Poor Nutrition Linked to Higher Risk of Chronic Pain

By Crystal Lindell

Vitamin and mineral deficiencies could play a key role in chronic pain, according to new research that found low levels of Vitamin D, B12, folate and magnesium were common in people with severe chronic pain. 

The study, led by researchers at the University of Arizona Health Sciences, analyzed health data on over 220,000 people in the National Institutes of Health’s “All of Us” Research Database. The study is the first to look at micronutrient levels of people with and without chronic pain on a large scale.

“I treat chronic pain patients, and oftentimes we don’t come up with a diagnosis. But just because there isn’t a surgery that will help you doesn’t mean you’re not in pain. It just means that our understanding of pain is limited to date,” said senior author Julie Pilitsis, MD, head of the Department of Neurosurgery at U of A College of Medicine–Tucson.

“This study is a novel way to approach chronic pain treatment, where you are looking at the patient holistically to see what could be going on systemically that is easily modifiable – changes in diet as opposed to medications or other things.”

Pilitsis and her colleagues focused on five micronutrients commonly associated with chronic pain: vitamins D, B12, and C, folate and magnesium. Nutritional data was analyzed for people without pain, those with mild-to-moderate chronic pain, and people with severe chronic pain.

They found that people with severe chronic pain were more likely to have deficiencies in vitamin D, vitamin B12, folate and magnesium. The findings, however, varied depending on gender, race and ethnicity.

“The finding that surprised us the most was that Asian females had higher vitamin B12 levels than expected,” said co-author Deborah Morris, PhD, a research laboratory manager in the Department of Neurosurgery. “Asian females with severe chronic pain had the highest vitamin B12 levels overall. We were expecting it to be lower.”

The results also varied for vitamin C, where males with mild-to-moderate or severe chronic pain were more likely to have low or borderline low levels of vitamin C, compared to males without pain. 

Researchers caution that they didn’t prove a cause-and-effect relationship between nutrition and pain, but they believe their findings could lead to personalized diets and nutritional supplements for people with chronic pain. 

The Western Diet, which is common in the United States, is deficient in fruits and vegetables and contains high amounts of meat, refined grains, and desserts. This could contribute to nutritional imbalances and deficiencies in micronutrients. 

Frustratingly, like so much medical research regarding chronic pain these days, it seems one of the primary goals of the researchers is to reduce opioid use. 

“Our goal is to improve the quality of life for people with chronic pain and reduce opioid usage, and these findings have the potential to do that as part of a holistic approach to pain management,” said Morris. 

Note how she doesn’t say she wants to help patients reduce ibuprofen or gabapentin use, despite the fact that both can cause serious side effects. 

I’m glad to see more progress when it comes to understanding the causes of chronic pain –  especially since I suffer from it – but constantly framing every advancement as a way to “reduce opioid use” is disappointing. Opioid prescriptions have already been greatly reduced to levels not seen in over 20 years.

While chronic pain patients should obviously be making sure their vitamin and mineral levels are within the normal range, my fear is that doctors will over-correct – and start pushing vitamins and supplements as alternatives to pain medication. 

I myself suffered from extremely low vitamin D levels, and I do find that keeping it in the normal range helps reduce my pain levels. Holistic treatments can be a good thing, but only if they are truly holistic – encompassing both non-traditional and traditional approaches. 

Learn the Latest Advances in Adhesive Arachnoiditis at a Free Seminar

By Pat Anson

If you suffer from adhesive arachnoiditis (AA) or would like to learn more about it, there’s a unique opportunity next month to learn about the latest research and treatments for AA, and to connect with other patients, advocates and physicians.

The Tennant Foundation and the Arachnoiditis & Chronic Meningitis Collaborative Research Network (ACMCRN) are hosting a one-day seminar on Saturday, August 16 in Westminster, Colorado outside Denver. Lodging, meals and transportation are not provided, but the conference itself is free of charge.

AA is a spinal disease that causes chronic inflammation in the arachnoid membrane that covers the spinal canal. When nerves in the spine also become inflamed, they can adhere or stick together, causing severe pain and a wide variety of other symptoms.  

AA can develop after surgery or trauma that damages the spine. It may also be triggered by an inflammatory autoimmune disease that originates outside the spine that spreads into spinal tissue.

There is no cure for AA, but advances are being made in its treatment. The problem is that few practitioners know how recognize the early symptoms of AA, much less how to diagnose and treat it. That’s why conference organizers hope physicians will attend, along with patients, caregivers and family members.   

“We'll take whoever is interested,” says Dr. Forest Tennant, who is recognized as the world’s leading expert in AA. “We'd like to have many nurse practitioners or physicians who really want to know the disease. We're going to cover it backwards and forwards. We hope to make them educators and advocates for the disease.”  

Tennant has developed a unique protocol to treat AA not only with pharmaceuticals, but with hormones, vitamins and supplements that can help ease the symptoms and slow or prevent the disease from spreading.

“I want to get across the point that treating arachnoiditis is no more difficult than treating emphysema or rheumatoid arthritis or high blood pressure. It can be done in a primary care setting quite easily. It is not something that has to be done at the Mayo Clinic or in a sophisticated medical setting. It can be done in any office,” says Tennant.

Also speaking at the conference is Eve Blackburn, VP of Patient Engagement for ACMCRN, who will talk about the resources her organization has for patients, including a list of physicians that treat AA.  

“I’ll be sharing an update on the relaunch of the International Arachnoiditis Patient Registry, which is currently undergoing final steps in the ethics review process. We anticipate reopening within the next two months through our new secure platform, Digital Cabinet. I’ll also highlight our growing peer support programs, our referral list of Arachnoiditis-aware physicians, and the wide range of educational resources available at acmcrn.org,” said Blackburn.

The conference is not just for people diagnosed with AA. Since the disease is often associated with autoimmune disease or other types of spinal problems, patients suffering from those conditions could also learn important lessons at the seminar.  

“I call them associated diseases. Ehlers-Danlos syndrome, Tarlov cyst, and the Epstein Barr virus, those three in particular, as well as other spinal conditions. You can't talk about arachnoiditis unless you're also talking about autoimmunity and these other conditions that are high risk factors for developing the disease,” says Tennant.

The August 16 seminar is being held at the Marriott Hotel in Westminster, Colorado — which a special rate for conference attendees. Click here for more details.

You can also visit the conference website for hotel information and list of phone numbers to call if you have any questions. All attendees are encouraged to register by August 1.

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

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

Microsoft Says Its AI Medical Tool is 4x Better Than Doctors at Diagnosing Patients

By Crystal Lindell

Microsoft is making some bold claims about the medical diagnosis tool it’s developing using artificial intelligence (AI). The company claims it is four times more accurate than a group of experienced physicians and can “solve medicine’s most complex diagnostic challenges.”.

Specifically, Microsoft’s AI Diagnostic Orchestrator – MAI-DxO for short — was able to correctly diagnose 85% of complex medical cases published in the New England Journal of Medicine (NEJM).

By comparison, when the company asked 21 practicing physicians from the US and UK to look at the same medical cases and provide a diagnosis, the human doctors were only accurate 20% of the time. 

In a demonstration video, Microsoft showed that MAI-DxO was able to order medical tests and provide the estimated financial costs for each test. It was then able to evaluate the test results and arrive at the correct diagnosis, even if the diagnosis was for an incredibly rare disease. 

“Our MAI-DxO orchestrator can handle some of the world’s toughest diagnoses with higher accuracy and lower costs. It puts us on the path to medical superintelligence - a big step towards better, more accessible care for all,” Microsoft said.

The company said it began testing its medical AI diagnosis systems with the United States Medical Licensing Examination, which is the same exam that physicians must pass to practice medicine in the United States. The test is a standardized assessment of clinical knowledge and decision making. 

But the fact that it was a standardized test made it too easy for AI. Microsoft said its orchestrator was able to get near-perfect scores within just three years. 

"These tests primarily rely on multiple-choice questions, which favor memorization over deep understanding," the company said. "By reducing medicine to one-shot answers on multiple-choice questions, such benchmarks overstate the apparent competence of AI systems and obscure their limitations."

To make its evaluations more challenging, Microsoft turned to having its AI evaluate the real-life cases published in the NEJM. 

MAI-DxO was configured to operate within different sets of cost constraints – just like in the real world when a patient’s care may be determined by what kind of health insurance they have, if any. That’s an important feature because without financial constraints, the orchestrator might default to ordering every possible test – regardless of cost, delays in care, or patient discomfort.

They also found that MAI-DxO delivered both higher diagnostic accuracy and lower overall costs than physicians or any other model they tested.   

"AI [could] reduce unnecessary healthcare costs,” the company said. "This kind of reasoning has the potential to reshape healthcare.”

Microsoft also touched on something that many patients with complex health challenges already know: the medical system is often overly reliant on siloed medical specialists. That’s another area where the company sees AI potentially improving patient care. 

With general practitioners treating a wide array of conditions and specialists focused on a single area of expertise, the hope is that AI would essentially be able to pull medical knowledge from both. 

While MAI-DxO seems to excel at tackling the most complex diagnostic challenges, Microsoft says further testing is needed to assess its performance on more common, everyday health conditions.

They also acknowledged that the clinicians in their study worked without access to colleagues, textbooks, or even AI – all tools that they may have in their day-to-day clinical practice. This was done to enable a fair comparison to raw human performance, but it also means that its unclear just how well AI actually competes against real-world physicians.

MAI-DxO is not available for commercial use yet. Microsoft said they need to do more testing to evaluate its reliability, safety, and efficacy. That could take about a decade. 

“It’s pretty clear that we are on a path to these systems getting almost error-free in the next 5-10 years. It will be a massive weight off the shoulders of all health systems around the world,” Mustafa Suleyman, chief executive of Microsoft AI, told The Guardian.

Descending Pain: A New Way to Control Severe Chronic Pain

By Dr. Forest Tennant and Ingrid Hollis

The control of severe chronic pain in medical practice today is almost exclusively based on “ascending” or “neuropathic” pain:

Ascending pain occurs when a pain signal is transmitted from the site of injury or disease up the spinal cord to the brain. Neuropathic pain is the pain that results when there is damage or dysfunction of nerve tissue in the brain, spinal cord or peripheral nerves. 

In recent years, researchers discovered that when chronic pain centralizes, it creates a third type of pain called “descending” pain. This is a critical issue for persons with adhesive arachnoiditis and other diseases that cause severe chronic pain, because descending pain requires different medications than those used for ascending and neuropathic pain.

A person with constant pain will produce excess bioelectricity (central sensitization or centralized pain) in the glial cell matrix of the brain. This bioelectricity “descends” or travels down the spinal cord and vagus nerve. It not only produces pain, but over-stimulates the cardiovascular system. 

Descending pain is controlled by the noradrenergic receptor.  The neurotransmitter to this receptor is called noradrenalin or norepinephrine. 

Symptoms of Descending Pain

Descending pain will be present in persons who have constant, unremitting pain. Here are the symptoms:

• Pulse rate elevates

• Periodic hot flashes

• Cold hands/feet

• Excess sweating

• Allodynia (pain upon light touch) 

Over-Reliance on Opioids and Neuropathic Agents

The lack of awareness about descending pain is one reason why high doses of opioids and neuropathic agents (i.e., gabapentin, diazepam) may be over-prescribed. Physicians may simply raise the opioid or gabapentin dosage if they are not aware that the cause is descending pain.  What’s more, the increase in dosage may be ineffective or even harmful.

This also applies to opioids in implanted pumps.  Countless persons have been treated with an implanted device or “pain pump” with the erroneous belief that no medication, except intrathecal opioids, are needed.  Patients with these devices soon learn that their pain is poorly controlled by opioids alone. 

Opioids and neuropathic agents have little effect on descending pain.  It must be treated separately.

Pain treatment and relief are based on a medicinal that activates or stimulates a specific receptor (think “action point”) that is present in nerve cells in the brain, spinal cord or peripheral nervous system. Here is how the three types of pain and their receptors can be treated:

1. Ascending pain needs to be treated with medications that activate the endorphin or opioid receptor. 

2. Neuropathic pain control depends on activation of a receptor called gamma amino butyric acid (GABA). 

3. Descending pain control must activate the norepinephrine (noradrenalin) receptor.

To achieve good control of severe, chronic or intractable pain, all three of these receptors must be simultaneously activated.  Severe chronic pain is commonly undertreated, because all three receptors are not simultaneously activated.

Medication Classes for Descending Pain

Three medication classes are used to treat descending pain.  Medical practitioners and patients have choices, and can experiment to help decide which medications and supplements bring the most comfort.

1. Bioelectric Blockers: Tizanidine, propanolol, clonidine, tapentadol (Nucynta).

2. Receptor Activators: Modafanil (Provigil), methylphenidate (Ritalin), dextroamphetamine, amphetamine salts (Adderall), phentermine, lisdexamfetamine (Vynanse). Non-prescription activators: lion’s mane, mushroom extract, St. John’s wort, rhodiola, mucuna, whole adrenal gland.

3. Precursor (Amino Acids) of Noradrenaline: Phenylalanine at 1,000 to 2,000mg a day. Tyrosine at 1,000 to 2,000mg a day.

When not controlled, chronic pain, inflammation and autoimmunity will deplete a number of neurotransmitters and hormones.  When that happens, noradenaline (norepinephrine) will often be depleted. 

Supplements of either amino acids (phenylalanine or tyrosine) and daily protein intake may help reduce both background and flare pains. Phenylalanine and/or tyrosine need not be taken every day, but they are highly recommended at least two days a week. They can and should be taken with a bioelectric blocker or receptor activator.

Noradrenergic receptor activators do not raise pulse rate or blood pressure in a constant pain patient like they do in a normal person.  They may actually lower blood pressure and pulse rate.  That’s because chronic pain, inflammation and autoimmunity deplete noradrenalin.

One medication, tapentadol (Nucynta), is both an opioid and norandrenergic blocker. It is highly recommended.

Descending pain is a new discovery that must be recognized and controlled to achieve relief from severe chronic pain.  A sole reliance on opioid and neuropathic agents may often provide inadequate pain relief.

To learn more about descending, ascending and neuropathic pain, you can watch a recent episode of DocToks with Dr. Forest Tennant and Friends.

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

Ingrid Hollis is a person in pain, patient advocate, and advisor to the Tennant Foundation.

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

Why Ice Cream May Be Bad for Your Gut Health

By David Hilzenrath, KFF Health News

It’s a marvel of food technology: ice cream that resists melting. In a video explaining the science behind it, a seller of food chemicals shows scoops of ice cream holding their shape under hot lights. The super ingredient? Polysorbate 80.

Polysorbate 80 is an emulsifier, a chemical used to control the consistency of thousands of supermarket products. Other widely used emulsifiers or stabilizers include carboxymethyl cellulose, carrageenan, and maltodextrin.

Recently, such ingredients have been showing up in scientific studies for another reason: Researchers say they may cause a variety of health problems.

Studies have found that emulsifiers can alter the mix of bacteria in the gut, known as the microbiome or microbiota; damage the lining of the gastrointestinal tract; and trigger inflammation, potentially contributing to problems elsewhere in the body.

Emulsifiers and stabilizers are among the most common ingredients in ultra-processed foods, a prime target of the “Make America Healthy Again” campaign by Health and Human Services Secretary Robert F. Kennedy Jr.

They are on the department’s radar: Their potentially harmful effects were flagged in a document HHS recently produced to support Kennedy’s drive to eliminate petroleum-based food dyes. But they illustrate the complexity of the war on food additives.

They show how, when it comes to food science, regulators are chronically playing catch-up. In the meantime, for many ingredients, regulators and consumers alike are left in a gray zone between suspicion and proof of harm in humans.

Emulsifiers’ assault on the microbiome could help explain inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, metabolic disorders, and even cancer, the studies suggest.

“There is a lot of data showing that those compounds are really detrimental for the microbiota and that we should stop using them,” said Benoit Chassaing, a research director at the French National Institute of Health and Medical Research and a co-author of several related studies.

Yet much larger and more ambitious clinical trials in humans are needed, Chassaing added.

For Lewis Rands, who has suffered from gastrointestinal illness, the research fits his own experience as a consumer. Changing his diet to avoid emulsifiers has made a shocking difference, easing symptoms that were debilitating, Rands said.

“Clinically, many patients have reported an improvement in symptoms with such changes,” said Ashwin Ananthakrishnan, a gastroenterologist and researcher at Massachusetts General Hospital.

The scientific findings come with caveats. For instance, much of the research has been done in mice, or by mimicking the human gut in a tube. There are many unknowns. Not all emulsifiers have bad effects, or the same effects, and some people are thought to be much more vulnerable than others.

Even some researchers who have co-authored papers say that the substances have not been proven harmful to humans and that it’s too soon to say regulators should ban them.

Still, the research poses a challenge for the FDA. When emulsifiers began spreading through the food supply, the agency wasn’t focusing on the gut microbiome, a relatively recent scientific frontier, researchers said.

Martin Makary, appointed by President Donald Trump to head the FDA, mentioned the microbiome at his Senate confirmation hearing in March. Though he didn’t cite emulsifiers specifically or identify chemicals by name, he said substances that affect the microbiome deserve the FDA’s attention.

“There’s a body of research now that suggests concern with some of these ingredients,” Makary said. “We have to look at those ingredients, and you have my commitment to do so if confirmed as FDA commissioner.

“These chemicals are creating an inflammatory response in the gastrointestinal tract, and with an altered microbiome lining that GI tract, kids feel sick.”

The FDA and the Department of Health and Human Services did not respond to questions about Makary’s testimony.

However, when journalist Emily Kopp asked HHS for the science behind its recent announcement that it is phasing out petroleum-based food dyes, the agency provided a compilation of information on potentially harmful compounds commonly found in ultraprocessed foods. The document, which appeared to be a draft, included a section on emulsifiers, such as xanthan gum and carrageenan. It noted that the section needed more work.

HHS subsequently provided the document to KFF Health News.

As far back as 2020, an international organization for the study of inflammatory bowel diseases advised that, for people with those conditions, it “may be prudent to limit intake” of maltodextrin, carrageenan, carboxymethyl cellulose, and polysorbate 80.

Emulsifiers are developed from a variety of sources, including plants and bacteria. Some ingredients that might affect the microbiome show up in foods because they were deemed “generally recognized as safe,” or GRAS.

“New information may at any time require reconsideration of the GRAS status of a food ingredient,” the Code of Federal Regulations says.

Ben & Jerry’s vs Häagen-Dazs

Rands, a genetic scientist, took matters into his own hands to battle severe inflammatory bowel disease. The illness caused bloating, stomach pain, cramps, frequent bowel movements, and bleeding, he said.

It left him in a constant state of anxiety and stress, he added, wondering where the nearest bathroom was and whether he’d reach it in time. Even taking a walk around the block with his wife and baby near their home in Australia was problematic.

Then, on the advice of a dietitian, Rands began avoiding foods with emulsifiers: chemicals such as carboxymethyl cellulose, carrageenan, guar gum, xanthan gum, and maltodextrin — plus other additives.

For instance, instead of eating Ben & Jerry’s ice cream, he switched to Häagen-Dazs ice cream that is free of the substances at issue. The relief was dramatic.

“It’s a huge difference,” Rands said. “To me, it’s made more of a difference than any drug.”

He has been able to scale back or stop taking several drugs, which is an added relief — not least because some can have harmful side effects, and, he said, one was taking its toll.

Rands said he used a scientific approach, isolating variables in his diet and logging the results. Avoiding artificial sweeteners helps, he said, but most of the benefit relates to avoiding the emulsifiers.

Ben & Jerry’s did not respond to a request for comment.

‘Science That Hasn’t Been Done Yet’

The Consumer Brands Association, which represents makers of processed foods, stands behind use of the chemicals.

“Food safety and protecting the integrity of the food supply is priority number one for the makers of America’s food and beverage products,” Sarah Gallo, the group’s senior vice president of product policy, said in a statement. “Emulsifiers and thickening agents play an important role in improving food texture and consistency, and have been studied by the FDA through a rigorous scientific and risk-based process.”

Asked for specifics on how the FDA had analyzed potential effects on the microbiome, the group did not respond.

Chassaing said the chemicals were “never considered for the potential effect on the microbiota.”

Robert Califf, who led the FDA under Presidents Barack Obama and Joe Biden, said in an interview that scientists are just beginning to understand the microbiome. He compared it to where the field of genomics was 20 years ago, only much more complicated — “multiplied by a thousand dimensions.”

He said the substances “fell within the standards” when they were greenlighted. “But hopefully most people agree that the standards need to be upgraded,” he added.

“This is different than traditional food safety thinking about, ‘Does it cause an immediate problem?’” Califf said. “We’re talking about long-term health outcomes here.”

And has the FDA evaluated those?

“How could it? There was no way to do it,” Califf said. The answers will vary depending on the emulsifier, and “proving whether it’s bad or good is going to require rigorous science that hasn’t been done yet.”

More recent scientific capabilities expand the possibilities, he said.

‘A Lot of Confusion in the Field’

For a consumer, trying to steer clear of emulsifiers can be difficult. Without realizing it, people can consume a variety of emulsifiers from a variety of foods — and the same chemicals from multiple sources.

Polysorbate 80 was listed as an ingredient on the labels of 2,311 products as of May 12, according to an online database posted by the Environmental Working Group using information from NielsenIQ. Carrageenan was listed on 8,100 product labels; maltodextrin, 12,769; and xanthan gum, 17,153.

Some emulsifiers have multiple names, making them harder to recognize. Some names can apply to more than one emulsifier. And some chemical names that appear on product labels don’t appear in the FDA’s “Substances Added to Food” inventory.

Carboxymethyl cellulose — not to be confused with methyl cellulose — is also known as carboxymethylcellulose  and cellulose gum. Maltodextrin can be derived from substances such as cornstarch, rice starch, and wheat starch — but the FDA doesn’t consider it synonymous with the term “modified food starch.”

The naming practices can frustrate efforts to track the chemicals in food, to measure how much of the stuff people are taking in, and even to figure out precisely which chemicals a scientific study evaluated, researchers said.

“There’s a lot of confusion in the field,” said Christine McDonald, a researcher at the Cleveland Clinic who has studied maltodextrin. She called for more consistent naming of additives in the United States.

The very term “emulsifier” is problematic. By strict definition, emulsifiers create an emulsion — a stable blend of liquids that would not otherwise mix, such as oil and water. However, the term is used broadly, encompassing chemicals such as maltodextrin that thicken, stabilize, or alter texture.

Gummed Up

Emulsifiers can be found in foods marketed as natural or healthy as well as ones that look artificial. Some products contain multiple emulsifiers.

Products sold at Whole Foods, for instance, list a variety of emulsifiers on their labels. 365 brand Organic Vegan Ranch Dressing & Dip contained organic tapioca maltodextrin and xanthan gum.

Pacific Seafood Starfish brand Cornmeal Crusted Fishsticks — marked as wild-caught and MSC-certified (sustainably sourced) — contain guar gum. Flour tortillas by 365 included monoglycerides of fatty acids and “stabilizer (guar gum, xanthan gum, carrageenan).”

At a Safeway supermarket, Healthy Choice Grilled Chicken Pesto With Vegetables listed modified potato starch, modified corn starch, carrageenan, xanthan gum, and guar gum.

The label on Newman’s Own Caesar salad dressing said the product contained no artificial preservatives or flavors, no colors from an artificial source, and was gluten-free. The ingredient label listed, “as a thickener,” xanthan gum.

In response to questions for this article, Whole Foods Market said it prohibits more than 300 ingredients commonly found in food.

“Our experts evaluate ingredients for acceptability in all food products we sell based on the best available scientific research,” the company said in a statement provided by spokesperson Rachel Malish.

Safeway’s parent company, Albertsons Companies, did not respond to inquiries. Nor did Pacific Seafood, Newman’s Own, or Conagra Brands, which makes Healthy Choice.

A Growing Body of Research

Research on emulsifiers has been building in recent years.

For example, a study published in January by the Journal of Crohn’s and Colitis concluded that a diet low in emulsifiers is an effective treatment for mild or moderate Crohn’s disease. The eight-week clinical trial, which tracked 154 patients in the United Kingdom, focused on carrageenan, carboxymethyl cellulose, and polysorbate 80.

A study published in February 2024 in the journal PLOS Medicine found that higher intakes of carrageenan and mono- and diglycerides of fatty acids were associated with higher risks of cancer. The study observed 92,000 French adults for an average of 6.7 years.

A study published in September 2023 in The BMJ, formerly known as the British Medical Journal, found that intake of several types of emulsifiers was associated with the risk of cardiovascular disease. The study observed more than 95,000 French adults for a median of 7.4 years.

A series of earlier studies found that emulsifiers “can promote chronic intestinal inflammation in mice”; that two in particular, carboxymethyl cellulose and polysorbate 80, “profoundly impact intestinal microbiota in a manner that promotes gut inflammation and associated disease states”; and that, based on a laboratory study of human samples, “numerous, but not all, commonly used emulsifiers can directly alter gut microbiota in a manner expected to promote intestinal inflammation,” as recounted in a 2021 paper in the journal Microbiome.

Other findings diverge. A study from Australia, published in February in Alimentary Pharmacology and Therapeutics, followed 24 Crohn’s patients over four weeks and concluded that, in the context of a healthy diet, the emulsifier content had “no influence over disease activity.”

The authors declared conflicts of interest, including payments from PepsiCo, drug companies, and Mindset Health Pty, which promotes hypnosis-based therapy. One of the authors, gastroenterology professor Peter Gibson of Monash University in Australia, said the conflicts of interest “have nothing whatsoever to do with the study.”

“It is important not to overinterpret results of studies,” he said, adding that his team’s report “does not mean that emulsifiers are good for you or that there are no health benefits in avoiding emulsifiers.”

Häagen-Dazs ‘Keeps It Real’

Häagen-Dazs touts the absence of such chemicals as a virtue. “Keeping it real, the way it should be,” it said in an online plug for its vanilla ice cream. “No emulsifiers. No stabilizers.”

However, at the company that makes Häagen-Dazs in the United States, Dreyer’s Grand Ice Cream, there are limits to that approach.

Under other brand names — such as Edy’s, Dreyer’s, and Drumstick — it markets products that contain emulsifiers or stabilizers. The company did not respond to questions. In addition, a spokesperson for Nestlé, which markets Drumstick and Häagen-Dazs brands internationally, did not respond.

Drumstick Vanilla Caramel Sundae Cones have no artificial flavors or colors, the package says — but they feature an array of other ingredients, including soy lecithin, guar gum, monogylcerides, and carob bean gum.

The cones, the company’s website says, offer “one incredibly creamy experience.”

But the creamy filling doesn’t melt. Instead, over 24 hours on a KFF Health News reporter’s kitchen counter, it bled a caramel-tinged fluid and shrank into a sticky white foam that could be cut with a knife.

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

Brain Receptor May Hold Key to Treating Neuropathic Pain

By Pooja Shree Chettiar and Siddhesh Sabnis  

Pain is easy to understand until it isn’t. A stubbed toe or sprained ankle hurts, but it makes sense because the cause is clear and the pain fades as you heal.

But what if the pain didn’t go away? What if even a breeze felt like fire, or your leg burned for no reason at all? When pain lingers without a clear cause, that’s neuropathic pain.

We are neuroscientists who study how pain circuits in the brain and spinal cord change over time. Our work focuses on the molecules that quietly reshape how pain is felt and remembered.

We didn’t fully grasp how different neuropathic pain was from injury-related pain until we began working in a lab studying it. Patients spoke of a phantom pain that haunted them daily – unseen, unexplained and life-altering.

These conversations shifted our focus from symptoms to mechanisms. What causes this ghost pain to persist, and how can we intervene at the molecular level to change it?

More Than Just Physical Pain

Neuropathic pain stems from damage to or dysfunction in the nervous system itself. The system that was meant to detect pain becomes the source of it, like a fire alarm going off without a fire. Even a soft touch or breeze can feel unbearable.

Neuropathic pain doesn’t just affect the body – it also alters the brain. Chronic pain of this nature often leads to depression, anxiety, social isolation and a deep sense of helplessness. It can make even the most routine tasks feel unbearable.

About 10% of the U.S. population – tens of millions of people – experience neuropathic pain, and cases are rising as the population ages. Complications from diabetes, cancer treatments or spinal cord injuries can lead to this condition. Despite its prevalence, doctors often overlook neuropathic pain because its underlying biology is poorly understood.

There’s also an economic cost to neuropathic pain. This condition contributes to billions of dollars in health care spending, missed workdays and lost productivity. In the search for relief, many turn to opioids, a path that, as seen from the opioid epidemic, can carry its own devastating consequences through addiction.

GluD1: A Quiet But Crucial Player

Finding treatments for neuropathic pain requires answering several questions. Why does the nervous system misfire in this way? What exactly causes it to rewire in ways that increase pain sensitivity or create phantom sensations? And most urgently: Is there a way to reset the system?

This is where our lab’s work and the story of a receptor called GluD1 comes in. Short for glutamate delta-1 receptor, this protein doesn’t usually make headlines. Scientists have long considered GluD1 a biochemical curiosity, part of the glutamate receptor family, but not known to function like its relatives that typically transmit electrical signals in the brain.

Instead, GluD1 plays a different role. It helps organize synapses, the junctions where neurons connect. Think of it as a construction foreman: It doesn’t send messages itself, but directs where connections form and how strong they become.

This organizing role is critical in shaping the way neural circuits develop and adapt, especially in regions involved in pain and emotion. Our lab’s research suggests that GluD1 acts as a molecular architect of pain circuits, particularly in conditions like neuropathic pain where those circuits misfire or rewire abnormally. In parts of the nervous system crucial for pain processing like the spinal cord and amygdala, GluD1 may shape how people experience pain physically and emotionally.

Fixing the Misfire

Across our work, we found that disruptions to GluD1 activity is linked to persistent pain. Restoring GluD1 activity can reduce pain. The question is, how exactly does GluD1 reshape the pain experience?

In our first study, we discovered that GluD1 doesn’t operate solo. It teams up with a protein called cerebellin-1 to form a structure that maintains constant communication between brain cells. This structure, called a trans-synaptic bridge, can be compared to a strong handshake between two neurons. It makes sure that pain signals are appropriately processed and filtered.

But in chronic pain, the bridge between these proteins becomes unstable and starts to fall apart. The result is chaotic. Like a group chat where everyone is talking at once and nobody can be heard clearly, neurons start to misfire and overreact. This synaptic noise turns up the brain’s pain sensitivity, both physically and emotionally. It suggests that GluD1 isn’t just managing pain signals, but also may be shaping how those signals feel.

What if we could restore that broken connection?

In our second study, we injected mice with cerebellin-1 and saw that it reactivated GluD1 activity, easing their chronic pain without producing any side effects. It helped the pain processing system work again without the sedative effects or disruptions to other nerve signals that are common with opioids. Rather than just numbing the body, reactivating GluD1 activity recalibrated how the brain processes pain.

Of course, this research is still in the early stages, far from clinical trials. But the implications are exciting: GluD1 may offer a way to repair the pain processing network itself, with fewer side effects and less risk of addiction than current treatments.

For millions living with chronic pain, this small, peculiar receptor may open the door to a new kind of relief: one that heals the system, not just masks its symptoms.

Pooja Shree Chettiar and Siddhesh Sabnis are neuroscience PhD candidates at Texas A&M University.

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

People Who Live in Rural Areas Have More Pain and Less Access to Treatment

By Crystal Lindell 

A new study by researchers at the University of Texas at Arlington found that people living in rural areas have significantly higher rates of chronic pain than those who live in big cities. They’re also at a big disadvantage when it comes to getting their pain treated.

As a rural resident myself for the last 11 years, I have some thoughts as to why this might be. I think one of the causes may be a little different than what researchers often assume. 

The study used data from a national health survey of over 10,000 people in 2019, and then followed up with them a year later in 2020. 

Respondents were split into four pain categories; those with no pain, nonchronic acute pain, chronic pain, and high-impact chronic pain (HICP), which is pain that significantly impacts daily life.

Participants were then assigned to one of four urban-rural metro areas based on where they live: Large Central Metro (big cities with at least one million people), Large Fringe Metro, Medium and Small Metro, and Non-Metropolitan (Rural).

The chart below shows that the highest rates of chronic pain (27.8%) and HICP (10.4%) were found in rural non-metropolitan areas. Pain rates were progressively lower in metro areas with more people. 

Notably, 43.1% of the people living in big cities had “no pain,” while only 34% of those in rural areas were pain free. That’s a statistically big difference.

The Journal of rural health

“We already know about the rural-urban gap in mortality and life expectancy,” said Feinuo Sun, PhD, an assistant professor of kinesiology at UT Arlington and lead author of the study in The Journal of Rural Health.

“But when you look at pain, especially chronic pain, it becomes clear that rural residents face additional burdens.”

Sun and her colleagues say their findings highlight the rural disadvantage that exists in pain development and treatment. Due to health care shortages in rural areas, people have limited access to pain treatment and lower quality services.

They also found that the percentages of people transitioning from milder pain conditions in 2019 to more severe ones in 2020 were highest in rural areas. Even when starting from the same baseline pain status, people in rural areas fared worse after one year compared to those in urban areas.

“Without early intervention, (chronic pain) can have serious long-term consequences, including premature mortality. That's why targeted outreach and early pain management strategies are so important," said Sun.

Rural residents are also more likely to work physically demanding jobs and experience higher poverty rates, both of which contribute to chronic pain.

Those are definitely contributing factors. People who live near me in northern Illinois tend have more physically demanding work, such as farming and construction, and they have a much harder time accessing good healthcare. 

Personally, I have to drive almost two hours each way just to see my primary care physician, because I have to get more complex pain care. That’s where the closest university hospital is to my house. 

Lower Cost of Living

But there’s another reason that is easy to overlook if you don’t live out here: Rural areas are much cheaper than urban ones. 

That’s literally the reason I choose to live in a rural area. The rent in my area is astronomically cheaper than nearby metro areas, and much less compared than a big city like Chicago. 

If you're managing a life with chronic pain, you’re going to be less likely to be able to work and you’re also going to be more likely to spend more of your income on medical expenses. You’ll need a cheaper place to live.

Additionally, many people move out to rural areas like mine because it’s easier to live on Social Security, disability or pensions. None of those benefits increase based on your local cost of living, so it makes sense to live in a rural area where the same amount of money can go much further. 

So it’s not always physically demanding labor that causes more pain in rural areas. It’s being in chronic pain that makes it more likely you’ll move to or stay in a rural community.

Of course, the researchers also found an association with opioid medication, because what would a pain study be in 2025 if the authors didn’t link it in some way to opioids?

The UT researchers think that  “elevated pain levels, along with fewer treatment options, may help explain the heavier reliance on opioids” in rural communities. They’re already working on a follow-up study to examine disparities in pain care. I can already tell them some of the answers they seek. 

People in rural areas are more likely to take opioids for pain care because they are incredibly cheap and accessible. Even if a rural area doesn’t have a local pharmacy, you still have access to mail-order pharmacies. 

And if a rural area doesn’t have a physical therapist, acupuncturist or a massage therapist, there are few alternatives besides opioids. Opioids also require fewer appointments with providers, which are at a premium when doctors are 2 hours away or more.

In the end, geography shapes both our pain and standard of living. Rural areas need better access to healthcare and more populated areas need lower costs of living. We can help people, we just have to work in both directions.  

Pain Research and Treatment Missing From 2026 HHS Budget

By Pat Anson

An estimated 60 million Americans suffer from chronic pain, costing the U.S. healthcare system about $77 billion a year.  According to the National Institutes of Health (NIH), chronic pain affects more Americans than diabetes, heart disease, and cancer combined.

You’d never know it though by reading the proposed $94.7 billion budget for the Department of Health and Human Services (HHS) released on Friday by the Trump administration.

There are nearly 21,000 words in the 55-page budget for 2026, and not a single word or dollar is devoted to pain research, treatment, or how to help those 60 million Americans.   

The only reference to pain is a quote attributed to HHS Secretary Robert F. Kennedy, Jr.

“A healthy person has a thousand dreams. A sick person only has one, and right now, there’s 60% of the people in this country who have only one dream – that they can make it through the day without pain, with energy, without having to take medications, and we are going to change that for this country,” Kennedy is quoted as saying.

One can quibble about whether RFK Jr. actually said those exact words or if they were invented for the budget document. In either case, many Americans living with chronic pain already get through the day without taking an effective pain medication, although its not by choice.

Kennedy has previously used the line about “a healthy person has a thousand dreams,” which is paraphrased from Confucius. Kennedy used it without attribution in his Senate confirmation hearing in January and again when he was sworn in as HHS Secretary a month later, but didn’t mention pain in either instance.   

Perhaps it’s only fitting, given how the topic of pain is notably absent from the HHS budget. What we get instead are platitudes about “making Americans the healthiest in the world,” while at the same time reducing the HHS budget by 26 percent, and downsizing or eliminating dozens of federal health programs.

The NIH faces some of the steepest cuts, with its $27.5 billion budget cutback to $18 billion. The Trump administration has already gutted the NIH’s Office of Pain Policy and Planning (OPPP), which focused on pain research. The OPPP’s entire staff was fired in April.

“Even though chronic pain is one of the leading health issues in America, it has never had a true home at NIH with a dedicated institute. Many pain researchers have described the NIH as a place where ‘pain lives everywhere and nowhere,’ and now, with the dismantling of the OPPP, I fear that pain may literally have no home at all,” Dr. Juan Hincapie-Castillo, an assistant professor at UNC Chapel Hill, wrote in The Charlotte Observer. Hincapie-Castillo received funding from OPPP for his studies of trigeminal neuralgia.

‘Embrace Radical Change’

In all, HHS plans to consolidate 28 operating divisions into 15, close five of its regional offices, and end funding for 5,000 contracts – all in the name of saving money.

“This planned realignment will allow the Department to do more at a lower cost to taxpayers by increasing operational efficiency and cutting bureaucratic sprawl,” the budget document states.

“America spends nearly one-third of the federal budget on healthcare, only to rank last in terms of health among developed nations. Americans are seeing declines in life expectancy and facing the highest rates of chronic disease in the world. HHS is committed to making Americans healthy again, making the American health system the best in the world, and putting patients first. To accomplish this, we need to embrace radical change.”

HHS is planning to move several agencies — including the Substance Abuse and Mental Health Services Administration (SAMHSA) and some programs in the Centers for Disease Control and Prevention (CDC) -- into a new agency called the Administration for a Healthy America (AHA), which would be under Kennedy’s direct control. AHA will administer $14 billion in discretionary funding to combat the “chronic disease epidemic.”

“(AHA) will prioritize prevention — a missing piece in the American health system — primary care, maternal and child health, mental health, substance use prevention and treatment, environmental health, HIV/AIDS, workforce development, and policy, research, and oversight,” the HHS says.

Note the absence of pain prevention and treatment in that sentence.

Opioids are mentioned nearly half a dozen times in the budget, but only in the context of addiction treatment, not pain management. Many of the CDC programs that deal with opioid abuse and treatment are being moved to AHA, and $4 billion in block grants for mental health and substance abuse treatment is earmarked for states and rural communities.

“States and local communities best know the way to serve their populations – not the federal government,” HHS said.

When he was running for president, Kennedy had ambitious plans to create a series of “wellness farms” in rural areas, where people addicted to illicit or prescription drugs could get treatment, job training and grow their own organic food.

“I’m going to create these wellness farms where they can go to get off of illegal drugs, off of opiates, but also legal drugs, psychiatric drugs, if they want to, to get off of SSRIs, to get off of benzos, to get off of Adderall, and to spend time, as much time as they need — three or four years if they need it — to learn to get re-parented, to reconnect with communities, to understand how to talk to people,” Kennedy said in 2024.

There is no mention of wellness farms or anything like it in the HHS budget, or in the “Make America Healthy Again (MAHA) Report,” which was also released by the Trump Administration last month.

Like the budget document, pain research and treatment are not discussed in the MAHA report, which has been widely criticized for its sloppy science and fake citations, including some that were apparently generated by artificial intelligence (AI).        

Gender Bias: Why Gynecological Pain Is Often Dismissed

By Elizabeth Hintz and Marlene Berke

For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people – most of whom identify as women – sexual intercourse and routine pelvic exams are unbearable.

Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women.

Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain.

We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions.

We’ve consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training.

‘It’s All In Your Head’

A 2024 study of patients who went to a clinic for vulvovaginal pain – pain experienced in the external female genitals and vagina – found that 45% of these patients had been told that they “just needed to relax more” and 39% were made to feel that they were “crazy”. A staggering 55% had considered giving up on seeking care.

These results echo what one of us – Elizabeth Hintz – found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this “It’s all in your head” response from doctors.

Another study followed patients in two different major U.S. cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information.

These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care?

“Let me describe the pain that would drive me to try so many different doctors, tests and treatments,” a patient with vulvovaginal pain said to her doctor. For her, sex “is like taking your most sensitive area and trying to rip it apart.”

“I can now wear any pants or underwear that I want with no pain,” said another patient after successful treatment. “I never realized how much of a toll the pain took on my body every day until it was gone.”

Medical Gaslighting

Many patients worldwide experience medical gaslighting – a social phenomenon where a patient’s health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright.

Medical gaslighting is rooted in centuries of gender bias in medicine.

Women’s reproductive health issues have long been dismissed as psychological or “hysterical.” Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy.

These historical views help shed light on why these symptoms are still not taken seriously today.

In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity.

This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed.

Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist.

Disparities in Funding and Care

Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January 2025 report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men.

This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women’s health has actually declined over the past decade. Despite these known disparities, in April 2025 the Trump administration threatened to end funding for the Women’s Health Initiative, a long-running women’s health research program, further worsening the problem.

Without sustained federal funding for women’s health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded.

As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race.

One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients’ pain and offered them less accurate treatment recommendations.

Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men.

Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine.

These lingering erroneous beliefs about gender and race are key reasons patients’ pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death.

Learning and Listening

Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients’ lived experiences and admit when an answer isn’t known.

In the meantime, people navigating the health care system can take practical steps when encountering dismissive care.

They can educate themselves about chronic gynecological pain conditions by reading books like “When Sex Hurts: Understanding and Healing Pelvic Pain” or educational information from trusted sources like the International Society for the Study of Women’s Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease.

Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting.

If someone you know has experienced medical gaslighting and would like support, there are resources available.

Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information – like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.

Elizabeth Hintz, PhD, is an Assistant Professor in the Department of Communication at the University of Connecticut.

Marlene Berke recently completed her PhD in Philosophy at the Computational Social Cognition Lab at Yale University.

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

‘Zombie’ Nerve Cells Make Chronic Pain Worse

By Pat Anson

The zombies are at it again.

Weeks after researchers announced a new way to treat low back pain by targeting so-called zombie cells – a new study suggests that peripheral nerve pain could also be treated with drugs that target aging cells.

Senescent neurons are cells that stop dividing, but refuse to die and linger in the central nervous system. As people age, more and more of these “zombie cells” build up, secreting inflammatory agents that increase pain sensitivity and raise the risk of age-related diseases like arthritis, Alzheimer’s and Parkinson’s.

“Very little is known about underlying causes of pain experienced during aging. The prevalence of chronic pain in aging populations and the lack of effective and non-addictive treatments motivated this exploration into neuronal senescence as a potential mechanism,” Lauren Donovan, PhD, a research scientist at Stanford University, told PsyPost.

In studies on laboratory animals, Donovan and her colleagues at Stanford found that pain was amplified in older mice by senescent cells, which released inflammatory signals when the mice were injured. The same inflammatory reaction was found in younger mice, but was more pronounced in the older ones.

When the injured mice were treated with a drug called ABT263 – a compound that destroys senescent cells – the older mice showed less pain sensitivity and significant improvement in their weight-bearing behavior.

The younger mice treated with ABT263 showed only modest improvements in their pain-related behavior, which suggests that senescent cells play a significant role in causing chronic pain.

“The key takeaway for the average person is that as we age, some of our sensory neurons undergo a process called senescence, which may contribute to chronic pain,” said Donovan, who reported the findings in the journal Nature Neuroscience.

“In addition, we found that injury can exacerbate senescence in neurons, leading to an additive effect of aging and injury that may enhance pain. This research identifies a new potential target for treating chronic pain, especially in older individuals. It suggests that addressing cellular senescence in the nervous system can lead to new ways of managing pain and sensory dysfunction.”

Researchers at McGill University reported similar findings last month in studies on laboratory mice with damaged discs. When the mice were given drugs that targeted senescent cells in their spines, they experienced less pain and their bone quality improved.

Previous animal studies have shown that senolytic drugs can reverse osteoarthritis by eliminating senescent cells, giving the body a chance to repair and rejuvenate damaged cartilage.

The findings need to be replicated in humans, but they suggest that senolytic drugs that target zombie cells have the potential to prevent or even cure some age-related diseases.

Anti-Inflammatory Drugs May Increase Risk of Pain Becoming Chronic

By Pat Anson

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

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

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

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

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

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

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

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

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

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

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

Pelvic Pain Patients Often Face Medical Gaslighting

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Can Gut Bacteria Help Diagnose CRPS?

By Pat Anson

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

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

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

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

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

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

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

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

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

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

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

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

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

Online Emotional Support Therapy Modestly Reduces Chronic Pain

By Pat Anson

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

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

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

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

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

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

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

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

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

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

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

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

By Jean Wactawski-Wende

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

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

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

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

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

Little Medical Research of Women’s Health

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

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

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

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

Menopausal Hormone Therapy

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

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

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

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

Advances in Women’s Health

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

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

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

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

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

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

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

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

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

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

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