Chronic Pain Patients Have Highest Rates of Stigmatizing Language in Medical Records

By Crystal Lindell

Chronic pain patients are the most likely group to find discriminating and judgmental language in their medical records, according to a new study published in JAMA.

The researchers also found that having a low income increased the likelihood of patients finding stigmatizing language in their records. Being older decreased the chances of finding it.

The research is based on a survey of 500 people from a nationally weighted sample of U.S. adults. The study was made possible by passage of the 21st Century Cures Act in 2021, which began a new era of transparency in healthcare by giving patients immediate access to their clinical notes in electronic health records.. 

About 1 in 6 patients (17.1%) reported discriminating or judgmental language (DJL) in their medical records or health care encounters. Such stigmatizing language was defined as any terminology that "conveys disbelief, disapproval, or implicit judgment about a patient’s character, behavior, or social identity.”

Researchers anticipated that medical providers would be more careful about their choice of words, knowing patients might see them. But five years after passage of the Cures Act, there was “little if any improvement” in stigmatizing language.  

“Our findings are consistent with a broader literature on stigma and health communication, demonstrating that DJL can undermine trust, reduce patient engagement, and negatively influence patient perceptions of health outcomes,” wrote lead author Natasha Steele, MD, Stanford University School of Medicine. 

Steele and her colleagues found that patients with chronic pain were 3.25 times more likely to find stigmatizing language in their medical notes, compared to people who did not have chronic pain. It was the highest rate of any group in the study.

Low-income patients were 2.64 times more likely to find discriminating and judgmental language, compared to other income groups.

Interestingly, older people were slightly less likely to find stigmatizing language compared to other age groups. For each additional year of age, the odds of finding it dropped by about 2%.

Beyond that, the researchers did not find links between gender, race, ethnicity, or educational level and the likelihood of patients finding stigmatizing language.

Not surprisingly, finding negative language in their medical records made patients less likely to trust that their medical providers were doing a good job of documenting their health issues. 

About 85 percent of patients said they were less likely to see that clinician again and 75% worried it would influence their treatment. A similar percentage thought it would lead to worse health outcomes, including the possibility of medication or diagnostic errors. 

The stigmatizing language was also associated with nearly 6-fold higher odds of diminished trust in clinicians to write accurate and respectful notes.

The researchers said that while health record transparency is a good thing, clinicians need to change their note-take practices in response.

“Our study demonstrates the need for clear standards promoting respectful communication in both medical documentation and clinical interactions. Clinical training programs should emphasize person-centered language, particularly since written notes are increasingly visible to patients, with special attention to populations that may be subject to bias based on social identity,” they said.

Clinical Trials Begin in U.S. for First Cannabis-Based Medicine for Chronic Pain

By Pat Anson

The first clinical trials in the United States for a cannabis-based medicine for chronic pain are getting underway.

New York State has authorized a clinical trial of VER-01 in patients with chronic low back pain from lumbosacral radiculopathy, commonly known as sciatica. VER-01 was developed by Vertanical, a German biopharmaceutical company, and recently became available by prescription in Europe, where it is sold under the brand name Exilby.

Exilby is a full spectrum extract derived from THC, CBD and terpenes found in cannabis sativa. Unlike other cannabis-based medicines already on the market, such as Epidolex and Marinol, which are used to treat epilepsy and improve appetite, Exilby was specifically developed to treat chronic pain.

“This is an important moment for cannabis research in New York and for the future of evidence-based cannabis medicine,” John Kagia, executive director of New York Office of Cannabis Management (OCM), told The Marijuana Herald. “For decades prohibition and criminalization limited the ability of researchers to fully understand cannabis and its potential therapeutic applications.”   

Research into the pain-relieving properties of cannabis has been slow in the U.S., in large part because of marijuana’s longtime status as an illegal Schedule One controlled substance. Marijuana is now more readily available for research purposes, but there’s a lot of catching up to do with the rest of the world.

“Clinical research allows us to move beyond anecdote and evaluate cannabis-based medicines with the same rigor applied to any other therapy,” said Nakesha Abel, PhD, Director of Scientific Programs & Research Health & Scientific Affairs at OCM.

Vertanical has also begun recruiting patients in Texas for a Phase Three clinical trial of VER-01 with 810 participants. Researchers are looking for patients with chronic painful lumbosacral radiculopathy who have previously used non-opioid analgesics that were not sufficient for pain relief or caused unwanted side effects. 

In studies already completed in Europe, VER-01 provided better pain relief to patients with chronic low back pain in a head-to-head comparison with low doses of opioids. Vertanical is also studying VER-01 as a treatment for osteoarthritis and painful diabetic peripheral neuropathy 

Exilby became available in Germany and Austria in September, with approval in the United Kingdom expected by the end of the year.

In March, VER-01 received a Breakthrough Therapy designation from the FDA, which will speed up its development and review in the U.S. But even with “breakthrough” status, a new drug application for VER-01 to the FDA is not expected until 2028.  

I’ll Never Stop Advocating for 7-OH

By Crystal Lindell

It looks like the federal 7-OH ban is actually going to go through this time, and it’s probably going to happen right before Thanksgiving, on November 13.

I guess they just want to make sure everyone who uses 7-OH is miserable and in pain for the upcoming holiday season. Cheers!

RIP 7-OH. You changed my life, and died far too young.

The fact that they aren’t even taking public comments this time is gut-wrenching. They really don’t care about us at all. 

But I will say that I am grateful that we still have one last month with legal 7-OH. I have tapered down significantly, and have hope that I can get fully off it in the next few weeks with almost no physical withdrawal symptoms.

Unfortunately, as a chronic pain patient, it’s not just about avoiding physical withdrawal. I’m still not sure how I’m going to functionally live my life without it.

In fact, when I got the news on Friday that the DEA had updated their letter of intent, I had just taken my morning 7-OH dose, which I need to be able to get ready for the job I only have because of 7-OH.

I’m very worried that I’m going to lose my job when I lose 7-OH.

I started working full-time again in April, and it’s been great! I have already worked my way up to manager, and finally have health insurance again.

I also have called in sick zero days since I started, despite the fact that I have intercostal neuralgia in my ribs, which causes extremely debilitating pain throughout the right side of my torso.  

Over the 13 years I’ve suffered from it, it’s been very difficult to find any medications that help with that pain. Even strong opioids only did so much. I worked a corporate job from home for many of those years, and even with morphine and hydrocodone, I would have to miss work because of the pain.

But then 7-OH came along and changed my whole life.

The fact is, 7-OH works on my pain. It works really well. And, it even helps me with energy as well. I assume that is because 7-OH comes from kratom, which comes from the coffee family of plants.

There’s some controversy in the 7-OH community about whether or not it’s relevant that it comes from the coffee plant rather than poppy plants. Some people say it’s disingenuous to pretend that 7-OH doesn’t impact your brain’s opioid receptors, which it definitely does.

But so does coffee. And as a user, I think it’s disingenuous to try to separate 7-OH entirely from coffee.

It is clearly a coffee-related drug. Coffee is one of those things that you will naturally drink less of if you don’t need it, and in my experience it will even start to taste different. As it happens, this is also my experience with both kratom and 7-OH. My body does not want to take more when I don’t need it.

I used to drink 2 cups of espresso a day, but since I started taking 7-OH, I’ve quit coffee entirely. I just have no taste for it, and the 7-OH does a much better job of giving me the stable energy I need to get through the day.

Before I end this column, I do want to reiterate that I will never again be purchasing any products from any of the ”qualified vendors” that support the American Kratom Association. I would call on all fellow 7-OH users to boycott them as well.

The AKA fought for this 7-OH ban because they think it’s eating into their profits.  

So, instead of making their own products more competitive, they decided the best course of action was to prevent people like me from using their competitors’ products. 

Even worse, the U.S. government is going to enforce the ban, by imposing “administrative, civil, and criminal sanctions applicable” – not just on 7-OH manufacturers, distributors and retailers, but for simple possession. Even research about 7-OH will be a criminal offense!

Land of the not-so-free, I guess.

I don’t know what my future looks like without 7-OH – but I do know what my past looked like without it. Multiple days each month bed-bound, unable to reliably show up for work, no health insurance, and lots of really, really bad pain days.

I refuse to accept that I will be forced back into that life, and that there are no other options. 

I’ll never stop advocating for 7-OH to be legal, no matter how hopeless that fight feels. After all, if medical cannabis can be reclassified and taken out of Schedule One, anything is possible. 

The life I have rebuilt is too valuable to give up on now.

Nationwide 7-OH Ban Likely to Begin Nov. 13

By Pat Anson

The U.S. Drug Enforcement has amended its scheduling order for 7-hydroxymitragynine (7-OH), placing further restrictions on the manufacture, sale and possession of concentrated forms of the kratom alkaloid.  

Under the amended order, to be published next week in the Federal Register, 7-OH products and all other concentrated kratom alkaloids will be classified as illegal Schedule One controlled substances. The order will likely take effect November 13, with no opportunity for public comment.

Kratom leaves have been used for centuries in Southeast Asia as a natural stimulant and pain reliever. Their active ingredients – 7-OH and other alkaloids – occur naturally in kratom in trace amounts. But in recent years manufacturers have found ways to concentrate the alkaloids in new products – essentially turning a mild pain reliever into a potent product with opioid-like effects.

7-OH and other kratom derivatives were recently involved in the deaths of two college students, and there is concern about their potential to cause addiction and overdoses. Three U.S. Senators this week called for all kratom related products to be scheduled or banned – including leaf kratom.     

That created further pressure on the DEA and Justice Department to act. 

“Our nation’s children and communities deserve protection from harmful substances like 7-OH and other powerful synthetic drugs. The actions taken by the Department of Justice today reflect our commitment to keeping Americans safe and holding drug traffickers accountable,” Attorney General Todd Blanche said in a DOJ press release.

Left unsaid in the press release is that the DEA’s amended order is largely in response to a lawsuit by the American Kratom Association (AKA), which represents natural leaf kratom vendors. The AKA supported the scheduling of 7-OH, but wanted a “carveout” for mitragynine pseudoindoxyl, a kratom alkaloid that the DEA banned just two months ago.

The AKA filed a lawsuit against the DEA in July, asking a federal judge to intervene and get the DEA to amend its original orders banning sales of 7-OH and mitragynine pseudoindoxyl.

“They actually did two things that were important. One is they established a carveout for mitragynine pseudoindoxyl, and they changed the standard for 7-OH to a much more restrictive standard, which we fully support because it captures more of the potential synthetic products that they could tinker with,” explained Mac Haddow, an AKA lobbyist and spokesman.

Under the new order, the ban on mitragynine pseudoindoxyl is being lifted to keep it from potentially interfering with sales of leaf kratom. Only trace amounts of 7-OH and mitragynine pseudoindoxyl will be legally allowed in tablets, gummies and liquid shots (1 mg per serving). A 100 to 1 ratio of mitragynine to the other alkaloids – what occurs in nature – must also be preserved. 

AKA Lawsuit Withdrawn

The new DEA order amounts to a major legal victory for the AKA, and comes at the expense of 7-OH manufacturers and vendors, whose products were taking a substantial amount of business away from leaf kratom vendors. 

“We made an agreement to dismiss our lawsuit, but it's conditioned on their publishing under the schedule that they submitted to the court,” said Haddow. “The thresholds draw the line the AKA has been asking for, targeting chemically manipulated opioid products while protecting natural kratom leaf that may contain only incidental trace amounts of these compounds.”

Not surprisingly, 7-OH manufacturers and consumers were disappointed by the DEA’s new order, but held out hope that changes could be made before November 13. Tens of thousands of Americans use 7-OH to relieve their pain, anxiety and fatigue, allowing them to work, care for family, and stay away from more dangerous substances. 

“This is still a Notice of Intent, not a scheduling order,” the 7-HOPE Alliance said in a note to advocates. “It gives us more time to fight, more time to negotiate with the administration, more time that consumers can safely access products they rely on.

“The revised proposal would still threaten access to 7-OH products. We do not agree with how these new thresholds are being set. Once again, this approach favors certain product categories over others without fully considering the consumers who depend on them.”  

While leaf kratom remains legal under federal law, it has been banned by dozens of states, cities and counties. The AKA hopes those local jurisdictions follow the DEA’s example, by taking leaf kratom out of their wholesale bans on 7-OH and other kratom derivatives.

 

Three U.S. Senators Call for FDA Regulation of Leaf Kratom

By Pat Anson

Three U.S. Senators are calling on the FDA and DEA to regulate the “entire kratom plant” under the Controlled Substances Act, a step that far exceeds current plans by the DEA to classify concentrated forms of the kratom alkaloid 7-hydroxymitragynine (7-OH) as illegal Schedule One controlled substances.

Sen. Chuck Grassley (R-Iowa), chair of the powerful Senate Judiciary Committee, initially said in a post last week on Twitter/X  that “All Kratom is deadly” and that it “is killing our kids BEWARE of special interest snake oil.”

The 93-year old Grassley was joined this week by two other U.S. senators, Sen. Mike Lee (R-Utah) and Sen. Susan Collins (R-Maine) in a joint letter to the DEA administrator and acting FDA commissioner calling for the immediate scheduling of 7-OH and to “consider scheduling the entire kratom plant.”

“We urge the Food and Drug Administration to conduct the necessary scientific and medical evaluations of these substances and provide a permanent scheduling recommendation to the Drug Enforcement Administration for the full kratom plant, its derivatives, and all levels of the semi-synthetic analogues like mitragynine pseudoindoxyl, MGM-15, and MGM-16 that are being marketed as natural products.”

The DEA, in fact, has already scheduled mitragynine pseudoindoxyl, MGM-15 and MGM-16 – synthetic forms of kratom alkaloids – as Schedule One controlled substances. 

The agency announced plans to schedule 7-OH in July, but has delayed implementing the order at the request of the Department of Health and Human Services (HHS), to allow more time for public comment on the appropriate threshold level of 7-OH that would still be legally allowed. 

(Update: The DEA now intends to implement the ban on November 13.)

Nearly 36,000 public comments were made in the Federal Register, most of them opposed to the DEA’s plan to set a limit of 1 mg per 7-OH tablet, gummy or shot, saying there is no evidence to support it.   

Confusion Over Letter

“I think there is a tremendous amount of confusion about the letter,” said Mac Haddow, a spokesman and lobbyist for the American Kratom Association (AKA), an advocacy group for leaf kratom vendors. “I know for a fact that Senator Lee does not agree with the request that all natural kratom be scheduled.”

In talking with Judiciary Committee staff about the letter, Haddow said there were “misunderstandings” about the differences between 7-OH and leaf kratom, and confusion about how the substances might be regulated under the Controlled Substances Act (CSA). 

Kratom comes from the leaves of a tree that grows in Southeast Asia, where it has been used for centuries as a stimulant and pain reliever. 7-OH occurs naturally in kratom in trace amounts, but manufacturers have recently found ways to concentrate the alkaloid in 7-OH products, turning a mild pain reliever into a more potent one that has opioid-like effects.  

The AKA maintains that 7-OH and other concentrated alkaloids are synthetic opioids created in a lab that have no relation to leaf kratom. The AKA supports the scheduling of 7-OH, but wants leaf kratom left alone.  

“I know where Mike Lee is on this, and my understanding is he didn't agree with the premise of that letter at all, and maybe because he's out of town, didn't read it carefully,” Haddow told PNN. “But that’s neither here nor there, the letter's written. I hope they rescind it and they give a more detailed analysis of what they really want.” 

Haddow said the Judiciary Committee staff, which likely wrote the letter, thinks leaf kratom should be classified under the CSA as a Schedule Two or Three substance that could be used for medical purposes. But that requires the approval of the FDA, which has long maintained that kratom is not approved for any medical condition.

“You can schedule FDA-approved drugs in any of those schedules,” explained Haddow. “But you can't take one that doesn't have a drug approval and schedule it anywhere but Schedule One. And they didn't even know that, so that was surprising to me. You'd think the Judiciary staff would understand the Controlled Substance Act better than that, but maybe I misunderstood them. But I don't think I did.”

If what Haddow says is accurate, it’s a surprising level of ignorance, as the Senate Judiciary Committee oversees the U.S. Justice Department, DEA, FBI and Department of Homeland Security. The DEA is the primary agency responsible for enforcing the CSA.   

It’s not the first time Haddow has encountered confusion at the federal level about kratom and its derivatives. In August, he told PNN there was “enormous confusion among some members of Congress and even staff at the DEA” about the differences between leaf kratom, 7-OH, and other kratom alkaloids. 

He fears that confusion could lead to all kratom related products being scheduled or banned – including leaf kratom –  which is exactly what the Grassley, Lee and Collins letter is proposing.  

The American Medical Association (AMA) also supports the regulation of leaf kratom and kratom derivatives.  In June, the AMA’s House of Delegates passed a resolution calling for a complete ban on 7-OH and recommended that kratom be scheduled under the CSA after the FDA evaluates its safety and efficacy through clinical trials — a process that could take several years. 

Until that happens, the AMA says kratom should not be “marketed or prescribed as treatment for any condition.”

Fear and Worry Living in 7-OH Limbo

By Crystal Lindell

Ever since the Trump Administration announced on July 1 that it planned to make the kratom alkaloid 7-OH a Schedule One controlled drug, people like me who use it have been living life in a horrible anxious limbo. 

I’ve had a deep feeling of dread in my stomach that a text or alert could bear the news I most fear: “7-OH is now illegal nationwide.” 

The original 30-day public comment period offered by HHS was set to end on July 31. We all expected the official ban to come shortly after that, sometime in early August. But then we got a respite when the comment period was extended through September 10.

Another month has come and gone, and the comment period ended weeks ago. But an official federal ban by the DEA still has not been announced. So 7-OH users like me are still unsure of what's happening.

(Update: The DEA now intends to implement the ban on November 13.)

Don't get me wrong. I would much rather live in this dark unknown limbo than have the ban be imposed.

But it's all very stressful.

While I have tapered down on my dose, I do still use 7-OH. It’s too much of a life-changing drug for me to stop when it is still legal where I live.

But that means if the DEA does make it Schedule One, in the same category as heroin and LSD, I’ll be stuck either going into instant physical withdrawal or becoming a felon.

I have had chronic pain from intercostal neuralgia since 2013. When concentrated 7-OH products became available a couple years ago, they seemed like an answer to a prayer I was reciting for over a decade. 

7-OH instantly treats my pain anytime I take it, and helps fight the fatigue I developed from living with chronic pain for so many years.

As such, it has allowed me to have so much of my pre-chronic pain life back. I can wake up early. I can shower in the morning. I can pretty much show up to any and all plans that get made. So many little things that healthy people take for granted.

But it’s also the big things. 7-OH has allowed me to work full-time for the first time in four years. It has allowed me to show up as the happy, bubbly person I used to be before pain destroyed my spirit. It has saved me.

I don’t know what my life will look like if and when the federal ban goes through. I don’t know if I’ll be able to continue working full time. I don’t know how bad the full withdrawal down to zero will be. I don’t know how quickly I’ll be forced back to my pre-7-OH life.

It’s not just me I’m worried about. I have multiple loved ones who also use 7-OH for their chronic pain, and I’m very worried about them as well. I’m worried how they will treat their pain once 7-OH is illegal, and I’m worried about how they will handle the withdrawal once they aren’t able to buy any more of it.

Sometimes, when I’m alone with my thoughts at night, I let myself believe that maybe there’s a chance the DEA and HHS will reverse course. It’s not a completely crazy thought, either. There’s precedent. In 2016, when the Obama administration announced plans to make kratom leaf a Schedule One drug, it dropped them a few months later after a public outcry.

My deepest, most sincere hope is that the same thing will happen with 7-OH now too. But I know I can’t count on that.

Truth be told, I’ve been scared to even write this column for fear that it will somehow jinx things. 

But this is my life right now with chronic pain. I’m in 7-OH limbo. I could either lose the most effective treatment I’ve ever found for my chronic pain, or I can risk being arrested for felony drug possession. 

For now, all I can do is anxiously wait.

Should AI Be Used to Prompt People in Pain to Exercise?

By Crystal Lindell

We all know that being too sedentary contributes to poor health. It might even make your pain worse. But many of us still spend way too much time sitting in one place watching TV, scrolling on our phones, or working at a computer.   

“Individuals with certain chronic pain disorders face a paradox: they are at increased risk for sedentary behavior due to pain-related interference, even though significant gains in symptom relief and health benefits from increasing their PA (physical activity) for symptom management have been demonstrated,” says Ipek Ensari, PhD, who studies artificial intelligence (AI) and human health. 

Ensari and her colleagues at the Icahn School of Medicine at Mount Sinai wondered if wearable devices could be used to help women with chronic pelvic pain stand up and move around more. 

Their study, recently published in the journal Women’s Health, wanted to see if AI could predict when patients would have prolonged periods of inactivity. 

They recruited 134 women with chronic pelvic pain, primarily from endometriosis, along with 61 healthy women for a control group. Participants wore Fitbit devices for up to 90 days, generating minute-by-minute information about their physical activity, heart rate, steps, and sleep patterns.

"Our goal was to determine whether everyday wearable devices could serve as an early-warning system for prolonged sitting in women living with chronic pelvic pain," Ensari explained in a news release. 

"Rather than offering generic advice after the fact, we wanted to determine whether we could anticipate these moments and support people with simple, well-timed prompts that fit naturally into their daily lives."

The research team gathered data from each participant and developed personalized forecasting models to predict their activity levels one hour ahead of time. The goal was to identify 15-minute periods when a participant could stand up and move around, which the researchers called an “exercise snack.” 

Those short activity breaks may be more realistic and achievable than longer exercise periods, especially for people with chronic pain. The work also challenged the assumption that AI focused on health needs to be complex. Relatively simple AI models forecast prolonged periods of sitting just as well as complex ones.   

"We were surprised by how well the simplest models performed," said lead author Jannes Jegminat, PhD, a former postdoctoral research fellow at the Icahn School of Medicine. "More complex AI is not always better. Lightweight, interpretable models can accurately forecast sedentary behavior while being practical enough to run directly on a person's own device, which also helps protect privacy." 

Unfortunately, the research did not include any further investigation into whether or not participants would actually get up for a walk when prompted. And there seems to have been no consultation with pain patients on whether this technology is something they’d want and use.

The researchers admit that further study is needed to see if the AI prompts could actually help patients.

"This study suggests that predicting prolonged sitting is feasible, even if the individual has chronic conditions that might impact their daily routine," said Ensari. "The next step is determining whether delivering personalized movement prompts based on those predictions actually helps reduce sedentary time, improves symptoms, and enhances quality of life. Those questions will require prospective clinical trials."

It’s unclear how the technology would be applied to periods when someone needs to be sedentary, such as when they are working, eating, watching a favorite show, or in too much pain to move. 

The last thing I want to see on my AI watch as I’m driving late to work is a notification telling me to go for a walk instead.  

It’s becoming clear that anything and everything related to artificial intelligence is the new trendy topic for research, and it’s likely the topic is now also yielding better funding opportunities. But as researchers continue to study the ways AI can help us medically, they would do well to remember to ask patients for their input as well.

The work was funded in part by the Eunice Kennedy Shriver National Institute of Child Health & Human Development and by the Clinical and Translational Science Awards at the National Center for Advancing Translational Sciences. 

Ketamine Infusions Effective in Reducing Fibromyalgia Pain

By Pat Anson

Ketamine infusions provided “substantial and sustained” relief for women suffering from severe symptoms of fibromyalgia, according to a small new study. But the results were uneven, with some patients reporting over 50% pain relief, while others had minimal or no benefit despite multiple treatments. 

Fibromyalgia is a poorly understood disorder characterized by widespread body pain, fatigue, headaches, brain fog and insomnia. About 3% of the world’s population has fibromyalgia, most of them women. 

For the study, researchers at the Carolinas Pain Institute enrolled 92 women suffering from chronic fibromyalgia, ranging from 24 to 78 years of age. Their median pain score at the start of the study was 8 on the zero to ten pain scale. About a third of them were on opioid pain medication.

Ketamine is an anesthetic drug that is only FDA-approved for depression and anesthesia, but is increasingly used off-label for chronic pain conditions such as Complex Regional Pain Syndrome. 

Participants received 1.5 mg/kg per hour of ketamine during 3-hour infusion sessions, which were repeated as needed every 3 to 10 months. Some patients needed only one infusion, while others needed as many as 32 infusions.

The study findings, reported recently in the Journal of Pain Research, show the median pain score for the women fell from 8 to 5 after three months. About a third reported more than 50% pain relief – improvements that were sustained for 24 months. 

“Although the duration of pain relief varied between patients, it was generally consistent for each individual patient and averaged approximately 6 months, which was considered highly satisfactory by most patients undergoing repeated infusions,” wrote lead author Leonardo Kapural, MD, an anesthesiologist at the Carolinas Pain Institute in North Carolina. 

“Clinically meaningful improvement, defined as at least a two-point reduction on the pain scale, was achieved in 75% of patients through 24 months, suggesting that the majority of patients with severe fibromyalgia benefited from this therapy.”

But 19 patients – about 20% of the participants – reported minimal or no benefit from treatment. Nineteen patients also experienced side effects, such as nausea, vomiting, hallucinations, confusion, and nightmares. 

It is common for patients to experience dissociation and “out of body” sensations during ketamine infusions. They appear to be awake, but are often unable to respond or react to sensory input.

Researchers say there were numerous changes in medication for the 92 participants during treatment. The number of patients taking opioids fell from 33 to 27. Others continued taking  antidepressants, muscle relaxants, and anti-inflammatory medications. Because of that, it is difficult to say if ketamine is best used alone or as an adjunct therapy used in combination with medication.

Despite those limitations, researchers say their findings of substantial pain relief from chronic fibromyalgia justifies a larger clinical trial with ketamine infusions. Previous small studies of ketamine as a treatment for fibromyalgia also suggest that infusions could be beneficial.  

Until recently, there were only three FDA-approved drugs for fibromyalgia: duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella). Many patients consider the drugs ineffective or have too many side effects.

Last year, the FDA approved Tonmya, a fourth drug for the treatment of fibromyalgia in adults. Tonmya is a new formulation of a muscle relaxer (Flexeril), which was originally developed as an antidepressant. 

‘Peak Pain’ Happens at a Younger Age Than Many of Us Think

By Pat Anson

We often think of pain as a symptom of old age. Aching muscles and sore joints don’t heal as quickly as we grow older, and chronic painful conditions like arthritis, neuropathy and spinal degeneration become more common as we age.

A large new international study published in Nature Medicine debunks that common belief, finding that many types of pain begin earlier and reach their peak before the age of 55.

Led by researchers at McGill University in Montreal, the study looked at self-reported pain data collected between 1990 and 2025 from over 6 million people in 118 countries and territories.

Of the 11 body areas studied, pain prevalence varied considerably depending on location, age and sex. Women reported pain in nearly every location more often than men. The one exception was chest pain, which occurs slightly more often in middle-aged men.

Headaches often peaked for both men and women in their 30’s, while stomach pain peaks for women at the age of 23 and males at age 5. Pain in those locations tends to decline as people grow older. 

The universal curse of back pain often begins for men and women in their 20’s, and tends to keep growing worse as we grow older. Knee pain and hip pain follow a similar upward trajectory.

Lifespan Pain Projections for 11 Body Areas

NATURE MEDICINE

“The global lifespan trajectories show that pain is not a single epidemiological phenomenon but, rather, a set of distinct nonlinear patterns that differ in their timing and anatomical distribution,” wrote lead author Matt Fillingim, PhD, a data scientist and researcher at McGill University who now works for Johnson & Johnson.

“Across most phenotypes, pain did not increase monotonically with age; instead, the steepest rises occurred before age 55 years, indicating that a substantial share of lifetime pain burden develops during working-age adulthood.”  

There is a fair amount of regional variability in pain prevalence. Headaches were most likely to peak in North America and Western Europe in early adulthood, while headaches in East and Southeast Asia were less common and have a flatter trajectory over time.  

Eastern Europe and Sub-Saharan Africa had some of the highest rates of back, joint and overall body pain. If you live in those regions, pain prevalence really is associated with age and just keeps growing worse the older you get.

Not surprisingly, smoking, obesity and coming from a low-income household are also contributing factors that significantly raise the risk of pain.

By age 80, overall pain prevalence is about 31% higher in less developed countries and low back pain was nearly twice as common  

Interestingly, the risk of having facial pain is significantly higher for female smokers, while pain in the foot, ankle, knee and hip — weight-bearing joints — is often linked with obesity.

What all this data tells us is that life-style changes, pain prevention and pain management need to start at an early age. And pain is a universal experience that knows no borders.

Exploring the Connection Between Chronic Pain and Dementia

By Cynthia Toussaint

Difficulty in finding words – also known as “brain fog” -- started for me 30 years ago after I began taking the medication gabapentin for Complex Regional Pain Syndrome. While it initially proved to be effective for me, pulling me out of a ten-year bout of bedridden hell, brain fog was an embarrassing side effect, as I was speaking publicly for HMO reform.

As a spokesperson, having the right word at the right time can make all the difference in “selling” something I’m passionate about. I prayed this troubling symptom would pass as my brain acclimated to gabapentin. It did not.

With time, not only did my brain fog worsen, I started losing thoughts and ideas mid-sentence. Though I could attribute the word loss symptom to gabapentin, my new challenge was something more, something scarier.

Research taught me that long-term persistent pain leads to neural overload and atrophy, literally shrinking parts of the brain responsible for language and memory. Concurrently, I learned that both gabapentin and the clonazepam that I’d been taking for pain and dissociation for four decades worsen dementia symptoms. That was shocking. 

Then in 2014, my mother, a woman grounded in pure love and goodness, but who’d not been herself for a decade, was finally diagnosed with Alzheimer’s disease.

Though Mom wasn’t on any pain meds, she’d suffered since her mid-20s with throbbing varicose veins made worse by failed surgeries.

She also struggled for most of her life with significant low back pain, often eschewing beds for the hard floor. Later, Mom had hip pain severe enough to provoke screams throughout the day. 

I believe my mother’s chronic pain very likely contributed to her dementia development. She’d been dealt a number of other cards that certainly aided the deterioration of her brain.

By the mid-2010s, there were multiple studies linking trauma to dementia. My mom suffered a tsunami of that from her family of origin, her husband, and some of her own children.

lEONA AND CYNTHIA

That trauma produced high levels of toxic stress that led to elevated inflammation, two factors now recognized as drivers of dementia. And she was a woman at an advanced age. Indeed, Mom was a poster child for dementia.

I fear that I may be, too. 

Though for me developing dementia often feels inevitable, being at high risk is not a fait accompli. Regardless of my future’s uncertainty, this I know: I’m not going to just wait for the lights to dim. And I’ll be damned if I suffer the way my beautiful mom did.

For Pain Awareness Month in September, For Grace launched its most personal project in our nearly 25-year history. Named for my beloved mom, “Leona’s Legacy” is a safe, online nurturing space where one can learn about the connection between chronic pain and dementia and how to avoid or, at least, slow down the onset of the disease.

For me, cognitive wellness comes in the form of a plant-based diet, abundant exercise, sleep hygiene, daily meditation, meaningful work, ample reading, and creative therapies like piano, singing and writing.   

But it’s the last pillar of this project that is most meaningful to me, and the closest to my heart. We at For Grace are working on state legislation that, if signed into law, will mitigate financial elder abuse in California.

You see, it wasn’t watching Mom waste away from this wretched disease that was the worst for me. It was what I witnessed during her last ten years, when she lost her capacity for decision-making and was utterly vulnerable to bad players. That’s when she was abused in every way possible by those she loved and thought she could trust.

I know my family’s horror show is far from unique. Elder abuse, in all its forms, is going to become a bigger problem as Boomers age.

Putting a face to the issue, Leona’s Legacy includes touching personal stories from people with pain who have heartbreaking, powerful connections to dementia. Taking a cue from their truth-telling, you’ll also learn about my forthcoming memoir, where I lay bare my family’s multi-generational dysfunction and how I finally broke the trauma cycle for my own survival.

While motivated in part by harm and hurt, the core engine of Leona’s Legacy is the epic love Mom and I shared, unflinching and unbreakable.

I can’t go back and change the abuse she endured, abuse that extended to me, as the family scapegoat, and hastened her death.

But I can still help others in her name.

It is Mom’s enduring love that continues to push me forward, love that will never be forgotten.

Cynthia Toussaint is the founder and spokesperson at For Grace, a non-profit dedicated to bettering the lives of women in pain.

She has lived with Complex Regional Pain Syndrome (CRPS) and 19 co-morbidities for 45 years, and is also a cancer survivor. Cynthia is the author of “Battle for Grace: A Memoir of Pain, Redemption and Impossible Love.”

Most Cancer Survivors Have High-Impact Chronic Pain

By Crystal Lindell

Just because someone beats cancer, that doesn’t mean the related physical pain is gone. In fact, new research suggests that a majority of cancer survivors endure high-impact chronic pain that significantly limits their life and work activities.

That’s according to a new study recently published in the journal Supportive Care in Cancer.

Danish researchers studied the different levels of pain, disability, psychological distress, and self-rated health of 270 cancer survivors classified as having high-impact chronic pain. Nearly two-thirds (61%) had high-impact pain, with the rest have mild or “bothersome” chronic pain. 

Compared with the mild and bothersome groups, the high-impact pain group reported significantly higher pain intensity and disability; higher depression scores; more widespread pain; and lower self-rated health and quality of life.

Researchers say medical professionals should be aware that many cancer survivors likely have high-impact chronic pain – and as such they may need more intense treatment options.

“The findings underline the need for systematic assessment of pain impact, not just its presence, in cancer rehabilitation,” the authors wrote. 

When high-impact chronic pain goes unrecognized in cancer patients, it has real consequences. 

Earlier this year, PNN reported how common it is for women to suffer from chronic pain after mastectomies, a lifesaving surgery that removes a patient’s breasts to treat or prevent breast cancer. After surgery, many women have post-mastectomy pain syndrome, which can last for years.

“I’ve known women who’ve had chronic pain — itching, burning, stabbing pain — for years after mastectomies,” said Kathy Steligo, an author of multiple books on breast cancer. “Of all the problems, that is probably the one least talked about by surgeons.”

It’s not just an issue isolated to patients in remission or recovering from surgery and chemotherapy. Even patients with active cancer can have a hard time getting medical teams to take their pain seriously. 

In 2023, we reported on a study that found the number of cancer patients seeking treatment for pain in U.S. emergency departments had doubled from 2012 to 2019.

Of the 35 million visits made to an emergency department by those patients, over half were deemed preventable – meaning the visits could have been avoided if the patient had received proper care earlier. 

One explanation for the lack of treatment was the widespread reduction in opioid prescribing after the 2016 CDC opioid guideline. The guideline was only intended for non-cancer primary care patients, but was quickly adopted by doctors treating all types of pain, including cancer. 

According to a small 2021 study in the journal Cancer, some cancer patients were so aware of the stigma surrounding opioids they were reluctant to take opioid medication to relieve pain – even though the risk of opioid addiction and overdose is low for cancer patients.

Are More Seniors Addicted to Cannabis?

By Pat Anson

Older Americans increasingly identify as cannabis consumers, with nearly 9% of adults over age 65 having used cannabis in the last 12 months.  Most use cannabis therapeutically to treat pain, insomnia, depression and other conditions associated with old age. A recent study even suggested that cannabis may improve cognitive function. 

But there’s a major drawback to the growing use of cannabis by seniors, according to a new study that found about one in nine (11.4%) meet the criteria for cannabis use disorder (CUD). 

While most cases of CUD were considered mild (76%), those that are moderate (20%) or severe (4%) need treatment, according to researchers.

“Given the rapid changes in cannabis use among older adults, it is imperative to understand who may be at risk for developing CUD when weighing the risks and benefits of its use,” wrote lead author Benjamin Han, MD, a geriatrician, addiction medicine physician, and researcher in the Department of Medicine at UC San Diego.  

“While the majority of CUD cases are mild and could benefit from early intervention, nearly a quarter of cases are moderate or severe and likely require additional intervention to prevent worsening severity and co-occurring problems.”

Han and his colleagues analyzed data from the National Survey on Drug Use and Health to assess how often older adults used cannabis, the modes of use (smoking, vaping or eating), and whether medical cannabis was recommended by a doctor. People who used hemp or CBD were not included in the analysis.

The study findings, published in the journal Addiction, show that over two-thirds (67.4%) of the older adults who used cannabis did so in the past 30 days, suggesting their use was fairly frequent. 

Men (10.9%) were more likely to use cannabis than females (7.2%), with smoking the most common form of use (65.8%). Only 20% said their doctors recommended they use medical cannabis.

Identifying who has cannabis use disorder is a less precise metric, since it depends on whether they have two or more of the 11 behaviors that qualify under the Diagnostic and Statistical Manual of Mental Disorders criteria.     

The 11 Cannabis Use Disorder Criteria

1. Taking cannabis in larger amounts or over a longer period

2. Wanting to cut down or stop using cannabis, but failing to do so

3. Spending a great deal of time obtaining, using, or recovering from cannabis

4. Experiencing intense urges, desires, or cravings

5. Failing to meet work, school, or home responsibilities because of use.

6. Continuing use despite recurring social or relationship problems

7. Giving up or reducing social, occupational, or recreational activities

8. Repeatedly using cannabis in situations that are physically dangerous.

9. Continuing to use despite knowing it causes physical or psychological problems

10. Needing larger amounts to get the same effect (tolerance)

11. Experiencing withdrawal symptoms

Among the older adults with CUD, researchers say the three most common criteria were cravings, tolerance, and spending more time obtaining and using cannabis. 

‘Our Definition of CUD Is Broken’

But critics say the CUD criteria are vague and fail to take into account how many seniors are using cannabis to relieve pain or to help them sleep. 

“People are defined as suffering from CUD if they meet two out of 11 possible criteria. Notably, these criteria make no accommodation for those who use cannabis medically,” says Paul Armentano, Deputy Director of NORML, which advocates for marijuana legalization.

“More importantly, the real-world relevance of CUD is undercut by the federal government’s own substance abuse treatment data. According to a 2026 report published by the US Department of Health, the percentage of Americans seeking drug treatment for cannabis has declined steadily for the last half-decade. By contrast, more than four times as many people are admitted to treatment annually for alcohol use disorder.”

Dr. Peter Grinspoon says the number of people estimated to have CUD is exaggerated, in part because tolerance and withdrawal are normal reactions for anyone taking a drug for medical reasons. But that makes them dependent, not “addicted” to a drug.    

“Our definition of ‘cannabis use disorder’ is broken and inadvertently ropes in many medical marijuana patients that couldn’t possibly qualify as being addicted. In my clinic, I have had patients who are thriving on medical cannabis, for insomnia or chronic pain, only to see the diagnosis ‘cannabis use disorder’ added to their medical record after they visit with another doctor,” Grinspoon wrote in a recent Substack column.

“As such, we are saddling people with a diagnosis of marijuana addiction just for having tolerance and withdrawal (which are physiological effects of the medicine). This harmful double standard exists because some of the old guard addiction psychiatrists don’t view cannabis as a medicine.”

Grinspoon says patients who are falsely labelled as addicted – whether to cannabis, opioids or other substances – are often abandoned or neglected by doctors. The label could also interfere with their employment, have legal consequences, and contribute to stigma and feelings of low self worth.

Instead of labeling patients with a diagnosis, a little empathy may be in order. 

“We can’t continue to unjustly label patients as addicted to cannabis when they are using it medically, without problems,” said Grinspoon.

My Cats Help Me Cope with Chronic Pain

By Crystal Lindell

It is ironic that I was initially opposed to getting a cat because I have chronic pain.

I hate getting up early. I hate having to do anything right when I wake up. And I have no money.  

Cats wake you up at 5 am, expect to be fed immediately, and keeping them alive is expensive.

But when the mother of my fiancé Chris moved into senior housing, she was only allowed to take one of her two cats with her.

Thus, her long-haired tortoiseshell cat – affectionately named Princess Diana – had nowhere to go but to our house.

Although I was initially reluctant, Princess D quickly won me over when, on her first visit, she ran over to me while I was sitting in a rocking chair. She stared up at me with the eyes of a cat looking for love, and jumped up into my lap.  

I was hooked.

We became a one cat household.

Eventually, Princess D’s former sister Basil was also looking for a home, after Chris’ mom was no longer able to care for her either.

CRYSTAL WITH PRINCESS DIANA

Basil, a beautiful long-haired black cat, came with a pre-written warning for the vet, and lots of war stories. She was a scratcher. And a biter. If we hadn’t taken her, they were going to put her down.

Over the years, in the comfort and predictability of our home, Basil has softened. But just last week, she bit my arm because she got confused in the middle of the night.

We love her regardless.

After Basil came to live with us, we found our orange boy Goose and our brown tabby Goldie Hawn, outside. 

And when we moved in with my relatives, two gray-haired cats, Gracie and Cinnamon, joined our crew.

Yes, that brings the total to six cats. Yes, I know that puts me into crazy cat lady territory. But the thing about being a crazy cat lady is that I love them all too much to care what you think.

Just as I feared, they do all wake us up at 5 am, asking for food. And it does indeed feel like I’m pulling myself out of cement to get out of bed, just so that I can open a can of Friskies for them at dawn.

Truth be told though, having a reason – actually six reasons – to get out of bed every morning goes a long way when you’re dealing with pain that never ends. They give me purpose, and in return, I give them treats.

Having six cats also means that at least one of them is always willing to nap with me whenever I’m having a bad pain day. And naps covered in cats are healing. 

I confess, we do spend a lot of our money on our cats, especially after Princess Diana developed diabetes and almost died. We buy $140 vials of insulin every other month to keep her alive.

But she keeps me alive by giving me a reason to live, so really it all evens out.

In the end, our six cats give my life meaning, relieve stress, take my mind off my pain, and fill our home with love. All of those things go a very long way toward helping me cope with chronic pain.

In fact, there’s even data to back this up.  

In 2019, a National Poll on Healthy Aging conducted by AARP and the University of Michigan found that pets can offer their owners a wide range of health benefits.

The people surveyed said their pets helped them enjoy life (88%), made them feel loved (86%), helped reduce stress (79%), kept them physically active (64%) and helped them cope with physical and emotional symptoms (60%), such as taking their mind off pain (34%).

For those who said their health was fair or poor, pet ownership offers the most benefits. More than 70% of older adults said their pet helps them cope with life’s challenges, and nearly half (46%) said their pets help distract them from pain.

I used to think that having chronic pain was why I could never care for a pet. But I’ve come to understand that caring for a pet is one of those things that gives more than it takes. It’s because of my chronic pain, that having a pet – or six of them – is so vital to my well-being.

Kratom Leaf Falsely Linked to Ole Miss Deaths

By Pat Anson

The suspected overdose deaths of two college students in Mississippi has renewed fears and misinformation about kratom and its alkaloids.   

Ole Miss students Aidan Hamilton, 18, and Robert Strang, 20, were found dead on Sept. 21 in separate locations.

The Lafayette County Sheriff’s Office said investigators found “packaged kratom” in both locations and released a statement saying, "Out of an abundance of caution, we encourage everyone to avoid kratom and any other medication or substance that was not prescribed to you.” 

That is what led led to numerous reports that the two deaths were “suspected kratom overdoses.”  

It turns out the “packaged kratom” was not natural leaf kratom but Smax Pseudo-DHM tablets. An affidavit lists the tablet ingredients as mitragynine pseudoindoxyl, MGM-15 and 7-hydroxymitragine (7-OH), which are concentrated or synthetic kratom alkaloids.

Mitragynine pseudoindoxyl and MGM-15 were recently classified as Schedule One illegal substances by the DEA. 

A Mississippi state law in 2025 restricts kratom sales to consumers 21 years of age and older, and bans all synthetic forms of kratom.

Deputies arrested two employees at a smoke shop near the Ole Miss campus, where one of the students apparently bought the tablets. A worker allegedly told an informant to “be quiet” about the pills because “people were dying from them.”

It’s not yet clear if the Smax Pseudo-DHM or other drugs played a role in the students’ deaths, because their autopsies are incomplete.

"If law enforcement knew the specific product involved, Ole Miss students should have been warned what product they needed to be concerned about," said Mac Haddow, a spokesman and lobbyist for the American Kratom Association (AKA). "Instead, the public was broadly warned about 'kratom' when the product was not kratom at all.

“When the Sheriff's Office characterized these products as kratom without identifying what they actually were, reporters understandably repeated that description. We now know the information available to investigators was substantially more specific. The public should have received that information."       

Confusing natural leaf kratom with 7-OH is something that even kratom advocates argue about. The AKA has long maintained that 7-OH and other concentrated alkaloids are synthetic opioids created in a lab that have no relation to leaf kratom. 

The Trump Administration agrees and may soon classify concentrated 7-OH as a Schedule One illegal drug, the same category as LSD and heroin.

Whack-a-Mole Alkaloids

At least 54 different alkaloids have been identified in kratom, which comes from the leaves of a tropical tree in Southeast Asia that has been used for centuries as a natural stimulant and pain reliever. 

Banning each individual alkaloid has turned into a game of whack-a-mole, with drug manufacturers developing new exotic formulations of kratom alkaloids faster than the DEA can classify them as illegal drugs.

The latest example is speciociliatine, an “overlooked” kratom alkaloid and partial opioid agonist that metabolizes slowly in humans, which makes it more potent and potentially dangerous. Speciociliatine has not been scheduled by the DEA, although it could fall under state laws that broadly ban “total kratom alkaloids.” 

Because it is still legal at the federal level, at least two kratom vendors are now selling speciociliatine tablets.

American Shaman, which developed the first 7-OH products, is marketing lemon-flavored tablets containing 30mg of speciociliatine to foster “mental clarity” and “an uplifted mood throughout the day.” Consumers are cautioned to only use the tablets occasionally, “rather than as a daily habit.” 

Burman’s Health Shop is selling 200mg speciociliatine tablets, advising consumers to cut the tablets down into 50mg doses. The company is careful not to make any health claims, saying it is “unable to provide guidance on recreational effects, medical concerns, addiction, or controlled-substance comparisons.”

“Speciociliatine is a real problem. No doubt about it,” Haddow told PNN. “I think that that's manipulating the alkaloids to create a novel product for which there's not any evidence of safety.”

AMERICAN SHAMAN

Haddow says vendors selling speciociliatine and other novel kratom alkaloids are trying to stay a step ahead of DEA scheduling efforts, which is one reason the AKA recently threw its support behind the “End Gas Station Heroin Act,” a bill sponsored by Sen. Bernie Moreno (R-Ohio) and Rep. Lance Gooden (R-Texas).

In a recent statement, Gooden said the deaths of the two college students in Mississippi point to a need for legislation that would close loopholes allowing vendors to sell new more potent formulations of kratom alkaloids.

“Dangerous synthetic opioids powerful enough to fuel addiction and destroy lives should not be sitting on convenience store shelves next to snacks and energy drinks,” said Gooden. “My bill permanently schedules these drugs, closes loopholes, and targets the entities putting them into our communities.”      

The bill would essentially do the same thing the DEA is planning to do with 7-OH, but expands its enforcement powers to allow the agency to target manufacturers and distributors who introduce novel synthetic alkaloids before they are scheduled by the DEA. Consumers who purchase or use those products would be exempt from prosecution. Natural leaf kratom would also not be affected by the legislation.

Less Is More: It Doesn’t Take Much Exercise to Reduce Pain

By Pat Anson

It won’t cure you or make your pain go away, but moderate levels of exercise could give you some relief from acute and chronic pain, according to a new study by Australian researchers.

In a systematic review of 157 clinical trials, a research team at Adelaide University found that less than two hours of exercise a week could reduce pain by about 1.1 points on the zero-to-ten pain scale. In fact, exercise of low intensity and short duration appears to be more beneficial than longer, intense workouts.

“Our study found that exercise was associated with substantial reductions in acute and chronic pain across all forms of exercise – whether that be via aerobic or resistance exercise, or through gentler movement such as yoga, Pilates or tai chi,” lead author Ben Singh, PhD, a Research Fellow at Adelaide’s School of Allied Health and Human Performance, said in a press release.

“Importantly, we found that more exercise wasn’t necessarily better. In fact, shorter-duration and lower-intensity programs showed greater reductions in pain, suggesting people may not need to exercise harder or for longer to experience meaningful benefits.”

The study findings, published in the journal PAIN Reports, show the most significant reductions were for pain caused by these conditions:

• Axial spondylarthritis

• Cancer

• Musculoskeletal conditions

• Fibromyalgia

• Hip replacement

• Low back pain

• Migraine and headache

• Neck pain 

• Osteoarthritis

• Idiopathic pain in older adults

• Osteoporosis

• Menopause

• Pregnancy-related pain

• Primary dysmenorrhea

• Rheumatoid arthritis 

Low intensity workouts from tai chi, yoga and Pilates were beneficial, but the form of exercise that produced the largest reduction in pain was a bit of a surprise: Dancing.

That finding, however, is based on a single study of dancing by fibromyalgia patients and should be taken with caution. “Although dance-based interventions may offer promise for this population,” researchers say further studies are needed to prove the effect.

There are four key reasons why exercise has an analgesic effect.

First, exercise stimulates the release of endogenous hormones (endorphins), which act as natural painkillers and increase pain tolerance.

Second, exercise enhances the production of neurotransmitters such as serotonin and norepinephrine, which play crucial roles in mood and pain modulation.

Third, exercise reduces systemic inflammation, a common driver of chronic pain, by modulating immune system function.

Finally, exercise activates the body’s endocannabinoid system, which helps to modulate pain perception, mood, and inflammation.

“When we exercise, our body releases chemicals including endorphins and serotonin that can help reduce how strongly we feel pain and increase our pain tolerance,” Singh explained. “Additionally, it helps calm inflammation and change the way our brain responds to pain, while also improving mood.

“These effects help explain why exercise can be such a powerful tool for pain management. Yet despite the evidence, it isn’t used as routinely as it could be and is rarely prescribed with the same precision as medication.”

The idea that exercising less than 2 hours a week is more effective runs counter to many current exercise guidelines, which recommend 150 minutes or more per week. That amount can feel unattainable for many people with chronic pain. Shorter, less intense physical activity is more realistic and may help people overcome their resistance to exercise. 

“These findings support starting with manageable, lower-dose (exercise) programs to build confidence, promote adherence, and reduce fear of symptom flare-ups, key barriers for people with chronic pain,” researchers concluded. 

“Exercise should not be considered a universal solution or expected to eliminate pain entirely. Its efficacy will depend on individual factors such as the underlying pain condition, level of physical function, and adherence.”