Chronic Pain and Suicide: Three Ways to Recognize and Reduce Risk

By Dr. Thomas Rutledge

Suicide is a cause of death that haunts the living in perpetuity. After a suicide event, those left behind are tormented by questions:

"Could I have done something?"  "What did I miss?" "How could this happen?" "Was it my fault?" 

Even the best answers fail to return the person lost, and natural grief is often compounded with unnecessary blame.

Discussions about suicide prediction and prevention primarily focus on known risk factors such as mental illness and suicidal ideation. 

In comparison, far less attention is paid to another common contributor to suicide present among a staggering 24.3 percent of the adult U.S. population. That makes this risk factor as prevalent as clinical depression, yet far more likely to be overlooked due to suicide stereotypes.

This unheralded suicide risk factor is chronic pain. In this post, we'll dive into three specific ways that chronic pain increases suicide risk, practical signs by which to recognize the patterns, and general strategies to help.

The Perfect Storm for Suicide

More than perhaps any other medical condition, chronic pain poisons the emotional well of what it means to be human. Although people differ in countless ways, our similarities are even more striking. Across time and cultures, for example, people universally share fundamental needs for meaning, interpersonal connection, safety, contribution, personal growth, and adventure, as articulated famously in psychological theories such as Maslow's hierarchy.

Many medical conditions compromise our ability to fulfill these fundamental human needs. Emotional struggles and mental health conditions are often a result of a medical condition impairing a person's ability to function in an important human need domain. Yet what makes chronic pain uniquely psychologically damaging is that it doesn't impact just a single human need. Chronic pain jeopardizes all of them.

As a psychologist who specializes in helping U.S. military veterans living with chronic pain, my aim is to share three of the most common patterns I see where pain becomes an existential threat.

1. Pain Without Purpose

One of the most profound ways that chronic pain increases suicide risk is by taking away a person's North Star for living. Like a sailor at sea without stars or a compass to guide them, chronic pain can remove the sense of purpose that allows people to endure in the face of suffering. Without sufficient purpose, pain becomes unbearable.

Scenarios: A retiree whose pain leaves them mostly housebound, estranged from friends, and increasingly unable to live independently. A veteran living on disability who has lost any sense of mission or way to contribute. A young adult whose pain condition limits opportunities for work, isolates them from others, and undermines their belief in a worthwhile future.

Characteristic thinking: "What's the point?" "Why go on this way?" "I feel like giving up."

Solutions: Based on the person's own values and lived experiences, explore flexible ways to reconnect them with their sources of meaning. Retirees may volunteer or consult in an area of interest. Former athletes may coach. Veterans may engage with military organizations and causes. Parents may become involved with youth activities. And, due to the staggering advances in technology that enable online and virtual participation, developing meaning-oriented lifestyles with chronic pain has never been more practical or lower cost.

2. Suffering in Solitude

No relationship is 100 percent safe from the corrosive effects of chronic pain. Chronic pain can ruin once-strong marriages, corrupt lifelong friendships, and erode the parent-child bond. Even as the person with chronic pain may need more social support in light of their condition, they frequently experience less in both quantity and quality.

Scenarios. There are two classic versions of this scenario. In the first, other people pull away or drift apart over time. In the second, the person living with chronic pain themselves retreats from others, usually because they feel like a burden or that they are holding other people back.

Characteristic thinking: "I'm useless this way." "I'm no good to anybody like this." "They would be better off without me."

Solutions: Consider all options for rebuilding a healthy social network. Although in-person activities may be best, virtual options—phone calls, text messaging, even multiplayer virtual reality or video games—may be good starting points. Aim, where possible, for relationship settings and activities where the person is an active contributor and teammate, where they can give as much or more than they receive. 

Because men often struggle more with forming new relationships, explore options where an activity of interest is the centerpiece, while in a setting where social interactions can spontaneously occur.

3. Loss of Self

Chronic pain can not only steal purpose and corrode personal relationships, it can even threaten personhood and self-image. What are the psychological consequences when chronic pain leaves a person adrift from the core values and ways of living that enable their sense of self?

Scenarios: A person whose pain took away a career that previously gave them a sense of worth and identity. A middle-aged parent struggling with chronic pain and whose grown children have left home. A veteran who spent their military career serving the greater good, who now has nothing but memories. A young adult whose pain condition took away the plan and future they envisioned for themselves.

Characteristic thinking: "I don't know who I am anymore." "I feel lost." "I'm just a disability now."

Solutions: Help people grieve the self they've lost while building a new one. Post-traumatic growth examples through stories, movies, and relatable people can be powerful mental seeds to help people see themselves as a human phoenix—capable of rising from the ashes in a new form—instead of as a person permanently broken by pain and loss. 

As in every hero's journey, people need not just examples but also guides and mentors to construct a new sense of self. A sense of self where their chronic pain helps them help others, view themselves as a survivor and not a victim, recognize hidden personal strengths, and find healthy ways to live their highest values.

Thomas Rutledge, PhD, is a Professor of Psychiatry at UC San Diego and a staff psychologist at the VA San Diego Healthcare System.

This post originally appeared in Psychology Today and is republished with permission from the author.

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.

How Chronic Pain Steals Your Time

By Crystal Lindell

Chronic pain is a thief. It steals your health, relationships, money, motivation, and time.

This week, so far, it has taken one full day away from me. My Tuesday was stolen.

That’s when my fiancé and I were supposed to go visit his relatives, who live about 2 hours away. But as soon as I woke up, I knew we weren’t going to make it. 

It was a bad pain day. Gray, dull, and full of inflammation.

The intercostal neuralgia in my ribs was flaring up, and I was having a hard time sitting upright. It was all I could do to keep myself out of bed long enough to brush my teeth.

Still, I tried to resist.

I told myself I just needed time to let my morning meds kick in. That, maybe, the weather would ease, and so would my pain.

But by 10:30 a.m. I knew I was going to have to tell my fiancé the verdict: there was no way I was going to be able to make that trip.

Thankfully, he didn’t hesitate. Just a quick and comforting “Okay.” And then he called his relatives to tell them we needed to reschedule for later in the week.

But I couldn’t help but feel disappointed and a little guilty. I hate having to cancel plans, and I hate worrying about what others will think when I do.

I was also frustrated with the realization that everything else I had planned for the week was now going to be squashed together or canceled.

Because having a bad pain day doesn’t suddenly mean that I have less to do. It just means I have less time to do it.

There were points in my life when my pain was so poorly managed that it would steal a lot more than one day of the week from me. Sometimes, it would take all seven.

And when those weeks happened, it was all too easy to blame myself. I should have pushed through it, been tougher, gotten it done.

It doesn’t help when other people make you feel guilty. After all, it is a lot easier to call someone “lazy” than it is to sympathize with their health struggles. 

A saying I often repeat to myself in those times is something my mom would always say to me when I was growing up: “All you can do is all you can do.”

I say it a lot because I still don’t always believe it. I have to constantly remind myself that my limits are actually my limits.

Beyond the guilt though, there’s also the sadness that comes when chronic pain steals your time. How many days do I have left on this earth, and how many of them will chronic pain take? How many holidays? How many more Tuesdays?

And how much time have I already lost to my pain?

It’s not fair. I want my time to be mine. I want to use it how I want to use it. 

The right pain medications give me a lot of my time back, and that’s why I treasure them so much. It’s why I work so hard to advocate for pain patients to have access to them. Because we all deserve to keep as much of our time as possible. 

In the end, all we can do is all we can do. But that doesn’t mean we shouldn’t get as much help doing it as possible. 

Food: The Daily Challenge for People With Chronic Pain

By Crystal Lindell

One of the biggest hurdles many people with chronic pain face is finding something to eat. It’s literally a daily challenge that has to be solved.

Personally, it’s something I struggled with even before I started having chronic pain in my right ribs.

Finding food three times a day just isn’t easy. Anyone who tells you it’s easy probably has someone else who cooks for them, and does all the shopping and clean-up.

The temptation is to eat out, but that gets expensive fast – especially if you use delivery apps like DoorDash. So, over the years I have become an expert at feeding myself, even when I feel like crap and have no money.

In fact, these days I’m even a vegan, living in a small town in the Midwest, so the option to eat out most days doesn’t even exist.

Below are some realistic tips for feeding yourself even when you’re sick, broke, and a bad cook.  

Level 1: Heat-and-Eat Meals

The first goal in feeding yourself is to avoid fast food and food delivery apps. Almost everything you get at the grocery store is going to be healthier and cheaper.

To avoid the strain of food preparation and cooking, look for anything that just needs to be opened and heated. This can include frozen meals and pizzas; canned meals like beef stew and ravioli; and refrigerated meals from grocery store deli sections.

When I first made it my goal to avoid eating out, I would literally stock my freezer with 14 frozen dinners each week. One of my friends commented that my refrigerator looked like an ad for Lean Cuisine. They aren’t cheap, but they are easy and they can offer a lot of variety.    

Frozen and prepared foods tend to be more expensive than fresh food at the grocery store, but they are all significantly cheaper than DoorDash. 

Level 2: Easy Cooking

When I say easy cooking, I mean easyyyyy cooking. So easy, you can do it on bad pain days.

If you can master this category, meals are also exponentially cheaper than prepared grocery food.

In this level I would include easy to prepare meals like spaghetti noodles with a jar of sauce, quesadillas, and cereal with a side of toast (warm toast really elevates the experience from sad and cold to warm and comforting). This level also includes sandwiches, whether it’s peanut butter and jelly or lunch meat.

There are weeks when I go days at a time living on vegan cheese quesadillas. For these, I simply put a non-stick pan on the stove, heat up a plain tortilla, add cheese, fold it over and eat. I dip it in vegan sour cream, hot sauce, or even add some microwaved vegan steak if I have any on hand. Voilà! A perfectly satisfying meal.

The trick to this category is to find meals you can make that don’t require you to chop a single thing. However, they may require you to pull out a pan. 

If you have the energy to chop something, even better!  Tomatoes and onions tend to make most things taste better.

For these meals, the microwave is still your best ally. There are a lot of foods usually cooked on the stove that can be cooked faster and easier in the microwave. So, if I’m adding some vegetables to my pasta, I will put the steam-in-the-bag version in the microwave first so they don’t have to be cooked on the stove top. Or if I’m adding vegan meatballs to sauce, I’ll heat them in the microwave first.

I firmly believe that a mix of Level 1 and Level 2 cooking can get most people through most days of the month when needed.  

Level 3: Meal Prep

That brings us to the most difficult level of chronic pain cooking: Meal Prep.

For this category, you will probably need to chop things, and you may need to dirty multiple pots and pans.

The shopping, cooking, and the clean-up are both more extensive, but if you can pull it off, the rewards can last for weeks.

When I have a good pain day, I try to use some of my time in the morning to make a large dish, whether that’s a soup, chili, or a casserole. There’s no rule that says you have to cook dinner at dinnertime. 

And I always triple the recipe so that I can eat leftovers for days. I’ll even make enough to freeze portions of it, essentially making my own frozen dinners.

Midwest cooking has a lot to offer for this category because our winters often make it hard to go to the grocery store more than once a week.

For example, chili is an especially great recipe in this category because you can do the whole thing with cans of beans and cans of tomatoes mixed with a chili seasoning packet in the crockpot. I add dried lentils to mine to give it a meaty texture, but you can also add something like cooked ground beef if you have the energy to make that on the stove top

I also love making vegan pot pie (I use chickpeas instead of chicken), potato soup, or a large batch of enchiladas.

I also have a bread machine, so when I have the energy, I like to throw the ingredients in there so I can have fresh, homemade bread for a few days. When I don’t want to deal with that, a loaf of $2 French bread from the grocery store bakery also hits the spot.

Eating three meals a day takes a lot of effort, and it’s understandable that a lot of people with chronic pain don’t have the physical or mental energy needed for cooking. But that doesn’t mean you have to eat out for every meal. Or starve yourself.

The trick is to forgive yourself for taking kitchen shortcuts, start off easy, and to find just a couple go-to homemade meals that you can make on autopilot. That’s more than enough. Then it’s just a matter of bon appétit! 

You Might Have Chronic Pain If…

By Crystal Lindell

Back in the 90s, comedian Jeff Foxworthy had this whole bit about, “You might be a redneck if…”  

He’d start off with a funny description and then make the obvious conclusion, like: “If you ever cut your grass and found a car… you might be a redneck.”

It was an in-joke among people who proudly saw themselves as rednecks. Foxworthy wasn’t laughing at them, he was laughing with them — because he portrayed himself as one of them.

Whether or not a rich comedian was ever authentically a redneck is a debate for another day. But regardless, I very much am a member of the chronic pain community, and as such, I think there’s a few of these I could share.

So without further ado:

• If your favorite breakfast is coffee and pain pills… you might have chronic pain.

• If you have ever wanted to argue with a pharmacist… you might have chronic pain.

• If you need at least 24 hours notice to leave the house… you might have chronic pain.

• If you know exactly how long you can go without showering… you might have chronic pain.

• If your favorite outfit is pajamas… you might have chronic pain.

• If you think your “Dr. Google” search results are more valuable than your doctor’s degree… you might have chronic pain.

• If the words “Have you tried yoga?” trigger your PTSD… you might have chronic pain.

• If you have ever slept for 24 hours and then woken up and needed a nap… you might have chronic pain.

• If your medical bills are higher than the GDP of a small country… you might have chronic pain.

• If your “desk” is just your bed with a pillow propped up behind you… you might have chronic pain.

• If you have ever had to diagnose yourself… you might have chronic pain

• If you currently have a 500-count bottle of ibuprofen at home — and another one in the car… you might have chronic pain.

• If your idea of a perfect date night is sitting at home under a heated blanket while watching Lord of the Rings … you might have chronic pain.

• If your favorite food is THC gummies… you might have chronic pain.

• If you ever used up all of your sick days in the month of January… you might have chronic pain.

• If you use more dry shampoo than regular shampoo… you might have chronic pain.

• If you ever hoped that a test actually showed you had cancer, so that then you’d at least have an explanation… you might have chronic pain.

• If your most worn accessory is some sort of medical brace… you might have chronic pain.

• If all your shoes have arch support… you might have chronic pain.

• If your entire social media feed is posts about surviving chronic pain… you might have chronic pain.

• If you have ever worn the same outfit for 5 days in a row… you might have chronic pain.

If you can relate to any of these… you might have chronic pain.

Here’s hoping today is one of your good pain days. 

And if you have any “You might have chronic pain if…” examples that you’d like to share, we’d love to read them in the comments. 

Medicine for the Soul: Friends Are Important When You Have Chronic Pain

By Crystal Lindell

Every month before book club, I count out some pain pills.

I have to make sure I have a dose to take before I leave the house, so that they will be fully working when I arrive. And I have to make sure I have another dose to bring along – in case things run late and my pain starts to creep back before I make it home.

Without doing that, I know there’s no way I’d be able to physically endure the hours-long social interaction – even if that social interaction is literally just sitting on the couch and talking about a book. That’s just how my life is with the type of chronic pain I have. 

And it’s a social interaction that I absolutely love, by the way. In fact, I love it so much that I sacrifice both before and after every meet-up to make sure I can show up for it.  

On the day of a book club meeting, I also have to cut back on things like chores so that I can make sure I have the energy to shower, get dressed and put on makeup before I leave the house. While I’m sure the group wouldn’t mind if I showed up disheveled, I would.  

And I have to plan my schedule after the book club to allow time for me to go to bed early, because I know I’ll need to. Being alert and upright for a few hours is that hard on my body. 

Living with chronic pain means all my friendships require planning, extra work, and usually pain medication. It’s a level of effort that would make it easy, even understandable, to give up on the whole ordeal. But I don’t.

The priorities each day for me with chronic pain are basic hygiene, nutrition, housework, and maybe earning some money. All of that usually only leaves time and energy for one other thing: Sleep.  

Driving somewhere to get coffee with an old friend just doesn’t feel as urgent. Especially if you’re also in a romantic relationship or taking care of loved ones who themselves have health problems.

And making new friends? Forget about it!  

But please trust me when I tell you that “maintaining friendships” and even “making new friends” truly is just as crucial as taking a shower and doing the dishes – especially when you have chronic pain.

I have only been in this book club for about a year now, and most of the people in it are completely new friends to me. But I’m so glad that I have prioritized going, even when my physical pain is especially bad. 

Meeting with them always enriches my spirit in ways I can’t predict. 

That’s the thing about friendships: They are literally medicine in and of themselves. Often comforting, rejuvenating, and even healing.

In fact, a few months ago, during the book club meeting we played a game where we each anonymously wrote three compliments about everyone else in the group. And then we each got to hear what the others said about us.

The things everyone said about me were like medicine for my soul. For weeks afterward, when I felt like the physical pain was too much, I would think of those compliments. And they would help me mentally to endure it.

It’s the kind of thing that makes counting out pills before we meet more than worth it.

Three Clichés That Help Me Get Through Bad Pain Days

By Crystal Lindell

As the old cliché goes: clichés are clichés for a reason. They tend to convey a lot of fundamental truth about the world and life itself.

While dealing with chronic pain for more than a decade now, I have come to appreciate certain clichés in ways that I couldn’t before I got sick and lived to tell the tale.

They may sound corny, but below are three clichés that I have found really do help me get through a day with chronic pain: 

Cliché #1: This Too Shall Pass

When I first started having chronic pain, flares felt eternal. I genuinely worried that the pain would last forever. Any relief felt like an impossible dream.  

But eventually, the pain would ease a bit. Over time, I was also able to find calming techniques, as well as pain medications and supplements that helped relieve my symptoms. 

Even during the worst pain flares, I take heart in knowing that it too shall eventually pass.

It goes both ways too. On the other side of this equation, I’m also now significantly more aware of just how fleeting my health truly is. While the bad pain flares will pass, that also means the good days will pass as well – making it that much more important to savor them.

As it turns out, losing your health is the best way to finally learn how to appreciate the good days.

Cliché #2: Other People’s Opinions Don’t Matter

This concept is, for me, the simplest and yet the most difficult to truly internalize. 

But when you have chronic pain, you have to learn to ignore other people’s opinions about what you’re going through. And trust me, people will rush to share their opinions with you as much as possible, whether you ask for them or not.

You have to tune it out though, otherwise you’ll just fall into a dark despair of guilt and impossible standards.

I also have realized that what people say they would do if they were in pain, and what they would actually do are two very different things. 

People love to say they would never take opioids, or that they would just use yoga to “cure” their chronic pain. But I have been dealing with my own pain long enough now to see those same people eventually have to put their money where their mouth is, and they always fail their own test.

People who are the most judgmental of your choices are also the first to crack under the pressure that pain causes. It then becomes clear that most of their judgmental comments are reflections of their own issues, rather than anything to do with you.  

People claiming they would never use opioids are trying to convince themselves of that, as opposed to making a statement about your choices. 

And people who quickly say they’d just do yoga to cure their pain are trying to mentally process the fear they have at the thought of ending up like us. It’s a coping mechanism that allows them to think that even if it did happen to them, they’d be fine.

If you’re struggling with chronic pain, it’s good to remember you’re doing the best that you can, under the circumstances. Whether or not other people agree is irrelevant.

Cliché #3: The Best Days of Your Life Haven’t Happened Yet

This cliché is honestly the most magical for me, and it has truly helped me get through some rough patches in my own life.

When you’re drowning in chronic pain, it’s easy to spiral physically and emotionally, and to assume that nothing good will ever happen to you again. But take it from me, good things will still happen.

When I first developed chronic pain in 2013, I still had not met the love of my life, I’d never had a cat, and I had never gone to Paris. In the years since though, I met my fiancé; I acquired six cats (all of whom I’m obsessed with); and I have been to Paris not once, but TWICE!

There are incredible things in store for you, too — and that’s worth hanging around for. 

While none of these clichés can cure chronic pain, they do make it a little easier to endure. And sometimes, that little extra is all you need to make an extraordinary life. 

If you have any clichés that you find helpful, I’d love for you to drop them in the comment section below. After all, we could also use a little life advice, especially when that advice has been tried and tested by people strong enough to survive chronic pain.

Prohibition Medicine and the Collapse of Patient Safety

By Michelle Wyrick

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

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

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

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

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

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

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

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

The same pattern is now playing out inside medicine itself.

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

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

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

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

In the real world, the opposite happened.

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

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

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

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

But the harm does not stop with overdose statistics.

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

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

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

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

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

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

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

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

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

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

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

It pushes people out.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You cannot ban your way to safety.

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

And right now, we are doing the opposite.

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

In More Pain? Blame the Weather – and Climate Change

By Crystal Lindell

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

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

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

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

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

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

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

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

And our bodies have noticed.

A recent story by Inside Climate News discusses the link.

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

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

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

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

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

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

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

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

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

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

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

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

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

3 New Year’s Resolutions on Behalf of Pain Patients

By Crystal Lindell

It’s now 2026, which means I’ve spent too many decades making mostly failed New Year’s resolutions for myself. So this year, I’m not going to bother.

Instead, I have some New Year’s resolutions for other people. Specifically, they’re for people with power, like doctors and healthcare policy makers.

After all, it really seems like they need to make some policy changes, given the current state of things for people in pain. Perhaps they are just waiting for someone to tell them what those changes should be. 

Below is a look at three of my 2026 New Year’s resolutions on behalf of pain patients..

Resolution # 1: Fully Legalize 7-OH and Develop New Edibles

There’s so many conflicting local regulations when it comes to kratom and 7-OH, despite the fact that neither one is as harmful as health officials and lawmakers often claim.

For those unfamiliar, 7-OH is short for 7-hydroxymitragynine, an alkaloid that occurs naturally in kratom in trace amounts. Some kratom vendors now sell concentrated versions of 7-OH to boost its potency as a pain reliever and mood enhancer.

A lot of pain patients find both 7-OH and kratom to be effective at treating chronic pain. And while I am glad that both are still legal in most places in the United States, I would really like to see them fully legalized across the country, as municipalities and states realize just how beneficial these products can be.

I also would really like to see 7-OH vendors come out with some new edible formats, like chocolates, gummies and even seltzer.

I think 7-OH in particular has the potential to help a lot of people who have been denied adequate pain treatment. However, many of them may not be comfortable figuring out where to buy and correctly dose a 7-OH chewable tablet, especially if they are among one of the largest demographic of pain patients: the elderly.  

I think of my grandma trying to get 7-OH tablets at a local smoke shop, or having to figure out how to order them online. Both options are bad. 

Ideally, regular grocery stores and local pharmacies would have a display of low-dose 7-OH chocolates available over-the-counter for pain patients like her.

Resolution # 2: Stop Prescribing Gabapentin and Tramadol for Pain

This would be such a relatively easy change for doctors to make, and there’s so much science to back it up.

In October of 2025, PNN covered a study showing that tramadol is often not effective for chronic pain. And PNN has long been covering how ineffective gabapentin is for most pain conditions.  

However, despite the evidence, doctors still regularly prescribe gabapentin and tramadol for chronic pain. 

It doesn’t have to be that way. Doctors have alternatives that actually work, most notably low-dose hydrocodone. Yes, there are more regulations around that medication, making it more difficult to prescribe. But actually giving pain patients real options shouldn’t be so difficult.  

So, I would like doctors and other healthcare professionals to make it their goal to stop prescribing ineffective medications. Instead, offer pain treatments that actually work. Your patients will thank you.

Resolution # 3: Implement Medicare for All

Yes, I know this one is kind of unrealistic. But that’s what New Year’s magic is all about —  putting whimsical ideas out into the universe with the hope of seeing them come to fruition. 

After all, it can’t happen if we never ask for it.

Unfortunately, as the year starts off, we are actually heading in the opposite direction, with many Americans seeing their health insurance premiums soar or even deciding not to buy coverage. 

But I’m hoping that may be the catalyst we need for the public to start demanding real change. Right now, millions of people are losing their health insurance because the Trump administration ended federal subsidies for coverage under the Affordable Care Act. 

It’s an awful and unnecessary situation that our policy leaders have the power to fix, if only they worked together on the issue.

Every human should have the right to healthcare, and Medicare for All would go a long way to making that happen.

I know a lot of these resolutions probably won’t come to fruition in 2026, but I do think they could realistically happen before we start the next decade. And all of them have the potential to vastly improve the lives of millions of people living with chronic pain.

Happy New Year everyone. May your 2026 be filled with low-pain days, too much joy, and lots of love.

A Pained Life: What's in a Name?

By Carol Levy

First, we were called “handicapped." It was a wholesale term to paint all those with physical, emotional or intellectual limitations. One inability meant total inability. Often, it was used as an exclusionary term, to mean someone was “less than.”

Eventually, it was realized that handicapped was a demeaning term. So, they changed it to “disabled.” That too was belittling — a word that tended to make us seem less than whole.

Then came physically (or emotionally or intellectually) “challenged.” That sounds better. After all, being challenged just means you have to try harder to meet goals and objectives.

But even that term carries a subtle meaning: we can overcome challenges if we just “try harder” or “do better.” It suggests we are too lazy, too much of a malingerer, and don't want to even try.

There has to be something better. In thinking about this, I had an “Aha!” moment: I am not disabled, I am “unable.”

That seems more appropriate. After all, being unable in one sense does not mean unable in all. "I am unable to answer the phone right now. Please call back later.".

Because of my trigeminal neuralgia, I can't use my eyes for more than 15 -20 minutes without severe pain. I can't tolerate wind or even a slight breeze against the affected side of my face.

But the rest of me is able and willing. It only makes me unable to do things that require the use of my eyes. I am still able to do things that are physically demanding. I can walk, talk, think, exercise, and thankfully take care of myself. That is far from being disabled. 

Others among us may be unable to lift things, clean a room, or even walk. But we can still think, talk, read, and interact with others, even if only on the phone or online.  We are “unable” in part, but able in many other ways.

But, at the end of the day, does the term used to describe those with inabilities really matter? Most healthy people don’t even consider the label, it’s just a way of quickly describing someone.

Quick descriptions, though, lead to stereotypes and misunderstandings. Take, for example, someone parking in a “handicapped” parking spot.

They may have the placard or license plate that gives them permission to park in these spaces, but when they exit their car and start to walk away, another person may object. They’ll start yelling, “You're not handicapped! How dare you park there and take the space away from someone who actually needs it!”

I have had this happen to me. But it’s too hard to explain what trigeminal neuralgia is, and how the wind or even a breeze could set off a pain flare.

Instead, I say, “I do not need to have a cane or wheelchair to be disabled. I may have a heart condition or emphysema or any number of other disorders that make it difficult for me to park farther away from the entrance.”

Looking abashed, if you're lucky, the person walks away.

It would be nice and so much easier, if I could respond by saying “You're right. I am not handicapped in the way you expect me to be. I am unable physically in a way that may be invisible to you, but necessitates my using this spot.”

I keep my fingers crossed, hoping it’s a teachable moment, that this person will understand that “unable” in one sense does not mean unable in all. Maybe, if we're all really lucky, she’ll be able to pass it on.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 40 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.  

On a Scale of 1 to 10…

By Julie Titone

Pain is the most common reason that people see a primary care doctor. If you have chronic pain – the kind that’s stuck around for three months or more – chances are you’ve seen lots of specialists, too. 

You may dread their standard question as much as I do: “On a scale of 1 to 10, how much pain do you feel, with 10 being the worst pain possible?”

I hesitate to answer. If I say 6, will I feel like a whiner? If I say 5, will my pain be taken seriously? 

How would I know if I felt the worst possible pain? 

Are you asking me how much it hurts when I stand or when I sit?

There is value in trying to quantify pain, and many have tried to improve upon the 10-point scale. But pain can never be captured by numeric language or, for that matter, by the English language. Good doctors are less interested in numbers than in how the pain is affecting someone’s life.

This subject is on my mind because of the responses to my column, “Arachnoiditis: My Not-So-Rare Disease.” 

Readers who share my diagnosis of adhesive arachnoiditis told me they appreciated my effort to spread the word about this chronic inflammatory disease. But a few chided me for downplaying how painful arachnoiditis can become. 

Here is what I wrote: “Patients experience lower body numbness and stinging pain that, at its worst, is likened to hot water dripping down the legs. The disease can lead to paralysis and bladder dysfunction.”

I debated which words to use in that paragraph. A litany of misery might cause folks to stop reading, so I kept the descriptive list short. 

Now, in recognition of those who suffer, I will expand upon the kinds of pain reported by arachnoiditis patients:

• Burning, stabbing, shocking, zapping

• Buzzing, icy hot, insects crawling under the skin. 

• Deep aching/boring in the spine. 

• Pain radiating down the back of the legs. 

• Vice-like pressure. Cramping. 

• Pain that increases upon standing or sitting. 

• Sudden flares triggered by movement. 

• Widespread burning in the lower body. 

• Pelvic, abdominal and bladder-related pain. 

• Unrelenting, throbbing, exhausting pain.

As one woman wrote in an online discussion: “How much can a body take?” 

Some patients would answer that question with suicide.

What makes this all doubly sad is that arachnoiditis often begins when people seek relief, via injections or surgery, from another source of pain.

So far, my own arachnoiditis is not debilitating. I get modest relief from medicines, movement and massage. Distraction helps. If you need advice on the best ice packs and seat cushions, I’m your gal.

Chronic pain plagues an estimated 20 to 30 percent of people in the world at any given time. The cliché goes that misery loves company. I don’t love it, but that massive company could work in my favor someday.

Researchers have 2 billion reasons to investigate pain treatment and prevention. As the secrets of neural pathways are unlocked, the knowledge is bound to benefit those of us with arachnoiditis.

Julie Titone is a former newspaper journalist who also worked in academic and library communications. She is retired and lives in Everett, Washington. Julie’s website is julietitone.weebly.com.

This column first appeared in Julie’s Substack blog and is republished with permission. 

Congress Went Home for Holidays, Leaving Millions to Face Rising Healthcare Costs

By Robert Applebaum

Dec. 15, 2025 – the deadline for enrolling in a marketplace plan through the Affordable Care Act for 2026 – came and went without an agreement on the federal subsidies that kept ACA plans more affordable for many Americans. 

Despite a last-ditch attempt in the House to extend ACA subsidies, with Congress adjourning for the year on Dec. 19, it’s looking almost certain that Americans relying on ACA subsidies will face a steep increase in health care costs in 2026.

As a gerontologist who studies the U.S. health care system, I’m aware that disagreements about health care in America have a long history. The main bone of contention is whether providing health care is the responsibility of the government, or of individuals or their employers.

The ACA, passed in 2010 as the country’s first major piece of health legislation since the passage of Medicare and Medicaid in 1965, represents one more chapter in that long-standing debate. That debate explains why the health law has fueled so much political divisiveness – including a standoff that spurred a record-breaking 43-day-long government shutdown, which began on Oct. 1, 2025.

In my view, regardless of how Congress resolves, or doesn’t resolve, the current dispute over ACA subsidies, a durable U.S. health care policy will remain out of reach until lawmakers address the core question of who should shoulder the cost of health care.

The ACA’s Roots

In the years before the ACA’s passage, some 49 million Americans – 15% of the population – lacked health insurance. This number had been rising in the wake of the 2008 recession. That’s because the majority of Americans ages 18 to 64 with health insurance receive their health benefits through their employer. In the 2008 downturn, people who lost their jobs basically lost their health care coverage.

For those who believed government had a primary role in providing health insurance for its citizens, the growing number of people lacking coverage hit a crisis point that required an intervention. Those who place responsibility on individuals and employers saw the ACA as perversion of the government’s purpose. The political parties could find no common ground – and this challenge continues.

The major goal of the ACA was to reduce the number of uninsured Americans by about 30 million people, or to about 3% of the U.S. population. It got about halfway there: Today, about 26 million Americans, or 8%, are uninsured, though this number fluctuates based on changes in the economy and federal and state policy.

Health Insurance for All?

The ACA implemented an array of strategies to accomplish this goal. Some were popular, such as allowing parents to keep their kids on their family insurance until age 26. Some were unpopular, such as the mandate that everyone must have insurance.

But two strategies in particular had the biggest impact on the number of uninsured. One was expanding the Medicaid program to include workers whose income was below 138% of the poverty line. The other was providing subsidies to people with low and moderate incomes that could help them buy health insurance through the ACA marketplace, a state or federal health exchange through which consumers could choose health insurance plans.

Medicaid expansion was controversial from the start. Originally, the ACA mandated it for all states, but the Supreme Court eventually ruled that it was up to each state, not the federal government, to decide whether to do so. As of December 2025, 40 states and the District of Columbia have implemented Medicaid expansion, insuring about 20 million Americans.

Meanwhile, the marketplace subsidies, which were designed to help people who were working but could not access an employer-based health plan, were not especially contentious early on. Everyone receiving a subsidy was required to contribute to their insurance plan’s monthly premium. People earning US$18,000 or less annually, which in 2010 was 115% of the income threshold set by the federal government as poverty level, contributed 2.1% of their plan’s cost, and those earning $60,240, which was 400% of the federal poverty level, contributed 10%. People making more than that were not eligible for subsidies at all.

In 2021, legislation passed by the Biden administration to stave off the economic impact of the COVID-19 pandemic increased the subsidy that people could receive. The law eliminated premiums entirely for the lowest income people and reduced the cost for those earning more. And, unlike before, people making more than 400% of the federal poverty level – about 10% of marketplace enrollees – could also get a subsidy.

These pandemic-era subsidies are set to expire at the end of 2025.

Cost vs Coverage

If the COVID-19-era subsidies expire, health care costs would increase substantially for most consumers, as ACA subsidies return to their original levels. So someone making $45,000 annually will now need to pay $360 a month for health insurance, increasing their payment by 74%, or $153 monthly. What’s more, these changes come on top of price hikes to insurance plans themselves, which are estimated to increase by about 18% in 2026.

With these two factors combined, many ACA marketplace users could see their health insurance cost rise more than 100%. Some proponents of extending COVID-19-era subsidies contend that the rollback will result in an estimated 6 million to 7 million people leaving the ACA marketplace and that some 5 million of these Americans could become uninsured in 2026.

Policies in the tax and spending package signed into law by President Donald Trump in July 2025 are amplifying the challenge of keeping Americans insured. The Congressional Budget Office projects that the Medicaid cuts alone, stipulated in the package, may result in more than 7 million people becoming uninsured. Combined with other policy changes outlined in the law and the rollback of the ACA subsidies, that number could hit 16 million by 2034 – essentially wiping out the majority of gains in health insurance coverage that the ACA achieved since 2010.

Subsidy Downsides

These enhanced ACA subsidies are so divisive now in part because they have dramatically driven up the federal government’s health care bill. Between 2021 and 2024, the number of people receiving subsidies doubled – resulting in many more people having health insurance, but also increasing federal ACA expenditures.

In 2025, almost 22 million Americans who purchased a marketplace plan received a federal subsidy to help with the costs, up from 9.2 million in 2020 – a 137% increase.

Those who oppose the extension counter that the subsidies cost the government too much and fund high earners who don’t need government support – and that temporary emergencies, even ones as serious as a pandemic, should not result in permanent changes.

Another critique is that employers are using the ACA to reduce their responsibility for employee coverage. Under the ACA, employers with more than 50 employees must provide health insurance, but for companies with fewer employers, that requirement is optional.

In 2010, 92% of employers with 25 to 49 workers offered health insurance, but by 2025, that proportion had dropped to 64%, suggesting that companies of this size are allowing the ACA to cover their employees.

Dueling Solutions

The U.S. has the most expensive health care system in the world by far. The projected increase in the number of uninsured people over the next 10 years could result in even higher costs, as fewer people get preventive care and delayed health care interventions, ultimately leading to more complex medical care

Federal policy clearly shapes health insurance coverage, but state-level policies play a role too. Nationally, about 8% of people under age 65 were uninsured in 2023, yet that rate varied widely – from 3% in Massachusetts to 18.6% in Texas. States under Republican leadership on average have a higher percentage of uninsured people than do those under Democratic leadership, mirroring the political differences driving the national debate over who is responsible for shouldering the costs of health care.

With dueling ideologies come dueling solutions. For those who believe that the government is responsible for the health of its citizens, expanding health insurance coverage and financing this expansion through taxes presents a clear approach. For those who say the burden should fall on individuals, reliance on the free market drives the fix – on the premise that competition between health insurers and providers offers a more effective way to solve the cost challenges than a government intervention.

Without finding resolution on this core issue, the U.S. will likely still be embroiled in this same debate for years, if not decades, to come.

Robert Applebaum, PhD,  is a Senior Research Scholar in the Department of Sociology and Gerontology at Miami University. He is also Director of the Ohio Long-Term Care Research Project and Senior Research Scholar at the Scripps Gerontology Center.

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

My Christmas Wishes for Pain Patients

By Crystal Lindell

With Christmas spirit in the air, and the hope of the New Year close behind, it seems only appropriate to make some holiday wishes for all my fellow pain patients.

Here are my wishes for people in pain:

More low-pain days than not. Easy opioid prescription refills. Clothes that don’t hurt to wear. Supportive family that always believes you and never judges you.

The ability to use a cane, the possibility of not needing it, and the wisdom to know the difference.

I wish for you a sweet pet to cuddle up in your lap whenever you can’t get off the couch. Money that comes in more than it goes out. And steady weather, so that the barometric pressure doesn’t increase your pain.

I wish that every book you read to get through a pain flare takes you to a new world where your pain isn’t as bad.

I wish for you a doctor who takes you seriously and prescribes you medications that actually work. Health insurance that actually covers all of your medical expenses. And a pharmacist who actually believes you.

I wish you more strength that you need to keep going when the pain is really trying to make you stop. And the ability to keep hope alive even when you’d rather be dead.

If you’re seeking answers and a diagnosis, I hope you find both. 

If you’re seeking a romantic partner, I hope they find you. 

If you’re just seeking a good TV show to watch on bad pain days, I hope you find one with lots of seasons. Hopefully, it’s on one of the streaming services you already subscribe to!

May your naps always rejuvenate you, your medications always kick in quickly, and your shoes always be comfortable.

But most of all, my wish for you is that your pain goes away. I really do.

Sadly, like my body, my wishes don’t always work so well. They only rarely come true. 

So, if your pain refuses to leave, I wish only that you know that this world needs you in it, and that it’s vitally important that you keep going. There are still so many things left for you to see and do and accomplish. 

Merry Christmas dear pain patient, and hopefully a very happy New Year – or at least a survivable year ahead.

I See Doctors All the Time, But They Won’t Treat My Pain

By Neen Monty

I am in complete overwhelm right now. It has been far too much, for far too long.

As I write this, in the last ten days alone, I’ve had seven medical appointments or treatments:

• Two GP visits.

• One neurologist appointment. And the news wasn’t great.

• My fortnightly IVIG infusion.

• A consult with a new pain management doctor. It did not go great.

• The introductory session for the public pain clinic. The first step in a very long process to see the doctor I was referred to.

• A psychologist appointment.

That’s seven appointments in ten days.

This is what being seriously ill looks like. This is what living with a disabling, incurable disease looks like.

I don’t choose for my life to revolve around my disease. The disease chooses. The disease dictates my schedule, my energy, my mobility, my ability to work, and my ability to participate in life.

When you’re very unwell, with a serious, progressive and incurable disease, there is no choice. You don’t get to opt out. You don’t get to think happy thoughts, and everything magically gets better.

You don’t get to postpone or not feel up to it today. You don’t get to decide what you do with your four functional hours a day. Your illness becomes the architect of everything.

People say, “Why don’t you try harder?”

Try what, exactly? Try not being sick? Thanks, that’s really helpful advice.

Instead of empathy, I get blamed.

You should change your diet. You should exercise more. You should get out more. You should try grounding. You should try Bowen therapy. You should read this great book I just read, it’s sooooo motivational!

You should read up on stoicism, it would help you be tougher. You should stop taking all those medications. Pharma makes customers, not cures, you know. Never mind that if I stop taking just one of my medications, I will die.

They are all saying, “You should try being not sick.”

The truth is that they don’t want to hear about it. It’s boring. And you’re exaggerating. You’re malingering. You’re not strong enough. You’re not positive enough. You are not enough.

Not one of these people has taken a moment to even consider what my life is really like. What it’s like to wake up sick and in terrible pain, every single day. Usually at around 3am.

That’s when my day starts. That’s when I start battling the pain. It’s truly a very difficult existence.

But instead of empathy and support, I get belittled. Dismissed. Treated as if pain — the most defining and disabling part of my disease — is somehow optional, psychological, or a personal and moral failing.

Something that I chose. Something I did wrong. Or something I didn’t do right.

Because people like to believe that everything happens for a reason. Spoiler: It doesn’t.

And that bad things don’t happen to good people. Spoiler: They do.

Doctors will treat the disease. But they refuse to treat the pain the disease causes.

And honestly, what’s the point? If you’re not going to treat the pain, how can you call yourself a doctor? How can you pick and choose what you will and won’t treat? And who you will and won’t help?

Pain is not my only disabling symptom. I have significant muscle weakness that is noticeably progressing.

I try to exercise, even though it usually makes things worse before it makes anything better. I hope it’s going to make me stronger long term. I don’t know that, but it’s my best hope. So I take my dogs on a slow jog and walk, and hope for the best. Always looking on the bright side.

Pain? It’s getting worse. No question. That’s disease progression. And maybe opioid tolerance in play.

But every doctor says the same thing: “You cannot have a higher opioid dose. No matter how bad the pain is.”

This isn’t medicine. It’s barbarism. It’s cruelty.

This is politics dressed up as healthcare. Policy made by people who are not doctors or scientists, and not interested in the terrible pain they cause. Yet they call it “evidence-based” and “best practice.”

These are rules made by people who will never experience what they’re inflicting. Because we know when doctors and politicians are in the hospital, they get opioids.

Just not us normal folk. The little people. We don’t matter, apparently.

Every week I talk to medical professionals, trying to understand why it’s like this. I don’t want to argue, I want to learn. Is this clinician bias I am looking at? Or is this what they’re all being taught?

Answer: It’s systemic. Doctors are being taught myths based on lies. And they don’t have time to check the science. If they did, they would be horrified at the patient harm they have caused and the lack of evidence for their decisions. But they’ll never check, so…

They have literally been trained to believe that education is more effective than opioid pain medication. How can any intelligent person believe that? It blows my mind.

They are taught that pain is “psychological” or caused by a “hypersensitive nervous system.” It has nothing to do with tissue damage, inflammation, disease or pathology.

Which is 100% wrong in every case.

We have a generation of clinicians who see pain not as a serious medical symptom, but as a faulty thought pattern. A cognitive glitch. A mindset problem.

Do you know what that belief system does? It erases empathy. Because why feel compassion for someone who is “catastrophising?” Why help someone whose pain is “in the brain,” which they can change themselves?

Why treat the suffering of someone who just needs to understand pain better?

I can always tell the exact moment a clinician realizes my pain is pathological and that their program, book, or brain training technique won’t work on me.

It’s like a curtain drops. Their interest vanishes. Their warmth evaporates. They stop asking questions. They stop seeing me as anything other than a problem.

Only one person in the last fortnight showed actual empathy — the sort of basic human response that should be universal when you have a severe, progressive, incurable, and painful disease. Every human being should be able to say, at the very least, “I’m so sorry you’re dealing with that.”

But only one did. I spoke to two physical therapists and one GP on social media. Asking them questions, hoping to learn. I answered their questions, but they didn’t answer mine. And as soon as they realized I would be of no use to them, they ghosted me.

Only one took the time to say, “I’m so sorry this has happened to you.”

My story is terrible. I have been abandoned, ignored, demonized, stigmatized, misdiagnosed and refused the most basic care. Any normal human being should be horrified by my story and the reality of my life. Of the pain I am forced to endure.

But only one showed me any empathy at all.

Mostly what I get is coldness. Defensiveness. Blank stares. Silence.

Not my problem-ism.

These are the people we rely on. The people who decide whether we get treatment, whether we get relief, whether we get to have any quality of life at all.

My life is not my own. I am not choosing this. No one would.

I’m trying to survive a body that is failing me and a system that refuses to see what pain really is — a physical experience rooted in biology, pathology and disease, that is sometimes influenced by psychological and sociological factors.

Not a mindset. Not a belief. Not a psychological construct.

The hardest part of being sick isn’t the disease. It’s fighting for your life while the system fights against you.

Neen Monty is a patient advocate in Australia who lives with rheumatoid arthritis and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), a progressive neurological disease that attacks the nerves.

Neen is dedicated to challenging misinformation and promoting access to safe, effective pain relief. For more information on chronic pain, the science, the politics and the lived experience, got to Pain Patient Advocacy Australia. You can also subscribe to Neen’s free newsletter on Substack, “Arthritic Chick on Chronic Pain.”

Medical Assistance in Dying: When Is Enough, Enough?

By Ann Marie Gaudon

Google AI defines the phrase "enough is enough" as a personal judgment that continued effort or tolerance is no longer beneficial or sustainable. When you are trying to fix a problem and you've exhausted all reasonable options, it's a signal that you need to let go and move on. 

If only we knew where moving on is meant to be.

If you’ve been following along, you will know I have lost a few friends to Medical Assistance in Dying (MAiD) here in Canada. I have written about Maggie and Melissa,who both ended their lives after struggling for years to meet MAiD’s requirements, which include having an “irrevocable and grievous medical diagnosis” that could not be cured or treated.

Some people call it “assisted suicide.” I don’t particularly like that term, only because the word “suicide” itself comes with centuries of baggage.

It’s Canadian law that an individual may not have a foreseeable death. However, if they are suffering to an extent that they choose to die, then they can access the MAiD option – what is supposed to be a peaceful, dignified death. 

It’s not as easy as the law sounds. Maggie’s choice took well over two years and only happened because her medical practitioner pushed for it. For Melissa, it never came first or last. My heart ached for her. Just because you are qualified to receive MAiD, doesn’t mean that you’re going to get it – and that frightens me.

Physically, things are not going well for me lately. What if I’m ready to leave this earthly body and no one will help me do it peacefully? 

You might already know that I am an advocate for personal choice in dying. That means a person’s right to choose for themselves only. But how does one even make this decision? When is enough, enough? 

I would think that relief of suffering is the most important factor in the decision to access MAiD. If you are actually dying, MAiD will provide you with a very peaceful and humane death. 

But I don’t think this is fair to a person living with pain who is not dying, but is suffering too much to cope or have any meaningful quality of life. 

I don’t think there should be a difference, however there is. There is a great reluctance for the MAiD doctors to provide assistance in dying to a person in pain. There’s a tendency instead to diagnose them with a mental illness — which then disqualifies them for MAiD.

A lack of support would surely be another factor in the decision for or against MAiD. I am eternally grateful for my inner circle and their support. Even if they hated the idea of MAiD for me (which they would), I would still receive their support if I was very certain I wanted to end my suffering forever. Unconditional love is what it’s all about.

Speaking about loved ones, I now have another one that has changed everything for me: a grandchild. He is nine months old as I write this and a ball of love and sunshine all rolled into one. How could anyone not want to see him grow? Be a part of his life? Be a beloved grandparent? 

I sit here crying as I write this to you. I can’t speak for others, but this grandchild has changed everything about how I feel regarding my own death – that is, if I even have a choice in the matter. Unknowingly, he has taken the priority off of myself as a candidate for MAiD and become the priority.

I think I’m asking a question that there is no answer to, at least cognitively. Perhaps enough is enough when you feel it. Even if you don’t have the language to explain it, maybe it is a feeling? 

Our minds have evolved to be great problem-solving machines, but what if the problem cannot be solved? It’s a conundrum. My chronic pain and illness cannot be solved, and with each passing year I feel physically worse than the year before.

That does not equate, however, to feeling emotionally worse. That is not my case. Perhaps my age has allowed me to give up a lot of the emotional struggle and grab a handful of happiness whenever I can. I can laugh easily and heartily at the healthy moments of life, yet my body is breaking beneath me. What does one do with this scenario?

For one, I am not convinced that although I legally qualify for MAiD, that it would actually be completed. For two, now with a grandchild in the mix, everything has been upended for me. 

What I thought I would do is now what I don’t want to do. The big problem is my body is breaking beneath me. I have acquired a world of coping skills, but they do not work when the pain is severe. 

How long do I suffer because I can’t bear to leave others? There is no answer for this and I damned well know it.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.