS much of her adult life.

“This study affirms the intricate connection between our gut and chronic pain, a link I’ve personally explored through microbiome testing, stomach biopsies, and whole genome sequencing. While the exact correlation remains unclear to me, it’s great to see McGill’s scientists uncovering similar patterns, paving the way for innovative, patient-centered care that could truly transform lives.”

Previous studies have linked gut bacteria to rheumatoid arthritis and irritable bowel syndrome (IBS). A healthy balance of bacteria helps the body fight disease and regulate inflammatory reactions. Changes in the microbiome can disrupt the immune system and lead to inflammaging, when low levels of inflammation become chronic and spread throughout the body.

Cancer Patients Were Supposed to Be Exempt From CDC Opioid Guideline. They’re Not.

By Crystal Lindell

Cancer patients needing pain treatment were always meant to be exempt from the recommendations of the 2016 CDC opioid guideline, including the updated guideline released in 2022:

“This clinical practice guideline does not apply to patients undergoing cancer-related pain treatment, palliative care, or end-of-life care because… for many persons at the end of life, serious potential long-term opioid-related harms such as opioid use disorder might not be relevant.” 

A new study reveals that many older cancer patients were deprived of opioids anyway, even though they often require opioids as a first-line pain treatment.

The study looked at nearly 12,000 older adults on Medicare who were being treated for cancer from 2010 to 2020, including about 1,300 with advanced cancer or cancer pain.

Researchers found a significant 24% decline in opioid prescribing to cancer patients after the 2016 guideline was released. What did they get instead for pain relief?

There was a 7.5% increase in tramadol prescribing for cancer pain, while gabapentinoid prescribing for cancer patients rose by 25%. Even patients with advanced cancer were switched to tramadol or gabapentinoids, a class of nerve medication originally developed to treat seizures, not pain. 

“These findings suggest the 2016 guideline may have led to pain management shifts from first-line opioids to less-safe tramadol and less-effective gabapentinoids for older adults with cancer,” wrote lead author Rebecca Rodin, MD, Assistant Professor of Geriatrics and Palliative Medicine at the Icahn Mount School of Medicine at Mount Sinai.

It’s great to see the study authors call out tramadol and gabapentinoids as being “less safe” and “less effective.” Pain patients have long known that to be true, but the medical community still seems resistant to this information. 

While tramadol is technically an opioid, the DEA classifies it as a weaker Schedule IV drug, unlike oxycodone, hydrocodone and other opioids classified as Schedule II. The differentiation means doctors face less restrictions for prescribing it and less risk of going to prison. 

Gapabentin (Neurontin), pregabalin (Lyrica) and other gabapentinoids are prescribed off-label for cancer pain and chemotherapy-induced neuropathy —  even though they are medical conditions the drugs are not approved for. Gabapentinoids are not only ineffective analgesics for cancer pain, they can cause sedation and confusion, particularly in older adults.

Opioids, on the other hand, are very effective for moderate-to-severe cancer pain, with a response rate of 75% and a 50% average reduction in pain intensity.

Studies like this validate what the pain community has been trying to warn about for almost a decade: opioid-phobia has gone too far. It has reached a point where even cancer patients can’t get the pain relief they need.

Part of why this persists is that most people don’t think opioid restrictions are a problem until they or a loved one needs them. But if you wait until you’re dying from cancer to oppose opioid restrictions, it will be far, far too late. 

Of course, the other problem is, cancer is not the only thing that can cause debilitating pain. And people with other types of pain also deserve effective relief.

Another recent study by Dr. Rodin found that seriously ill patients in palliative and hospice care also have trouble getting opioids, due to inadequate supplies in pharmacies and insurance obstacles.

“The reality is that hundreds of thousands of seriously ill patients in the U.S. rely on opioids as a first-line treatment for pain. For people with advanced cancer, chronic organ failure, or other life-limiting conditions, opioids are often the only medications that can effectively control pain and allow them to function, Rodin wrote in a recent op/ed in STAT .  

Opioids have been used for centuries to treat pain for a reason: They work very well, and the risks of opioid addiction and.overdose are far less than what the public has been led to believe. 

Now we just need to convince doctors and the CDC of that. 

Online Emotional Support Therapy Modestly Reduces Chronic Pain

By Pat Anson

An online support program designed to “retrain the emotional brain” modestly reduces chronic pain and helps patients keep their negative emotions in check, according to a small pilot study in Australia.

Many people with chronic pain also develop anxiety and depression, but are unable to get psychological treatment because they live in rural areas or have mobility issues, and don’t have easy access to a therapist.

“We’ve known now for some time that chronic pain is more than just ‘Ouch, it hurts.’ It’s more than a sensory experience, it’s incredibly emotional,” says lead author Nell Norman-Nott, PhD, a research fellow at the University of New South Wales and clinical trial manager at the NeuroRecovery Research Hub.

Norman-Nott and her colleagues enrolled 89 people with chronic pain in the “Pain and Emotion Therapy” program. Half of the patients participated in 8 weekly group sessions over Zoom, in which a therapist teaches them emotional skills such as distraction, breathing exercises, and relaxation and self-soothing techniques.

The other participants received the treatment they were already getting, such as medication or physical therapy, and served as a control group.

The study findings, published in JAMA Network Open, show that after 9 weeks there were moderate improvements in depression, anxiety and sleep in those that received online therapy. But there was no change in pain intensity compared to those in the control group.

However, after a 6-month follow-up period, participants reported a 10% reduction in their pain levels, as well as continued improvement in their emotions and sense of well-being.

One of them is Janelle Blight, who lives with chronic back pain, arthritis and neuropathic pain. For the first time in 30 years, she was able to reduce her morphine dose after getting online therapy.

“I’ve been on a lot of opioids and things like that, but I’ve had nothing or found no course that’s been able to help take away the pain or help control the pain at home,” said Blight. “By doing the course, I’ve been able to learn how to reduce my emotional side of my pain, which has helped my chronic pain in the end.”

During a briefing with reporters, researchers called the study a “major step forward in pain care.” But in the actual study, they said the 10% reduction in pain intensity after six months was not well understood and “should be treated with caution.” The improvement was dependent on participants continuing to use the emotional skills they developed during online therapy.

Researchers hope to build on what they’ve learned with a larger study involving 300 participants in 2026. Registrations are open (for Australians only) on the NeuroRecovery Research Hub website.

Women’s Health Initiative Improved Healthcare, but Has Uncertain Future

By Jean Wactawski-Wende

Women make up more than 50% of the population, yet before the 1990s they were largely excluded from health and medical research studies.

To try to help correct this imbalance, in 1991 the National Institutes of Health launched a massive, long-term study called the Women’s Health Initiative, which is still running today. It is the largest, longest and most comprehensive study on women’s health ever conducted in the U.S. It also is one of the most productive studies in history, with more than 2,400 published scientific papers in leading medical journals.

On April 20, 2025, the Department of Health and Human Services told the study’s lead investigators it plans to terminate much of the program’s funding and discontinue its regional center contracts. On April 24, after pushback from the medical community, HHS officials said the funding had been reinstated. But the reversal was never officially confirmed, so the study’s lead investigators – including me – remain concerned about its future.

I am a public health researcher who has studied chronic disease prevention in women for nearly 40 years. I have been centrally involved with the Women’s Health Initiative since its inception and currently co-direct one of its four regional centers at the University at Buffalo.

The project’s findings have shaped clinical practice, prevention strategies and public health policies across the U.S. and the world, particularly for older women. In my view, its loss would be a devastating blow to women’s health.

Little Medical Research of Women’s Health

The Women’s Health Initiative was established in response to a growing realization that very little medical research existed to inform health care that was specifically relevant to women. In the U.S. in the 1970s, for example, almost 40% of postmenopausal women were taking estrogen, but no large clinical trials had studied the risks and benefits. In 1985 an NIH task force outlined the need for long-term research on women’s health.

Launched by Bernadine Healy, the first woman to serve as director of the NIH, the Women’s Health Initiative aimed to study ways to prevent heart disease, cancer and osteoporosis.

Between 1993 and 1998, the project enrolled 161,808 postmenopausal women ages 50 to 79 to participate in four randomized clinical trials. Two of them investigated how menopausal hormone therapy affects the risk of heart disease, breast cancer, hip fractures and cognition. Another examined the effects of a low-fat, high-fiber diet on breast and colorectal cancers as well as heart disease. The fourth looked at whether taking calcium plus vitamin D supplements helps prevent hip fractures and colorectal cancer.

Women could participate in just one or in multiple trials. More than 90,000 also took part in a long-term observational study that used medical records and surveys to probe the link between risk factors and disease outcomes over time.

Menopausal Hormone Therapy

Some of the most important findings from the Women’s Health Initiative addressed the effects of menopausal hormone therapy.

The hormone therapy trial testing a combination of estrogen and progesterone was set to run until 2005. However, it was terminated early, in 2002, when results showed an increased risk in heart disease, stroke, blood clotting disorders and breast cancer, as well as cognitive decline and dementia. The trial of estrogen alone also raised safety concerns, though both types of therapy reduced the risk of bone fractures.

After these findings were reported, menopausal hormone therapy prescriptions dropped sharply in the U.S. and worldwide. One study estimated that the decreased use of estrogen and progesterone therapy between 2002 and 2012 prevented as many as 126,000 breast cancer cases and 76,000 cardiovascular disease cases – and saved the U.S. an estimated US$35 billion in direct medical costs.

Reanalyses of data from these studies over the past decade have provided a more nuanced clinical picture for safely using menopausal hormone therapy. They showed that the timing of treatment matters, and that when taken before age 60 or within 10 years of menopause, hormones have more limited risk.

Advances in Women’s Health

Although the Women’s Health Initiative’s four original clinical trials ended by 2005, researchers have continued to follow participants, collect new data and launch spinoff studies that shape health recommendations for women over 65.

Almost a decade ago, for example, research at my institution and others found in a study of 6,500 women ages 63 to 99 that just 30 minutes of low to moderate physical activity was enough to significantly boost their health. The study led to changes in national public health guidelines. Subsequent studies are continuing to explore how physical activity affects aging and whether being less sedentary can protect women against heart disease.

Bone health and preventing fractures have also been a major focus of the Women’s Health Initiative, with research helping to establish guidelines for osteoporosis screening and investigating the link between dietary protein intake and bone health.

One of the Women’s Health Initiative’s biggest yields is its vast repository of health data collected annually from tens of thousands of women over more than 30 years. The data consists of survey responses on topics such as diet, physical activity and family history; information on major health outcomes such as heart disease, diabetes, cancer and cause of death, verified using medical records; and a trove of biological samples, including 5 million blood vials and genetic information from 50,000 participants.

The Women’s Health Initiative set out to prevent heart disease, cancer and osteoporosis in menopausal women.

Any researcher can access this repository to explore associations between blood biomarkers, disease outcomes, genes, lifestyle factors and other health features. More than 300 such studies are investigating health outcomes related to stroke, cancer, diabetes, eye diseases, mental health, physical frailty and more. Thirty are currently running.

In addition to data amassed by the Women’s Health Initiative until now, about 42,000 participants from all 50 states, now ages 78 to 108, are still actively contributing to the study. This cohort is a rare treasure: Very few studies have collected such detailed, long-term information on a broad group of women of this age. Meanwhile, the demographic of older women is growing quickly.

Continuing to shed light on aging, disease risk and prevention in this population is vital. The questions guiding the project’s ongoing and planned research directly address the chronic diseases that Health Secretary Robert F. Kennedy Jr. has announced as national priorities.

So I hope that the Women’s Health Initiative can continue to generate discoveries that support women’s health well into the future.

Jean Wactawski-Wende, PhD, is a Professor of Public Health at the University at Buffalo and is the principal investigator of UB's Women's Health Initiative (WHI) Northeast Regional Center. She has served in various leadership roles in WHI, including publications chair and the WHI executive committee, and has served as the national Chair of the WHI Steering Committee.

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

I Hate That I Need Opioid Pain Medication

By Crystal Lindell

I genuinely hate that I need opioid pain medication. 

I hate that I need it to function. I hate how expensive it is. I hate how I have to endure background checks like drug tests and interrogations to get it — like I was a criminal. 

I hate how tired it makes me. 

I hate that I can’t just buy it over-the-counter. I hate that I have to deal with judgmental doctors and pharmacists every single month to get it. I hate how vulnerable it makes me feel. I  hate how much stigma there still is around it. 

I hate that I hate it as much as I do, and yet people still think that I only take it because I’m a lazy loser who loves to get high. 

I hate that when I take it — it actually works — because that just shows how much I need it. 

Chronic pain sucks. But needing daily pain meds for a chronic condition also sucks. 

I have gone to great lengths to try to get off opioids — to try to live without them. 

I’ve done painful nerve block procedures, weekly lidocaine infusions at a hospital over an hour from my house, and gone to every specialist in that hospital. I’ve tried THC, kratom, nicotine gum, wine, and capsaicin cream. I’ve tried yoga, chiropractors, and acupuncture. I’ve tried gluten-free diets, losing weight, daily walking, and prayer.

I’ve also tried to just live with the pain. 

But I can’t. I still need opioid medication. 

I need it to shower. I need it to work. I need it to relieve the pain that makes me suicidal if left untreated.

Without opioid pain meds, I’d either be too disabled to function, or in too much pain to live. 

And I hate that so much. 

I wish that was not the case. I wish I could just exist in this stupid world without needing opioids to be alive, to actually live. 

I wish there was some other way to manage my chronic pain or even better, that I didn’t have chronic pain to begin with.

But alas, that is not the case. I literally need opioid pain medication to survive. 

So I keep taking it. 

I keep submitting to all the stupid hurdles put in place by doctors, pharmacists, and the DEA. I keep coming up with money to pay for my appointments and prescriptions. And I keep enduring the stigma that comes with it.

But I still have hope that one day people who need opioid pain medication won’t have to hate that they need it. That they’ll have access to it, and that they won’t have to submit to dehumanizing treatment to get it. 

I hope that one day needing opioid pain medication won’t be a burden to patients that must be endured on top of whatever ailments they already have. I’d rather they just bring the relief they were intended for.

The healthcare system doesn’t have to be like this. We can change it. Opioid pain medication could be accessible, inexpensive, and stigma-free. We just have to make it so.

Lupus Unknown to Most Americans, Despite Widespread Prevalence

By Pat Anson

About 1.5 million Americans suffer from lupus, a disabling autoimmune condition that causes extreme fatigue, cognitive issues and damage to tissues and joints. Although lupus is a leading cause of death for young women, many of them Black or Hispanic, most Americans know little about the disease.

A new survey commissioned by the Lupus Foundation of America found that over half of American adults (53%) know very little about the disease or nothing at all --- even though 42% say they personally know someone living with lupus. The survey findings are being released to coincide with Lupus Awareness Month in May.

"The survey is a sobering reminder that lupus remains a misunderstood and underestimated chronic condition," Louise Vetter, President & CEO of the Lupus Foundation of America, said in a press release. "Lupus Awareness Month is a call to action because we know that awareness is the first step toward deeper understanding, stronger doctor-patient engagement, and healthier lives."

One of the reasons lupus is so poorly understood is that it is difficult to diagnose. The symptoms vary from person-to-person, can come and go or change over time, and are often misdiagnosed. On average, it takes nearly six years for people to be diagnosed after they first notice lupus symptoms.

About 43% of survey respondents said they did not know lupus is an autoimmune disease, 44% did not know lupus can impact any organ in the body, and more than a third (38%) were not aware that lupus can be fatal.

While lupus primarily impacts younger women aged 15-44, nearly half of Americans (40%) said they did not know that children can also develop the disease. Up to 20% of people with lupus are diagnosed as children, and pediatric onset of the disease tends to be more severe and aggressive than in adults.

There are no known causes or cure for lupus, and the FDA has approved only three medications that were specifically developed to treat lupus. Several non-lupus medications, originally developed to treat malaria or cancer, are being repurposed to treat lupus. On average, people with lupus take an average of nearly eight prescription medications to manage their symptoms.

The Lupus Foundation says there has been significant progress in developing new lupus treatments in the last five years, but concern is growing that cuts in federal health research will stifle further progress.

A continuing resolution passed by Congress in March would eliminate funding for the Lupus Research Program at the Department of Defense. The Department of Health and Human Services would also lose about a third of its funding under a proposed 2026 budget. That would coincide with a major reorganization of the CDC and the HHS Office of Minority Health, which threatens to eliminate two additional lupus programs.

“The Lupus Foundation of America is profoundly concerned by the reorganization and significant staff reductions taking place at the U.S. Department of Health and Human Services (HHS) in addition to cuts that already have been made to the Lupus Research Program at the Department of Defense (DoD). These changes threaten to disrupt and delay vital lupus programs and negatively impact lupus research, drug development, and public health initiatives,” the foundation said in a statement.

The foundation will hold its annual National Lupus Advocacy Summit on May 4-6 in Washington DC, which you can watch via livestream.

World Lupus Day is on May 10, with a call to action for patients and advocates to wear purple and light significant landmarks with the color purple.

How Workplace Conditions Contribute to Chronic Pain and Mental Health Issues

By Pat Anson

If you are of a certain age – like me – you’ll remember when computers started entering the workplace in the 1980’s. There was a huge learning curve, but eventually work became faster and more efficient.

There was also a tradeoff: employees reported back and neck pain from sitting at keyboards all day, and carpal tunnel syndrome became a thing. Companies learned about the hazards of repetitive motion, and how chair height, limited desk space and poorly shaped computer mouses affected worker health, absenteeism and productivity. A new industry was born: ergonomics.

Flash forward 40 years and companies are now being urged to think about “emotional ergonomics” – how workplace stress contributes to anxiety, depression, burnout, and chronic pain.

“Physical pain is often a symptom of deeper, underlying stressors—from job pressures to mental health challenges. Addressing industrial ergonomics without considering emotional well-being is an incomplete strategy. The most forward-thinking companies recognize that true injury prevention must integrate both,” says Kevin Lombardo, CEO of the DORN Companies.

DORN has partnered with organizations that specialize in ergonomics, business psychology, and suicide prevention on a new white paper called “Emotional Ergonomics: How the Intersection of Industrial Ergonomics, Pain, and Mental Health Shapes Worker Wellbeing.”

The paper’s main findings are that workplace conditions deeply affect the physical and mental health of workers, and that organizations must address them together to have a healthy, high-performing workforce. Workplace stress affects 40% of employees in the United States and contributes to about $190 billion in added healthcare costs.

Unlike the 1980’s, when most jobs entailed a 40-hour work week and were performed outside the home, today’s knowledge-driven economy blurs the lines between professional and personal lives. Employees may get work-related emails or texts at all hours of the day and night, and a growing number work from home. This increases exposure to stress, cognitive demands, poor sleep habits, and the psychosocial risks that come with juggling work, family and personal time.

A recent study found that stress and anxiety have become the most common work-related injuries, accounting for over half (52%) of new cases. That trend is mirrored in Google searches for “burnout,” which have risen dramatically in the last 10 years.

“This research signals a necessary shift in how we approach workplace well-being. Emotional Ergonomics bridges the gap between physical safety and mental resilience, ensuring that employee health is not just a compliance checkbox but a business imperative. Organizations that fail to recognize this connection risk long-term workforce instability and financial strain,” says Dr. Sally Spencer-Thomas, President of United Suicide Survivors International.

Common psychosocial hazards in the workplace include:

• Excessive workload and time pressures

• Toxic relationships between coworkers and supervisors

• Hazing, bullying, harassment and discrimination

• Exposure to workplace accidents and trauma

• Low autonomy and limited decision-making

• Job insecurity

• Work-Life disruption

To address these issues, companies can adjust workloads and allow for more flexible scheduling; adopt health and wellness programs; train supervisors in empathetic communication skills; and allow for “quiet time” and space where workers can decompress from job strain.

The goal is to view workers not as cogs in a machine, but as individuals with different physical, emotional, and psychological needs. An “I’ve got your back” mentality in the workplace builds trust and helps employees feel valued.  

To learn more about the study findings and ways to build emotional ergonomics, you can sign up to watch a live webinar on Wednesday, May 21.