Every Chronic Pain Patient Should Have Their Hormone Levels Tested

By Dr. Forest Tennant

Periodic hormone panel testing should be a standard procedure in chronic pain care. Why? Some specific hormones are essential for pain control and others for healing and restoration of damaged tissues. 

Unfortunately, both chronic pain and opioid medications can suppress hormones, which the body needs for pain control and tissue healing. Nerve receptors in the brain that control pain, such as the opioid/endorphin, dopamine, GABA, and serotonin receptors, use hormones as energizers – the same way gas is needed to fuel your car. 

One of the first signs that your hormone levels are deficient — and that you’re running out of gas —- is when your pain relief medication seems to be losing its effectiveness. If that is the case, hormone panel testing should be performed and hormone replacement may be necessary. 

Six hormones that you should test for:

• Pregnenolone

• Progesterone

• Dehydroepiandrosterone (DHEA)

• Estradiol

• Testosterone

• Cortisol

Opioids can suppress all of these hormones. Long-acting opioids like oxycodone, morphine, methadone, fentanyl patches, and intrathecal opioids are the worst.

Short-acting opioids like hydrocodone and hydromorphone are less disruptive, because they do not constantly remain in the blood, so they give the pituitary and other hormone-producing glands time to recover. 

Long-acting opioids constantly suppress the pituitary and other glands. Consequently, any person who takes a long-acting opioid needs hormone panel testing at least every 6 months. All deficiencies must be replenished.

Hormone Therapies

Given the importance of hormone testing and hormone replacement therapy, I recently published a new book, “Hormone Therapies in Chronic Pain Care.”

I wrote the book because I strongly believe it is time to incorporate hormonal therapies into the care of essentially every chronic pain patient.  

Despite an imperfect pain care system that admittedly has some supply, regulation, and financial issues, modern pain management has achieved great success.  

Recently developed medications, physical therapies, and surgical procedures have brought pain relief and recovery to millions around the world.  Hormones can and will build on this foundation. 

The book is designed to help both medical practitioners and patients identify hormone therapies that can improve their current treatment. You can’t control pain or acquire healing and restoration with deficient hormone levels.

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

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

Today’s Wounded Troops Are Tomorrow’s Chronic Pain Patients

By Crystal Lindell

This week Reuters reported that as many as 150 U.S.troops have been wounded so far in the War on Iran. Of those, eight were seriously injured.

That’s in addition to the 7 U.S. service members who have been killed in the conflict, which started less than two weeks ago.

Those numbers will continue to rise the longer the war drags on.

It can feel tempting to dismiss wounded soldiers as no big deal, and that’s how the Pentagon is framing it, saying the vast majority of injuries are minor and that 108 of the wounded had already returned to duty.

But many of those who get wounded in conflict zones will experience life-long symptoms, including chronic pain, post-traumatic stress disorder (PTSD) and traumatic brain ​injuries, which are common after exposure to blasts.

According to the National Institutes of Health, about two-thirds of U.S. veterans (65.6%) have  chronic pain, and one in ten (9.1%) live with severe chronic pain. 

Of course, it’s not just U.S. troops who are casualties in the war. Estimates vary, but about 1,200 Iranians have died, 28 Israelis and nearly 600 in Lebanon. The number of injured is well into the thousands.

Even if the war ends tomorrow, its effects will likely linger for generations. Living with chronic pain can impact your life until you die — and enduring it can impact everyone around you, including your children.

It can make you more short-tempered, less productive, and more depressed. It can make you harder to live with emotionally, and harder to live with logistically because you need extra care.

I doubt most of the wounded understand the ramifications. I don’t blame them. It’s almost impossible to understand chronic pain until you suffer through it yourself.

But as a chronic pain patient, I know what their future holds.

It’s years, even decades, of dealing with dismissive doctors; fighting for pain medication; and spending your days and nights in bed because it hurts too much to move.

I think, if they truly understood, many members of the military would tell you it’s not worth it.  

A recent report from the Department of Veterans Affairs found that 6,398 U.S. veterans died by suicide in 2023. While that’s down slightly from 2022, the veteran suicide rate actually increased to 35.2 deaths per 100,000 veterans. That’s about twice the suicide rate of civilians.

It averages out to over 17 suicides by veterans each day. Most of them probably suffered from chronic pain.

It’s easy to skim past headlines about the number of people wounded in the War on Iran. But for the people who are enduring it, and those who love them, nothing about their future will likely be easy.

PEA: A Supplement That Helps Reduce Pain and Inflammation

By Julie Titone

It is a question I’ve long had but never bothered to look up: How do drugs get their names? Then I heard about palmitoylethanolamide and, given it has the longest name of anything I ever considered consuming, I had a solid reason to pursue the question.

PEA, as the tongue-twister is unsurprisingly known, isn’t a prescription drug. It’s a fatty acid found naturally in our bodies and in some foods. PEA can also be manufactured and is sold in over-the-counter supplements. It binds to cells in the body and reduces inflammation and pain.

When a fellow arachnoiditis sufferer called it to my attention, I read up on it.

PEA was first identified in the 1950s, after doctors observed that children who ate eggs were less likely to get rheumatic fever. Early studies found PEA not only in the fatty solids of egg yolks, but also in components of peanuts and soybean lecithin.

Researchers found that the compound had anti-inflammatory effects in animal models, and noticed it could also reduce allergic reactions. That lead to early clinical trials for conditions like influenza and the common cold.

Interest in PEA then dropped off for two decades. It was revived again thanks in large part to Nobel Prize-winning neurobiologist Rita Levi-Montalcini. Her work in the 1990s and 2000s helped establish PEA's role in modulating mast cells, which are key players in inflammation and allergic responses. She was a huge fan of PEA, reportedly taking it herself. She lived to be 103.

Interest in PEA is strong and getting stronger. For two recent reports, researchers analyzed scores of studies, tabulated the results of the rigorous ones, and reached upbeat conclusions.

The 2023 meta-analysis in the Swiss journal Nutrients looked at PEA’s effect on chronic pain, and found “PEA was associated with improved functional status and quality of life in many studies, while reported side effects were essentially negligible.”

A 2025 meta-analysis published by the journal Nutrition Reviews confirmed that “PEA effectively reduces pain and enhances quality of life, with significant benefits observed within 4-6 weeks of treatment. Palmitoylethanolamide is a promising alternative to chronic opioid analgesics, potentially reducing the risk of opioid abuse and dependency.”

That last point — that PEA could provide a safe alternative to opioids — is a big driver of interest in the nine-syllable compound. Researchers are also looking at its promise in treating long Covid, glaucoma, Alzheimer’s, Parkinson’s, ALS and more. So far, it’s shown to be most effective in the treatment of neuropathic pain.

To make PEA more effective, researchers have figured out how to make it more available in the body. Thus “micronized,” PEA is now available in some countries as a prescription drug. Why didn’t that happen earlier? For one thing, drug manufacturers apparently didn’t see great promise or profit in it.

Chemists also discovered PEA before the United States and WHO came up with national and international naming councils, which give drugs generic names such as ibuprofen.

Manufacturing marketing teams are the ones who come up with brand names. Though I find it hard to picture a room full of those folks looking at PowerPoint slides, rubbing their chins thoughtfully until someone exclaims “Yes! Let’s call it Advil! That certainly says ‘Be gone, demon headache’ to me!”

Am I taking PEA? Yes, dear reader, I am. For the past three weeks. Because the research says it takes four to six weeks to see results, I have nothing to report. Perhaps PEA won’t show definitive improvement, but works in the background to keep my inflammatory spinal disease from getting worse.

I would certainly take that outcome from a supplement that is readily available, doesn’t break the bank, and has no side effects.

Following a career in journalism and academic communications, Julie Titone writes about health, environment and other issues at julietitone.substack.com.

Weight Loss Drugs May Help Fight Addiction

By Dr. Ziyad Al-Aly 

A patient of mine, a veteran who had tried to quit smoking for over a decade, told me that after he started a GLP-1 drug for his diabetes, he lost interest in cigarettes. He didn’t use a patch. He didn’t set a quit date. He simply lost interest. It happened without effort.

Another patient on one of these drugs for weight loss told me that alcohol had lost its pull – after years of failed attempts to quit.

People struggling with many addictions, ranging from opioids to gambling, are reporting similar experiences in clinics, on social media and around dinner tables. None of them started these drugs to quit. This pattern of people losing their cravings across a broad range of addictive substances has no precedent in medicine.

But my patients were giving me an important clue. People taking GLP-1 drugs often talk about “food noise” vanishing: the constant mental chatter about food that dominated their days simply goes quiet. But my patients were reporting that it wasn’t just food: They were noticing that the preoccupation with smoking, drinking and using drugs that drives people back despite their best intentions to stop was going quiet too.

As a physician whose patients are often on GLP-1 drugs, and as a scientist who works on answering pressing public health questions – from long COVID to medication safety – I saw a problem hiding in plain sight: Many addictions have no approved treatment.

The few medications that exist are massively underutilized, and none works across all substances. The idea that a drug already taken by millions might do what no addiction treatment has done before was too important to ignore.

My team and I set out to test whether GLP-1 drugs – medications like semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound), originally developed for diabetes and then approved for obesity – could do what no existing addiction treatment does: curb craving itself.

Our evidence strongly suggests they can.

Reduced Cravings

The hormone that these drugs mimic – GLP-1 – is not only produced in the gut. It is also active in the brain, where the receptors it binds to cluster in regions governing reward, motivation and stress – the same circuitry that gets hijacked by addiction. 

At therapeutic doses, GLP-1 drugs cross the blood-brain barrier and dampen dopamine signaling in the brain’s core reward center, making addictive substances less rewarding.

GLP-1 drugs seem to inhibit cravings for several different substances in multiple animal models. For instance, rodents given GLP-1 drugs drink less alcohol, self-administer less cocaine and show less interest in nicotine. 

When researchers gave semaglutide to green vervet monkeys – primates that voluntarily drink alcohol much like humans do – the animals drank less without showing signs of nausea or changes in water intake. This suggests the drug lowered the reward value of alcohol rather than making the animals feel sick.

Fewer Overdoses

To find out whether these drugs have a similar effect on people, we turned to the electronic health records of more than 600,000 patients with Type 2 diabetes at the U.S. Department of Veterans Affairs – one of the largest health care databases in the world.

We designed a study that applied the rigor of randomized controlled trials – the gold standard in medicine – to real-world data. We compared people who started GLP-1 drugs to people who did not, adjusting for differences in health history, demographics and other factors, and followed both groups for three years.

My team and I asked two questions: For people already struggling with addiction, did the drugs reduce overdoses, drug-related hospitalizations and deaths? And for people with no prior substance use disorder, did GLP-1 drugs reduce their risk of developing one across all major addictive substances: alcohol, opioids, cocaine, cannabis and nicotine?

What we found was striking. In the group already struggling with addiction, there were 50% fewer deaths due to substance use among those taking GLP-1 drugs compared with those who were not. We also found 39% fewer overdoses, 26% fewer drug-related hospitalizations and 25% fewer suicide attempts. Over three years, this translated to roughly 12 fewer serious events in total per 1,000 people using GLP-1 drugs – including two fewer deaths.

Reductions of this magnitude are rare in addiction medicine – and what’s remarkable is that the finding came from drugs initially designed for diabetes, later repurposed for obesity and never intended to treat addiction.

The drugs also appeared to prevent addiction from developing in the first place. Among people with no prior substance use disorder, those taking GLP-1 drugs had an 18% lower risk of developing alcohol use disorder, a 25% lower risk of opioid use disorder and an approximately 20% lower risk of cocaine and nicotine dependence. Over three years, this translated to roughly six to seven fewer new diagnoses per 1,000 GLP-1 users.

With tens of millions of people already using GLP-1 drugs, the reductions in deaths, overdoses, hospitalizations and new diagnoses could translate into thousands of prevented serious events each year.

Our findings align with a growing body of evidence.

A Swedish nationwide study of 227,000 people with alcohol use disorder found that those taking GLP-1 drugs had 36% lower risk of alcohol-related hospitalizations. This is more than double the 14% reduction that the same study found with naltrexone, which was the best-performing medication approved for treatment of alcohol use disorder in that analysis.

Other observational studies have linked GLP-1 drugs to lower rates of new and recurring alcohol use disorder, reduced diagnoses and relapse in cannabis use disorder, fewer health care visits for nicotine dependence and lower risk of opioid overdose.

Meanwhile, randomized controlled trials that directly test whether these drugs help people with addiction also show promise. In one trial, semaglutide reduced both craving and alcohol consumption in people with alcohol use disorder. In another, dulaglutide reduced drinking. More than a dozen additional trials are already underway or actively enrolling, and several more are planned.

The Future of Addiction Treatment?

GLP-1 drugs are the first type of medication to show potential benefit across multiple substance types simultaneously. And unlike existing addiction medications, which are prescribed by specialists and remain vastly underused, GLP-1 drugs are already prescribed at enormous scale by primary care doctors. The delivery system to reach millions of patients already exists.

The consistency of GLP-1 effectiveness across alcohol, opioids, cocaine, nicotine and cannabis suggests these drugs may act on a shared vulnerability underlying addiction – not on any single substance pathway. If confirmed, that would represent a fundamental shift in how society understands addiction and how doctors treat it.

Some unanswered questions remain, though, about how these drugs would affect addiction. Many people who take GLP-1 drugs to treat obesity or diabetes discontinue them; afterward, their appetite typically returns and they regain the weight they lost.

Whether the same rebound would occur with addiction, and what it would mean for someone in recovery to face the roar of craving again, is unknown. Nor is it clear whether the benefits persist over years of continuous use, or whether the brain adapts in ways that dampen those effects.

Also, because GLP-1 drugs engage the brain’s reward circuitry – the same system that governs not just craving but everyday motivation – prolonged use could, in theory, dampen motivational drive in some people. Whether that might affect real-world outcomes, such as initiative, competitive drive or performance at work, remains an open question.

GLP-1 drugs have not been approved for addiction, and there is not yet enough evidence to prescribe them solely for that purpose. But for millions of people already weighing whether to start a GLP-1 drug for diabetes, obesity or another approved indication, it is one more factor worth considering.

A patient living with diabetes who is also trying to quit smoking might reasonably choose a GLP-1 drug over another glucose-lowering medication, not because it is approved for smoking cessation, but because it may help them quit, a benefit that other diabetes drugs do not offer. Similarly, for people living with obesity who also struggle with alcohol, the potential for benefit beyond weight loss could be one more reason to consider a GLP-1 drug.

If additional trials confirm that they effectively curb cravings across addictive substances, these drugs could begin to close one of the most consequential treatment gaps in medicine. And the most promising lead in addiction in decades will have come not from a deliberate search but from patients reporting a benefit no one anticipated. Like my patient who quit smoking after a lifetime of trying, it happened without effort.

Ziyad Al-Aly, MD, is a Clinical Epidemiologist at Washington University in St. Louis. He also directs the Clinical Epidemiology Center, and serves as the Chief of Research and Development Service at the VA Saint Louis Health Care System. 

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

Bill Expands Pain Care Options and Lowers Cost for Medicare Patients

By Dr. Lynn Webster

Everyone who reads this publication understands chronic pain is often treated as a symptom. However, for tens of millions of Americans, it is a disease state. It reshapes the nervous system, erodes function, and can narrow life experiences to what hurts least.

It’s also becoming more common. Federal survey data show that roughly a quarter of U.S. adults report chronic pain, and a substantial subset report “high-impact” chronic pain severe enough to limit work or daily activities.

The public conversation about pain has been dominated for a decade by opioids, and for good reason. Opioids carry real risks, especially with long-term use, and the nation has paid dearly for indiscriminate prescribing and poor safeguards. But focusing only on opioids can obscure a quieter policy failure. Many patients who are trying to avoid opioids can’t reliably access effective non-opioid options, particularly in Medicare Part D.

That gap is structural, as well as clinical. Medicare Part D plans commonly use utilization management tools, prior authorization and step therapy among them, that can delay or block access to certain medications. For older adults living with neuropathic pain, fibromyalgia, or other chronic pain conditions, delays can mean months of impaired function while paperwork circulates, appeals are filed, and “fail-first” sequences play out.

In practice, these barriers can shape prescribing in ways that have little to do with what a clinician believes is best. When a newer non-opioid medication is placed on a high cost-sharing tier, requiring multiple authorizations, or is only covered after a patient “fails” other therapies, the path of least resistance too often becomes the therapy that is easiest to access — not necessarily the therapy that best matches the patient’s needs.

A bipartisan bill now before Congress is designed to address a narrow but consequential piece of that problem for Medicare beneficiaries: the Relief of Chronic Pain Act of 2025 (S. 3064). Its basic logic is simple: If policymakers want less reliance on opioids, coverage rules should not systematically disadvantage non-opioid alternatives.

The bill would do three things for qualifying non-opioid chronic pain management drugs in Part D plans, beginning in 2026. It would waive the deductible, require plans to place the drug on the lowest cost-sharing tier, and prohibit prior authorization and step therapy, which forces patients to try an opioid first.

Importantly, S. 3064 is not written as an open-ended mandate for all pain treatments. It defines qualifying drugs as FDA-approved non-opioid products for chronic pain conditions that do not act on opioid receptors and, in general, are not simply interchangeable with an existing therapeutically equivalent product.

It also defines “chronic pain condition” with specific examples, including diabetic peripheral neuropathic pain, endometriosis, fibromyalgia, musculoskeletal pain, neuropathic pain, post-herpetic neuralgia, and trigeminal neuralgia.

Why does a target change like this matter? Because pain is not just discomfort; it is an economic and social force. Chronic pain drives health care use, disability claims, and lost productivity on a massive scale, with major national cost estimates in the hundreds of billions of dollars annually.

When coverage delays effective treatment, the downstream costs do not disappear. They shift to more Medicare patients falling, more deconditioning, more depression and isolation, more emergency visits, and -- in some cases -- greater exposure to higher-risk medications.

Coverage policy won’t solve chronic pain by itself. The best care is multimodal: movement, behavioral strategies, physical and occupational therapy, interventional options when appropriate, and medications when they add meaningful benefit. Opioids will remain appropriate for a subset of people with chronic pain. But insurance design can either support alternative therapies or quietly undermine them.

S. 3064 asks Congress to make one pragmatic adjustment: Stop treating certain non-opioid options as luxuries for Medicare beneficiaries and start treating timely access as a basic component of safer pain care.

Unfortunately, since its introduction in Congress last October by Sen. Steve Daines (R-MT) and Sen. Maria Cantwell (D-WA), the bill has languished in the Senate Finance Committee. No hearings on S. 3064 are currently scheduled.

Readers who want to follow the proposal can review the bill text and legislative updates here. A public petition supporting the measure is also circulating for those who wish to add their names. If you want more options that are accessible and affordable, you should consider signing the petition and spreading the word. 

Lynn R. Webster, MD, is a pain and addiction medicine specialist. He writes and lectures on pain policy, patient safety and evidence-based treatment. Webster is currently a Senior Fellow for The Center for U.S. Policy. He is the author of the forthcoming book, “Deconstructing Toxic Narratives: Data, Disparities, and a New Path Forward in the Opioid Crisis.”

Sounds Are More Intense When You Have Chronic Pain

By Crystal Lindell

Throughout the day, whenever I hear something particularly high-pitched or loud, I will often turn to my fiancé and say, “Turn it down. That sound is literally causing me pain.”

He always obliges, but I know he’s skeptical. And I understand that my complaint doesn’t really make sense. 

However, new research seems to support my experience.

A study at the University of Colorado Anschutz School of Medicine, published in the Annals of Neurology, found that people with chronic pain are significantly more sensitive to sound.

For the study, researchers recruited 142 adults with chronic back pain and 51 healthy people who were pain free. While receiving MRI brain imaging, both groups had mechanical pressure put on their bodies to stimulate pain, while being subjected to annoying sounds. Participants were then asked to rate how unpleasant the experience was.

The differences in responses between chronic pain patients and healthy controls was significant. On average, back pain sufferers reacted more strongly than 84% of people without pain.

The researchers also looked at brain activity during the experiments. The MRI scans showed stronger responses in brain regions that process sound (the auditory cortex) and emotional sensations (the insula). There was lower activity in regions that normally help calm or regulate emotions, like the medial prefrontal cortex.

Interestingly, the results overlap with other studies showing how patients with fibromyalgia react to painful stimuli.

"Our findings validate what many patients have been saying for years, that everyday sounds genuinely feel harsher and more intense. Their brains are responding differently, in regions that process both the loudness of sound and its emotional impact,” said senior author Yoni Ashar, PhD, Co-Director of the Pain Science Program at the Anschutz School of Medicine. 

“This tells us chronic back pain isn't just about the back. There's a broader sensory amplification happening in the brain, and that opens the door for treatments that can help turn that volume down." 

The researchers wanted to see which treatments could help reduce the brain’s response to noise. The pain patients were broken up into three groups that received either Pain Reprocessing Therapy (PRT), a placebo saline injection, or the usual care they were already getting for back pain. 

PRT is a type of mindfulness therapy, in which patients are encouraged to think differently about their pain in order to minimize it.

Out of all the treatments, PRT was the most effective. It reduced the heightened brain response to sound and increased activity in brain regions involved in regulating unpleasant experiences. But the effect was only minimal.

"These findings add to growing evidence that chronic back pain is not just a problem in the back. The brain plays a central role in driving chronic pain, by amplifying a range of sensations – such as sensory signals from the back, sounds and likely other sensations as well," said Ashar.

Overall, it’s great to see research like this validating what I know is a common experience for chronic pain patients.  

However, I do think there may be some “chicken and the egg” issues with this study. Which comes first: sensitivity to sound or back pain?

Maybe people who are more sensitive to sound are more likely to develop chronic pain. In other words, does the pain cause sound hypersensitivity, or does hypersensitivity cause the pain? 

Ashar and his research team plan further studies of senses other than hearing — such as light, smell or taste — to see if chronic pain causes sensitivity to those stimuli and how brain regions respond to them.

California Expands Crackdown on Kratom and 7-OH

By Pat Anson

California is expanding a statewide crackdown on kratom and 7-OH products, with Gov. Gavin Newsom boasting of a “95% compliance rate” in removing the products from store shelves.

“California will not stand by while dangerous, illegal products are sold in our communities. We’ve shown with illegal hemp products that when the state sets clear expectations and partners with businesses, compliance follows. This effort builds on that model — education first, enforcement where necessary — to protect Californians,” Newsom said in a statement.

California’s crackdown began last October, when state health officials issued a consumer warning claiming that kratom and 7-OH are dangerous and illegal to sell. State agents also began visiting over 4,500 licensed retailers, urging them to voluntarily remove the products from their shelves.

Enforcement actions stepped up in January, with most retailers complying. To date, 61 violations have been reported, with over $5 million worth of kratom and 7-OH products seized.  The state has warned non-compliant vendors that they could lose their licenses to operate.

To be clear, the enforcement action is uneven. It’s still relatively easy to order kratom or 7-OH products from out-of-state and have them shipped to California, where I live.  

I visited a retail outlet in the San Gabriel Valley this morning that was still selling kratom, but not 7-OH. A clerk at the store told me they knew 7-OH “would be a problem” due to its potency and, as a result, had never sold 7-OH products. 

7-OH (7-hydroxymitragynine) is an alkaloid that occurs naturally in kratom in trace amounts. When concentrated, it has opioid-like effects that can relieve pain and boost energy levels. Natural leaf kratom has similar, but milder effects, and has been used for centuries in Southeast Asia as a natural pain reliever and stimulant.

While hundreds of fatal overdoses in the U.S. have been blamed on kratom, the evidence supporting that claim is thin. Other drugs and substances are usually involved, making it difficult to attribute the deaths to a specific cause.

Federal Efforts Foiled

In recent years, several states and dozens of local municipalities have banned kratom and/or 7-OH sales, but federal efforts have been stymied by lack of evidence they are harmful. 

In 2016, the DEA and FDA tried unsuccessfully to classify 7-OH and the kratom alkaloid mitragynine as illegal Schedule One controlled substances, only to drop those efforts after a public outcry. A top federal health official later said the FDA withdrew its scheduling request because of “embarrassingly poor evidence & data.” 

Last summer, the FDA said it would ask the DEA once again to schedule 7-OH as a controlled substance, but the DEA has yet to act on that request.

Even when the FDA has acted on its own, it has run into difficulty. In 2023, the agency seized nearly 250,000 bottles of “Feel Free,” an herbal drink containing kratom, from Oklahoma-based Botanic Gardens. The FDA alleged the drink was an adulterated substance and there was inadequate information that it was safe to consume.

Over a year later, the FDA quietly dropped the case. Botanic Gardens has continued to manufacture and sell Feel Free, because the FDA never obtained a permanent injunction telling them to stop. 

Some of the agency’s own research, recently published in the journal Therapeutic Drug Monitoring, supports the safety of kratom.  

When natural leaf kratom was given to 116 healthy volunteers for 47 days in a placebo-controlled clinical trial, including some at very high doses, researchers reported kratom was “well tolerated,” with no serious adverse events and “no evidence of meaningful abuse potential or withdrawal.”

The FDA now says it “not focused on natural kratom leaf products” and only wants concentrated 7-OH extracts banned.

Critics say ham-handed efforts by federal, state and local governments to ban either kratom or 7-OH could backfire by fueling demand for a new illicit drug. 

“Moving 7-OH into Schedule I would not eliminate demand; it would displace it, shifting sales from regulated retail settings into illicit markets where potency is unverified, adulteration is common, and risks are far greater,” Jeffrey Singer, MD, a senior fellow at the Cato Institute, wrote in an op/ed in the Washington Examiner.

“Such a step could also provide transnational criminal organizations with yet another product to layer onto a portfolio already dominated by fentanyl and its analogues. In striving to prevent harm, lawmakers risk repeating a familiar policy pattern — one that inadvertently amplifies danger while removing a lower-risk alternative from the legal marketplace.”

Why Is There Always Money for War, But Never Healthcare?

By Crystal Lindell

When Sen. Bernie Sanders was running for president in 2020, he campaigned for universal healthcare, also known as “Medicare for All.”

As someone with a chronic illness that started to impact my life at just 29 years old, it’s a program I supported. I was too young for traditional Medicare, and was quickly getting too sick for traditional work. So, I was desperate for a realistic alternative.

But any time Bernie’s Medicare for All proposal was mentioned, people always responded in the same robotic way: “How are we going to pay for it?”

They were not calling for the federal budget to suddenly be balanced. The question was solely intended to make advocacy for Medicare for All sound childish. And unaffordable.

Nobody ever asks that about war though.

As the United States showered multi-million-dollar bombs and missiles on Iran this week, the war was framed as such a national security imperative that the cost was barely worth addressing.

Questions about how we’ll pay for the war were dismissed as absurd by the political class and by many Americans.

But no mistake, there is a price tag — and it’s a large one.

Kent Smetters, director of the Penn Wharton Budget Model and one of the nation’s foremost fiscal analysts, told Fortune that the total economic cost of “Operation Epic Fury” could reach $210 billion.

It’s tempting to think of these things as separate problems. War in one bucket, healthcare in another.

But the thing about my federal taxes is that I don’t pay them in separate buckets. I pay my taxes and let someone else decide how to spend it.

That means, when they take my tax money and give it to weapons manufacturers, that’s money not spent on funding things that would actually improve my life as a citizen, like universal healthcare.

It’s a lose-lose option.  

I was laid off from my full-time job in 2022 — and that was the last time that I had health insurance. In the years since, I have navigated life with a mix of freelancing, DoorDashing, and cash payments for medical care that I couldn’t avoid.

In fact, I have a prescription to pick up this afternoon, and my main concern is a familiar one: “How am I going to pay for it?”

When our government abandons us, our problems don’t go away. Rather, they just turn into personal struggles that we are expected to figure out on our own.

So, if it’s childish to not want my taxes used to kill people in Iran, and childish to prefer that money be use for universal healthcare – then call me a little kid, because that’s not the type of adulthood I want to be a part of. 

Many Rotator Cuff Surgeries May Be Unnecessary

By Pat Anson

Since I write about chronic pain and the many different treatments for it, it’s not uncommon for readers to ask if I’ve ever experienced it myself.

The answer, unfortunately, is yes. 

About 15 years ago, I started feeling a dull pain in my left shoulder that wouldn’t go away. It progressively grew worse, and my arm became so painful to move that I had trouble putting on a shirt or sleeping in the same position for more than a few hours. 

Only then did I finally see a doctor. An MRI confirmed there was a “wrinkle” in my rotator cuff,  and that the ligaments, muscles and tissue in my shoulder were inflamed. I had adhesive capsulitis, also known as a “frozen shoulder.” 

The doctor gave me a cortisone shot and prescription strength ibuprofen, and when neither of them helped, he recommended rotator cuff surgery or physical therapy. I opted for the latter. 

Everyone thinks their lived experience with pain is unique, and I’m no different. But it turns out my experience with shoulder pain is all too common and is likely a normal part of aging. 

According to a new study in JAMA Internal Medicine, almost everyone over the age of 40 will experience a rotator cuff injury.

Using MRI images, researchers in Finland studied the shoulders of over 600 people between the ages of 41 and 76. Although only 1 in 6 had complaints of shoulder pain, virtually everyone had a rotator cuff injury of some kind, ranging from a full tendon tear to age-related joint damage.

The findings challenge the value of advanced imaging like MRIs, which may be diagnosing shoulder problems that don’t need fixing — or at least don’t need to be treated with invasive injections and surgeries.

“In this population-based study, RC (rotator cuff) abnormalities were nearly universal after age 40 years and showed poor concordance with shoulder symptoms,” wrote lead author Thomas Ibounig, MD, an Orthopaedic Surgeon at Helsinki University Central Hospital.

“These findings suggest that RC abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain.”

Ibounig and his colleagues found that many people can have inflamed tendons (tendinopathy), full tendon tears (FTTs) and partial tendon tears (PTTs) in their shoulders without experiencing pain or any other symptoms. Only when they get medical imaging are the rotator cuff abnormalities found, which sets in motion a process that can lead to invasive treatments. 

About half a million rotator cuff repairs are performed annually in the United States, with the surgeries increasing at a rate of about 2% a year for patients 50-64 years of age. Their success rate is mixed, from about 90% for PTTs to as low as 50% for FTTs. Full recovery from rotator cuff surgery may take several months to a year. 

The Finnish study suggests that many of those surgeries are unnecessary and that shoulder pain should be accepted as a normal part of aging.  

“Given that tendinopathy, PTTs, and even FTTs may be incidental findings, clinicians should consider their high population prevalence when interpreting imaging results and deciding on interventions targeting these abnormalities. Reframing many of these findings as normal age-related changes rather than disease may help guide more appropriate care and reduce unnecessary interventions,” they concluded.

It took several months of physical therapy before my shoulder pain subsided. It still aches occasionally, but I no longer have the sharp stabbing pain that I used to get. And it’s no longer chronic.

I still use the stretches and exercises that I learned during physical therapy to keep my left shoulder from “freezing” again. It’s a good thing I learned how to do them, because now my right shoulder aches too. 

As Anxiety Grows, More Americans Turn to Antidepressants

By Phillip Reese, KFF Health News

After a grueling year of chemotherapy, surgery, and radiation to treat breast cancer, Sadia Zapp was anxious — not the manageable hum that had long been part of her life, but something deeper, more distracting.

“Every little ache, like my knee hurts,” she said, made her worry that “this is the end of the road for me.”

So Zapp, a 40-year-old communications director in New York, became one of millions of Americans to start taking an anxiety medication in recent years. For her, it was the serotonin-boosting drug Lexapro.

“I love it. It’s been great,” she said. “It’s really helped me manage.”

The proportion of American adults who took anxiety medications jumped from 11.7% in 2019 to 14.3% in 2024, with most of the increase occurring during the covid pandemic, according to survey data from the Centers for Disease Control and Prevention. 

That’s 8 million more people, bringing the total to roughly 38 million, with sharp increases among young adults, people with a college degree, and adults who identify as LGBTQ+.

Even as psychiatric medications gain public acceptance and become easier to access through telehealth appointments, the rise of a class of antidepressants called selective serotonin reuptake inhibitors, known as SSRIs, has triggered a backlash from supporters of the “Make America Healthy Again” movement who argue they are harmful. 

Doctors and researchers say medications such as Prozac, Zoloft, and Lexapro are front-line treatments for many anxiety disorders, including generalized anxiety disorder and panic disorder, and are being misrepresented as addictive and broadly harmful even though they’ve been proved safe for extended use.

Health and Human Services Secretary Robert F. Kennedy Jr. has decried broadening SSRI use. During his 2025 confirmation hearing, he said he knows people, including family members, who had a tougher time quitting SSRIs than people have quitting heroin. More recently, he said his agency is studying a possible link between the use of SSRIs and other psychiatric medications and violent behavior like school shootings.

Food and Drug Administration Commissioner Marty Makary has also suggested that SSRI use among pregnant women could lead to poor birth outcomes.

SSRIs’ common side effects include upset stomach, brain fog, and fatigue. Some SSRIs also can reduce libido and cause other sexual side effects.

For many people, however, the side effects are mild and tolerable and the benefits of treating chronic anxiety are worth it, said Patrick Kelly, president of the Southern California Psychiatric Society. “The statements about SSRIs were just not grounded in any sort of evidence or fact,” Kelly said of Kennedy’s comments.

A recent comprehensive study showed that over half of people with generalized anxiety disorder taking an SSRI saw their anxiety symptoms reduced by at least 50%. Side effects prompted about 1 in 12 to stop taking an SSRI.

“When it’s being done right and when you’re also using appropriate therapy techniques, SSRIs can be really, really helpful,” said Emily Wood, a psychiatrist who practices in Los Angeles.

MAHA Blames Anxiety on Poor Diet, Lack of Exercise

Supporters of MAHA have partly blamed poor dietary choices and the increase of a sedentary lifestyle for the rise of a number of health problems, including anxiety, depression, and other mental health disorders. 

As a remedy, they have called for measures such as reducing consumption of ultraprocessed foods, which studies in recent years have connected to depression and anxiety, and cutting back on screen time in favor of exercise.

Psychiatrists often encourage a healthy diet and exercise as an adjunctive therapy for anxiety and depression. Wood said those who can manage anxiety without medication should also consider talk therapy. 

The proportion of American adults using mental health counseling boomed from 2019 to 2024 as teletherapy grew in popularity, federal data shows. “Anxiety disorders are amongst our psychiatric disorders that really respond well to cognitive behavioral therapy,” she said.

But medication can help.

Studies show the risks of taking SSRIs during pregnancy are low for mother and child. By contrast, “depression increases your risk for every complication for a mother and a baby,” Wood said, adding that recent statements by government officials about SSRI use during pregnancy are “potentially leading to real harm for these women.”

Some people who stop taking antidepressant medication will experience nausea, insomnia, or other symptoms, especially if they quit suddenly. But “the concept of addiction simply does not apply to these chemicals,” Kelly said, a statement backed up by studies.

Addiction, though, is a possibility with benzodiazepines such as Xanax that are often a second line of treatment for anxiety. These controlled substances can also increase the risk of opioid overdose in patients taking both types of drugs. During congressional hearings last year, Kennedy also decried benzodiazepine overuse as a problem.

While benzodiazepines are effective for short-term use, they require monitoring and care, Wood said.

“Those are really great meds for acute anxiety and not great as long-term anxiety medications, because they are habit-forming over time,” Wood said. “If you’re taking them on a daily basis, you’ll need more and more to get the same effect, and then you have to come down from them in a tapered way.”

And an increasing number of people are also occasionally taking beta-blockers such as propranolol for anxiety. Some people use beta-blockers to prevent a racing heart before a public speech or other big moments, even though they are not FDA-approved for treating anxiety and are prescribed “off-label.”

Beta-blockers can cause dizziness and fatigue, but they are “nonaddictive, really helpful for bringing down the autonomic nervous system, going from fight or flight to something more neutral, and really safe,” Wood said.

Social Changes Drive Increased Use of Anxiety Meds

A number of leading theories could explain why so many more people are taking anxiety medication, including increased social media use, more isolation, and heightened economic uncertainty, physicians and researchers say.

Plus, the medicines are relatively easy to get. Many people obtain SSRI and benzodiazepine prescriptions from their primary care physician. Others obtain the medications after a brief teletherapy appointment.

Many social media influencers talk about their mental health struggles, easing some stigma among young people and encouraging them to get help. About a third of teens in a recent study said they get mental health information via social media.

Still, increased access to anxiety medication can be a problem when combined with a trend of self-diagnosis based on social media trends. A Google search for “buy Xanax online” leads to sponsored promises of same-day treatment, though fine-print disclaimers clarify that a prescription is not guaranteed.

“I think increased access is good, but that’s not the same thing as, you know, ordering Xanax online,” Kelly said.

Young adults are largely driving an increase in anxiety medication use. The proportion of Americans ages 18 to 34 taking anxiety medication rose from 8.8% in 2019 — the first year such survey data became available — to 14.6% in 2024. By contrast, the rate didn’t change much among adults 65 and older, CDC data shows.

The pandemic and covid lockdowns greatly increased stress among many American adults, particularly young adults.

And data shows more women than men take anxiety medication. Jason Schnittker, a department chair and professor of sociology at the University of Pennsylvania, said that’s because they’re more likely to need them. They are also likelier than men to report when they feel anxious, and doctors are “inclined or see anxiety more readily in their female patients than their male patients,” Schnittker added.

Broader trends could also be at work. Schnittker said studies have shown anxiety growing more prevalent among ensuing generations for much of the 20th and 21st centuries. 

Schnittker, author of Unnerved: Anxiety, Social Change, and the Transformation of Modern Mental Health, said growing income inequality could be partly to blame, with people feeling stress over improving their economic status. Social and religious activities have been replaced by more isolation. And people have become more suspicious of others, creating a sense of unease around strangers.

For Zapp, the cancer survivor, it took a few months on Lexapro before she started seeing clear results. When she did, she said, it felt like her mind was less noisy, making it easier to focus. She also underwent talk therapy, but now her chronic anxiety is stabilized on medication alone.

“It definitely helped me get back to my day-to-day in a way that was productive and not just riddled with my anxieties throughout the day,” she said.

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

Tapering Plan Led by Pharmacists Shows No Benefit for Seniors

By Crystal Lindell

If pharmacists helped taper elderly patients off opioids and benzodiazepines, would that reduce their risk of falling?

Turns out, the answer is no. Having pharmacists get involved in a senior’s treatment plan doesn’t significantly reduce fall risk or prescriptions for the medications, according to research recently published in JAMA..

Falling is a significant risk factor for seniors, because their bones fracture more easily and it takes longer for them to recover. Medications that impair balance – such as opioids and anti-anxiety drugs – raise the risk of falling, especially in seniors who take them concurrently. 

Researchers at the University of North Carolina School of Medicine recruited 15 primary care clinics to participate in the study. Nearly 2,100 patients at the clinics met the study criteria, which was being over the age of 65 and having a long-term prescription for opioids and/or benzodiazepines. 

Over 95% of the patients on opioids had chronic pain and about a third of them had a fall in the past year..

Pharmacists for about half the patients were encouraged to “deprescribe” them, when appropriate, by recommending a voluntary taper plan to their doctors  The other patients received usual care from their doctors, without any tapering recommendations, and served as a control group.

A year later, doctors followed the pharmacists’ advice by tapering 21.4% of patients off of opioids. But that was only slightly more than the control group, which saw opioids discontinued for 19.9% of patients. The tapering rates for benzodiazepines were similar and “not statistically significant."

Notably, there was little difference in falls between the two groups, which were essentially “unchanged” by the tapering.

In other words, having a pharmacist make tapering recommendations to doctors had very little, if any, impact. Tapering occurred in both groups, whether a pharmacist was involved or not.

“Although reductions occurred in both groups, the intervention did not significantly reduce prescribing or falls at 1 year. Still, pharmacist recommendations were feasible to implement and accepted more often than rejected, indicating general practitioner receptiveness,” researchers concluded. “These results suggest that a consultant pharmacist–led intervention is feasible to implement in primary care clinics.”

Note the word, "feasible" rather than "effective." Sure, it can be done, but that doesn't mean it should be done.

I would guess that the program did not reduce prescriptions for opioids and benzodiazepines anymore than the control group because prescribing had already been reduced. At the start of the study, the average daily dose of opioids was 23.6 morphine milligram equivalents (MME), which is a low to moderate dose.

Given how much these medications are already being restricted, few patients are getting opioids or benzos if they don’t desperately need them – not even seniors.

Beyond that, I think it’s really important to take a step back when looking at research like this and consider the patient’s perspective. 

How were the tapering plans presented to patients? Were they asked to weigh the pros and cons? Did they have a voice in their treatment?  

I suspect if they were given the option of staying on a medication or reducing their fall risk, many seniors would choose to stay on the medication. 

Unfortunately, the study authors seem to take the wrong lesson from the research, at least in my opinion. Although their study failed to prove much of anything, they concluded there should be “more intensive or sustained deprescribing strategies.”

There are a lot of studies looking at ways to reduce opioid prescriptions — I suspect because those are the easiest to fund — and I’m honestly glad this one failed. 

The biggest problem many seniors face today is that they cannot get access to effective pain and anxiety treatment. If anything, researchers should be working to address that problem, rather than making it worse.

Instead of working on blanket reductions for these types of medications, I wish they would look at finding alternatives that actually work.

If you lost a loved to suicide after a change in their prescription pain medication, please consider participating in a survey to help researchers learn more about these tragic situations. Click here or on the banner below for more information.

Opioids Effective for Many Acute Pain Conditions

By Pat Anson

As pharmaceutical companies scramble to develop new non-opioid treatments for pain, a large new review found that opioid analgesics are effective for many acute pain conditions and come with little risk.

Led by researchers at the University of Sydney, the study looked at 59 clinical studies for dozens of short-term acute pain conditions.

They found “high-certainty” evidence that opioids were effective in treating abdominal pain, postpartum pain and dental pain; “moderate-certainty” evidence that they relieve pain from sciatica, post-operative pain and ten other acute conditions; and “low-certainty” evidence that they work on nine other short-term pain conditions.

There was no high quality evidence that opioids are ineffective for acute pain, but there was moderate and low quality evidence that they provide little relief for some acute conditions, such as pain from minimally invasive surgeries.

Adverse events were limited to vomiting and nausea, with no serious events like overdose, death, or addiction reported in any of the 59 studies.

“This paper is best understood as a broad evidence map, not a simple yes/no verdict on opioids for acute pain. It shows that opioids have helped in some acute pain conditions, but benefits are mixed, often modest, and vary by condition and timepoint,” said Lynn Webster, MD, a pain management expert and Senior Fellow at the Center for U.S. Policy, who was not involved in the study.

“The authors did not find a significant increase in serious adverse events in these short-term trials, but they also emphasize that harms reporting was incomplete.”

In short, opioids work for many acute pain conditions, depending on the dose, and pose no serious risk of harm, at least over the short-term.

“There was no high certainty evidence showing that opioids were not efficacious,” researchers reported in the journal Drugs. “There was no significant increased risk of serious adverse events in any review.”  

‘Opioids Aren’t Effective’ 

But that is not how the study was portrayed in a University of Sydney press release, which warned in a headline that “opioids aren’t effective for many acute pain conditions.”

The release quoted one author as saying opioids work “only slightly better than a placebo” and are not worth the risk.

“Our review found that they did not provide large or lasting pain relief compared with placebo for the vast majority of acute pain conditions, with pain relief typically lasting only a few hours,” said lead author Christina Abdel Shaheed, PhD, an Associate Professor in the School of Public Health at the University of Sydney. 

“By showing that the benefits are generally small, short-lived, absent for many common conditions, and sometimes harmful, our research challenges the widely held belief that opioids are the most effective ‘go-to’ option for acute pain.”

Shaheed and several of her co-authors have participated in other studies that take a dim view of opioids. One is a controversial 2023 trial, known as the OPAL study, which found that low doses of oxycodone work no better than a placebo in relieving acute back or neck pain. 

“Opioids should not be recommended for acute back and neck pain, full stop,” said Christine Lin, PhD. a Professor of Public Health at the University of Sydney, who was the lead investigator of the OPAL study and a co-author of the new study. 

Critics complained the OPAL study’s conclusions were too broad, not supported by evidence, and “misplaced and dangerous.”  In reply, Lin agreed that they may have gone too far and that their findings “might not be generalizable to all patients.”

Dr. Webster takes a similar view of the new study, saying it would be wrong to draw conclusions about the effectiveness or harm caused by opioids, given the low quality of most studies that were reviewed.

“The paper is best viewed as a map of evidence gaps and variable-quality evidence, not a final word,” Webster told PNN. “Most of the underlying reviews were rated critically low quality, so the paper is very useful for mapping what we know and what we still don’t know. Broad conclusions about opioid efficacy would be inappropriate.” 

One of the co-authors of the new study is Jane Ballantyne, MD, a former President and current Vice-President of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group. Ballantyne reported no conflicts of interest, although in the past she has acknowledged serving as a paid expert witness in opioid litigation cases.

Why Are Women More Likely to Have Chronic Pain? Blame Hormones

By Crystal Lindell

Chronic pain typically lasts longer for women than men, and new research suggests hormones could be to blame. That’s according to a study at Michigan State University, published in Science Immunology. 

We’ve known for some time that women are more likely to have chronic pain, and that is likely because it takes longer for their pain to resolve. Acute pain becomes chronic when it lasts longer than three months. 

The researchers looked into the potential causes of this phenomenon, and found that differences in hormone-regulated immune cells, called monocytes, seem to be the culprit.

A subset of monocytes releases a molecule – called interleukin-10 or IL-10 – that can “switch off” pain. Those cells are more active in males because of higher levels of sex hormones such as testosterone. Females, however, experienced longer-lasting pain and delayed recovery because their monocytes were less active.

When the team tested their theory on laboratory mice, they discovered the same pattern they saw in human patients. They performed five different tests on the mice to make sure what they saw wasn’t an anomaly. Each time, the results were the same.

“The difference in pain between men and women has a biological basis,” lead author Geoffroy Laumet, an associate professor of physiology at MSU, explained in a press release. “It’s not in your head, and you’re not soft. It’s in your immune system.

“This study shows that pain resolution is not a passive process. It is an active, immune-driven one.”

These findings could mean those immune cells can be manipulated into producing more signals to calm pain.

Laumet hopes this research could one day help millions of people experience relief with non-opioid treatments — and ensure women’s pain is taken more seriously. Such treatments could help acute pain resolve faster, instead of relying on analgesics to block pain signals.

The next step is to investigate how treatments could target this pathway and boost IL-10 production, although Laument admits that could take years. 

“Future researchers can build on this work,” Laumet said. “This opens new avenues for non-opioid therapies aimed at preventing chronic pain before it’s established.”

In the meantime, hopefully this type of research will encourage medical professionals to believe women when they say their pain is not going away. 

The MSU study was funded by the National Institutes of Health and the Department of Defense.

Exercise Is Hard for Me. Now I Know Why

By Madora Pennington

Exercise is difficult for me. I’m lucky I can do it at all. I am extremely double-jointed because my tendons and ligaments are excessively stretchy as a result of hypermobile Epstein-Danlos Syndrome (hEDS), a connective tissue disorder I was born with.

When I play sports, go the gym or even swim, I see others moving with an ease that is out of my reach. I wonder what exercise feels like for them. I get so worn out — and no matter how fit I get — this does not change. What exactly is different about exercise for me, I never fully understood.

I am hardly alone. Here are some typical comments in online support groups from people with hEDS or Hypermobility Spectrum Disorders (HSD) looking for advice on exercise:

“I try now and then to walk on the treadmills for a slow 20 min, but it just makes me feel worse.”

“I’m 27. When I exercise, I get migraines and all over muscle tension. I always fail at physical therapy. My body does not respond like others.”

“Exercise intolerance hardly describes it. I can’t keep up with my peers. I have severe pain and fatigue. If I exercise, pain starts in my legs, builds and becomes intolerable.”

“I went to Disneyland. I couldn’t stay more than two hours before I was in so much pain, I could barely make it to the car.”

Recently, Canadian researchers published a study on the mechanics of walking in people whose joints are loose to better understand why it might be so painful and exhausting for them. They compared 11 hypermobile adults with 11 healthy (non-hypermobile) adults of the same age and gender, and found why walking can be such an arduous affair for those of us with loose joints.

Tendons and ligaments — the connective tissue that connect bones to bones and muscles to bones — should be like tight rubber bands. They should bend, but not stretch. Part of their job is to transfer force and energy like a coiled spring back to muscles.

When tendons and ligaments are stretchy or hypermobile, not only do they fail to hold joints in place, they cannot return unused energy back to the muscles to power more movement. Simply moving a body with loose joints is, in fact, a very big problem.

To understand the difference between the two groups, study participants had ultrasound images taken of their legs, the stiffness of their Achilles (ankle) tendon measured, and their ankles’ range of motion recorded. They walked on a treadmill and had their oxygen consumption and muscle electrical activity measured.

The results showed that if you are double-jointed:

• Your muscles have to shorten excessively to compensate for too much “give” in the tendons. This is extra work for a muscle that does not enhance performance.

• A stretchy tendon cannot send energy back to the muscle, so energy is drained, not recycled back into the system, even as muscles are working harder.

• Neighboring joints and muscles have to participate in walking in ways they normally would not to compensate for the lack of stability. That’s yet another energy drain.

In short, researchers found that each step takes more energy, and is less powerful and less efficient. That’s why walking with loose joints can be so exhausting and painful.  

“In this investigation, people with HSD/hEDS showed a significantly higher energy cost of walking and lower muscle strength. These differences were accompanied by significantly higher ratings of pain and higher muscle coactivation during stance following walking at, above and below their preferred walking speed,” researchers concluded.

Individualized physical therapy or gait training designed for people with hypermobility could help them become better walkers. After all, mobility —  being able to get around and do things for yourself — provides quality of life and better health. Good mobility also reduces the likelihood of falling injuries. 

While increasing strength and physical fitness won’t solve hypermobility issues, it can make exercise safer, less of an effort, and more enjoyable.

Illicit Use of Rx Opioids Down Significantly

By Pat Anson

The illicit use of prescription opioids by patients undergoing addiction treatment has fallen dramatically over the past decade, according to a new analysis by Millennium Health. 

The drug testing company analyzed nearly 1.7 million urine samples collected from patients diagnosed with substance use disorder (SUD). The findings show that opioid pain medication now plays only a minor role in the nation’s drug crisis, while the use of stimulants is growing.  

In 2016, up to 80% of the patients who tested positive for illicit fentanyl also tested positive for a prescription opioid that was not prescribed to them. 

By 2025, only 4.9% of patients tested positive for both fentanyl and an illicit prescription opioid. There was a lot of regional variability in the numbers, with 9.1% of SUD patients in the South testing positive for both fentanyl and Rx opioids, compared to only 4.1% in the West.

Positive Drug Tests for Fentanyl and Prescription Opioids

SOURCE: MILLENNIUM HEALTH

“Within the population using fentanyl, we've seen a continued drop in the detection of prescription opioids in those using fentanyl. In 2025 the positivity rate for prescription opioids, I’m talking about hydrocodone, hydromorphone, oxycodone, oxymorphone, tramadol as a group, are at all-time lows in our database,” said Eric Dawson, PharmD, Vice President of Clinical Affairs at Millennium Health.

The findings suggest that fewer prescription opioids are being diverted into the illicit drug supply. That makes sense, as opioid prescribing has fallen sharply over the past decade and the medications are difficult for many pain patients to get. According to the DEA, the estimated diversion rates for hydrocodone (0.53%) and oxycodone (0.69%) in 2026 are both well under one percent.

In their place, illicit drug users have increasingly turned to stimulants, such as methamphetamine and cocaine. Millennium’s data shows that while fentanyl and opioid use have declined in recent years, stimulant use has risen steadily.

Positive Drug Tests for Fentanyl, Opioids and Stimulants

SOURCE: MILLENNIUM HEALTH

“It makes us wonder if we're now moving to something more prominent, larger. I don't know the right word there, but a stimulant era,” Dawson told PNN.

“I continue to hear it everywhere I travel. Stimulants, methamphetamine and cocaine, are just incredibly plentiful in so many communities, and extremely inexpensive. And so, if you present a drug in front of a population that tends to use drugs and it's cheap or free and potent, they tend to gravitate toward that.” 

Another trend that appears in Millenium Health’s drug testing data is the growing detection of kratom and its alkaloids, mitragynine and 7-hydroxymitragynine (7-OH).

In 2016, less than 1.5% of patients nationwide being treated for SUD tested positive for a kratom alkaloid. By 2025, that had grown to about 3 percent, with even higher levels in the South.

Positive Drug Tests for Kratom

SOURCE: MILLENNIUM HEALTH

Part of that growth can be attributed to the wider availability of kratom and increased awareness that the herbal supplement can be used to treat pain, anxiety and other health conditions. 

The federal government estimates that 1.7 million Americans used kratom in 2021. The American Kratom Association, a kratom advocacy group, puts the number much higher, at 10 to16 million Americans.

The growing awareness about kratom has spread to addiction treatment providers. In 2016, only about a third of Millennium Health’s urine drug tests included a request from a provider to test for kratom. By 2025, over 77% of urine drug tests included an analysis for kratom.