Chronic Pain Shouldn’t Be Judged With Brain Scans

By Jan Vollert

In 2006, Carl Koch sued his employer for damages after burn injuries during a workplace accident left him with chronic pain. The employer accused him of malingering, so the judge admitted a neuroscientist as an expert witness, who testified that he could see Koch’s pain on a brain scan. The case was settled for more than ten times the amount the employer initially offered.

This case is not unusual, as chronic pain can be severely debilitating. It can make it impossible to work, exercise and have a social life. It can make you depressed and anxious.

Having pain recognised by insurers, employers and government agencies can mean the difference between receiving benefits and being left without support. So it’s understandable that a judge wants to see objective evidence, such as a brain scan, showing chronic pain.

The problem is that it doesn’t work. However, as Koch’s case shows, it is used anyway. Good for Mr. Koch, in this case, but what if the neuroscientist had told the judge that he is faking his pain?

Who Is Believed?

Chronic pain is invisible, and everyone living with it has stories to tell about the time someone did not believe them: employers, friends, family, partners and doctors. Is it really that bad? Are you sure it’s not just in your head? Have you tried to toughen up a bit?

Who we believe and who faces more scepticism is not random either: women, people of colour, poor people and the less educated are far less likely to be believed that their pain is real. The cruelty is doubled as these are the groups most likely to experience chronic pain in the first place.

With modern brain scanners and AI, it seems tempting to develop what is effectively a pain-lie detector test. The pictures brain scanners show have been too complex to fully understand before, but AI can often solve such problems of complexity. Two studies published in Nature Neuroscience and Nature Medicine seemed to promise to be a first step towards a pain lie detector.

In the US, AI tools are already used to decide who should be prescribed opioids for their pain and who is probably an addict pretending to be in pain. An article in the technology magazine Wired uncovered how flawed the system was, and that it had a tendency to distrust all the groups mentioned above.

This is a problem with AI: even when it seems to work, it does not tell you how. This makes it dangerous to put too much confidence in it.

There can be no such thing as a pain lie detector for the same reasons that regular lie detectors do not measure if you lie; they measure if you are nervous – but you might be nervous telling the truth in a high-stakes situation.

It is similar for measuring pain. Pain causes distress, so any brain pattern of pain will also be a pattern of stress – and often anxiety. We cannot factor that into our pain lie detector: when we develop it, it will be with curious participants volunteering for a scientific study (not very stressful).

When we use it, it will be for the patient who has been disbelieved for years and knows if the scan does not “prove” their pain, no one will ever believe them, and they will not get compensation or benefits (as stressful as it gets). It will always be a catch-22, as explained in The Conversation in 2025.

A Private Experience

Pain is a personal and very private experience. It depends on your history with it, and on the context, meaning everyone’s pain is different, and your pain today can be different from your pain tomorrow. Some pain can even be pleasurable – spicy food being an obvious everyday example. This means that your brain scan of pain may look very different from mine. Until we have measured both, we cannot know.

It is for these reasons that the International Association for the Study of Pain has stated that pain lie detectors are useless. In a new article in Nature Neuroscience, my colleagues and I discuss technical and fundamental problems with the idea and ask the scientific community to abandon the idea.

So what does this mean for you? If someone tells you about their chronic pain, put all scepticism aside. Remember that most forms of chronic pain are invisible. Back pain, for example, is the biggest cause of disability worldwide, according to the World Health Organization, and a physical cause can rarely be found.

Keep in mind that machines make mistakes as well, and that they have the same stereotypes as we do. That is especially true for AI.

A pain scan will not tell us who is suffering and who is lying. But it may tell us something else: how easily we mistake technological confidence for truth. In medicine, insurance and law, that mistake could make already invisible pain even harder to prove – and easier to dismiss.

Jan Vollert, PhD, is chronic pain researcher and lecturer at the University of Exeter.

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

21 Million Americans in Severe Pain Don’t Have a Diagnosis

By Pat Anson 

A new study has found what many chronic pain patients have already learned the hard way: It’s difficult to get a diagnosis.

Researchers at The University of Texas at Arlington (UTA) estimate that 21 million Americans living with severe pain have never received a medical diagnosis for what’s causing it.

Their findings, recently published in the journal PAIN, are based on four years of federal health data, which found a significant gap between the painful symptoms that patients report and what actually appears in their medical records.

“What this study shows is that a significant number of people experience pain that interferes with their work and daily activities, yet the healthcare system does not capture a reason for that pain,” said lead author Feinuo Sun, PhD, an Assistant Professor of Kinesiology at UTA. “That mismatch represents a real problem.”

Pain is one of the most difficult conditions to diagnose because of its subjective nature. What may be “severe” pain to one patient may be “minor” to someone else.

Given the well-known disparities in healthcare access in the United States, it’s not surprising that undiagnosed pain is more common in some groups than others.

Compared to white and native born Americans, people who are Black, Asian or foreign born are more likely to have undiagnosed pain, due to barriers in getting treatment and more limited healthcare resources. People without health insurance and those with poor mental health face similar obstacles in getting a diagnosis.

Undiagnosed pain is also more common among men and young or middle-aged adults. Researchers think that may be due to the fact that women and older adults are more likely to see a doctor and describe their symptoms in a more detailed way – making them more likely to get a diagnosis.

Geography also plays a role. Americans living in the West are more likely to have pain, and more likely to be without a medical diagnosis. A previous study by Sun found that people have less access to healthcare in rural areas, and have greater distances to travel for treatment.

Two findings were unexpected: People with higher incomes and those who are employed are more likely to have undiagnosed pain. That’s because wealthier people are more likely to self-manage minor pain with over-the-counter painkillers and alternative treatments. And people who have jobs may be reluctant to take time off to see a doctor or to use up their sick days.

Overall, about 30% of Americans who have some degree of pain do not have a corresponding medical diagnosis. The percentage of undiagnosed pain drops to 17.8% for those with moderate-to-severe pain. 

It’s worth noting that the UTA study analyzed health data from 2016–2019, a period when pain was still classified as a symptom rather than a disease. That changed in 2022, when the World Health Organization updated the International Classification of Disease (ICD) coding system to recognize chronic pain as a disease for the first time.

The implementation of a new ICD-11 code may help narrow the diagnosis gap by bringing greater clinical attention to chronic pain, leading to quicker diagnosis and treatment. 

“Because pain was not classified as a disease during the years we studied, many people likely had their pain overlooked or inadequately documented, even when it significantly affected their quality of life,” Sun said. “When pain goes undiagnosed, it is very likely to be undertreated or poorly managed.” 

A recent study found that rates of chronic pain and disabling pain surged in the U.S. after the Covid pandemic, reaching the highest levels ever recorded. Today, about 60 million Americans have chronic pain, and 21 million have “high impact” pain severe enough to interfere with work and everyday life.

Managing Expectations Is Often Key to Chronic Pain Treatment

By Chris Seenan

In a 2026 study I conducted with colleagues on people with peripheral arterial disease, one participant described how leg pain had disrupted his golf for years. It forced him to stop mid-round, shake his leg and apologise to his playing partners while he waited for the pain to pass. He found it mortifying. 

Then he tried a small electrical device that delivered gentle pulses through pads stuck to his skin. He still had pain. But he could get round the course.

When we measured his walking on a treadmill, we found no improvement. He had not noticed. That was not the outcome that mattered to him. Before the study ended, he had already gone out and ordered his own device.

A different participant reached the opposite conclusion. The pain was still there when he used the device, he said. It had not done him any good. And he was right, in a narrow sense. The device had not eliminated his pain. 

What it had done was reduce its intensity and delay its onset, allowing him to walk measurably further. His expectation of complete relief meant that genuine, partial relief felt like failure. He concluded the treatment did not work.

The study did not tell a simple story of success or failure. For some participants, standard treadmill measures did not capture what had changed in daily life. For others, measurable improvements still failed to feel meaningful because they fell short of what the person had hoped for. 

The difference was not only the treatment, or the severity of their condition. It was what each person had been led to expect.

Recognising Relief

Both men were living with peripheral arterial disease, a condition caused by a build-up of fatty deposits inside the arteries that supply the legs. It affects an estimated 236 million people worldwide. 

Its hallmark symptom is a cramping pain in the calf during walking that eases with rest. Over time, it can shrink a person’s world, limiting independence and increasing the risk of serious cardiovascular problems.

The recommended first-line treatment is supervised exercise therapy: structured exercise sessions led by trained professionals. But in many countries, access to supervised exercise therapy remains patchy and under-resourced. That gap is fertile territory for the wellness market.

Transcutaneous electrical nerve stimulation (TENS) delivers small electrical impulses through electrode pads on the skin to interfere with pain signals travelling to the brain. There is evidence that it can help with some kinds of pain, and it is used in hospital pain management settings. It is not a wellness product. 

In our study, we explored what happened when people with peripheral arterial disease used TENS independently at home, outside the controlled conditions of a clinical trial.

The findings point to something standard clinical tests rarely capture. Expectation can shape whether useful relief is recognised as useful.

That finding matters well beyond this particular device or condition. The global wellness industry is worth over a trillion dollars and operates with minimal regulatory oversight. People living with painful long-term conditions are among its most heavily targeted consumers. 

Companies sell electrical stimulation devices, supplements and wearable gadgets to people in chronic pain, using influencer testimonials in place of evidence and social media algorithms to reach people who are frightened, frustrated or in pain.

When a product fails to deliver the transformation it promised, patients rarely conclude they were misled. They conclude that nothing can help them. In conditions where reduced physical activity carries real health consequences, that conclusion is not merely disappointing. It is dangerous.

Poor Communication Hinders Treatment 

This is where the study speaks to a much wider problem. Whether a person is using a clinical device, a wearable gadget or a supplement sold online, they are often asked to judge it against expectations they did not set for themselves. Even legitimate, clinically tested treatments can be undermined by poor communication about what to expect.

The golfer’s experience illustrates this clearly. He valued an outcome that no clinical trial had thought to measure: the ability to play a round of golf without humiliation. Once he understood the device could offer that, it worked for him. His fellow participant was never given the chance to find his equivalent.

A market built around selling hope is poorly equipped for that kind of honesty. But the same danger can appear even when the person giving advice has medical credentials.

Research shows that even medically qualified doctors who become prominent wellness influencers on social media are subject to many of the same pressures as their unqualified counterparts: to build a personal brand, produce content constantly, stand out from competitors and make advice sound more certain than it really is. 

Having a medical degree does not make someone’s Instagram post better at managing a patient’s expectations. It just makes it more convincing.

What actually helps requires something platforms cannot provide: time, a genuine clinical relationship and communication that is not contingent on making a sale. 

It requires asking a patient not just whether their pain has reduced, but what they were hoping to do that pain had been stopping them from doing. It requires explaining that partial relief is still relief and that the outcome worth measuring might not be the one on the form.

That kind of honesty does not feature in any influencer’s discount code, medical degree or otherwise. But for the person who just wants to get round the golf course, it might be the most important part of the treatment.

Chris Seenan, PhD, Senior Lecturer in Physiotherapy at the University of Stirling 

His research focuses on the lived experiences of people with long-term conditions, particularly Peripheral Arterial Disease (PAD), Diabetes, and Chronic Pain. 

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

Study Shows Antibiotics Don’t Relieve Chronic Lower Back Pain

By Crystal Lindell

Antibiotics are not an effective treatment for chronic lower back pain caused by bulging herniated discs, according to a small new study by researchers in Australia.

That may sound like a “Well, duhhh” finding, but some patients with back pain are actually being treated with antibiotics.

“Antibiotics are currently being recommended for chronic low back pain, particularly when treatments have failed, even though the evidence for their use is conflicting,” writes lead author Flavia Cicuttini, PhD, School of Public Health and Preventive Medicine at Monash University. 

Low levels of bacteria have been found in the spines of people suffering lower back pain from bulging discs, and some previous studies have found that antibiotics have a “substantial effect” in relieving their pain.

One such study in 2013 estimated that up to 40% of patients with chronic back pain could benefit from antibiotic treatment. That research created a bit of a frenzy in the media, with a prominent UK surgeon saying the discovery was “the stuff of Nobel Prizes” and predicting “this is going to require us to rewrite the textbooks.”    

Now, more than a decade later, the new study seems to disprove that theory.

Monash researchers set up a clinical trial with 170 adults, all of whom had chronic low back pain (LBP) caused by disc herniation that was confirmed with an MRI. Half the participants were randomly assigned to receive the antibiotic amoxicillin twice per day for 90 days, while the other half received a placebo.

Their findings, published in JAMA Network Open, show that amoxicillin did not result in greater pain reduction than treatment with a placebo.

“Our results do not support the findings of previous studies,” wrote Cicuttini. “These findings suggest that antibiotics should not be used in the management of chronic low back pain and provide important data to prevent their inappropriate and harmful use.

“Although the potential for antibiotics to be an effective treatment has been an appealing prospect, the results of this trial do not support this hypothesis. These findings are important in informing updates of clinical practice guidelines for LBP, which to date have been unable to make recommendations for or against the use of antibiotics.”

Not only was the antibiotic ineffective, it caused more side effects. Over 16% of people who received amoxicillin stopped taking it due to adverse events, compared to about 2% in the placebo group.  

The overuse of antibiotics is actually an emerging problem in medicine, due to some strains of bacteria developing resistance to antibiotics. The World Health Organization considers antibiotic resistance to be a global health threat, with about 5 million deaths per year associated with drug-resistant bacteria. 

Does Depression Screening Work for Chronic Pain Patients?

By Crystal Lindell

For many patients with a chronic illness, every time they go to the doctor they have to fill out the infamous depression questionnaire – even if the reason for their visit has absolutely nothing to do with their mental health.

Formally known as “Patient Health Questionnaire-8 (PHQ-8),” it starts with this question:

"Over the last 2 weeks, how often have you been bothered by any of the following problems?"

It then lists things like "Little interest or pleasure in doing things" or if you are feeling tired, have trouble sleeping, or have a poor appetite.

Patients are then asked to rank their responses on a scale that goes from "Not at all" to "Nearly every day."

Over the years, I have often scored poorly on this questionnaire, which means I ranked very high for clinical depression during those times in my life. 

Looking back, I’m pretty sure what it really measured was whether I was so depressed that I just didn’t care about trying to hide anything. But regardless, I do think that when I scored high, I actually was very depressed.

However, there has long been a belief that the questions don’t work well for chronic pain patients, who often have sound physical reasons for their poor sleep, appetite, and other symptoms. This would inflate their depression scores. 

For example, "Feeling tired or having little energy" as well as "Trouble falling or staying asleep, or sleeping too much" and "Trouble concentrating on things" are all symptoms that can be greatly impacted by physical pain, regardless of your mental health.

Now, a new study claims to prove the questions are an accurate way to measure clinical depression – even in patients with chronic pain. Published in the Journal of Affective Disorders, the research analyzed how reliable the questions are for people with and without chronic pain.

In a news release about the study published by the University of Arizona, lead author Jennifer De La Rosa, PhD, discussed the motivation for her research.

"Could pain symptoms artificially inflate depression screening scores among those with chronic pain? It's a reasonable question, but it had not yet been definitively answered," said De La Rosa, who also serves as Director of Strategy at the school’s Comprehensive Center for Pain and Addiction.

"Using nationally representative population data, we rigorously evaluated this question and found no evidence to support this long-standing concern."

De La Rosa and her team analyzed data from nearly 32,000 U.S. adults who participated in the 2019 National Health Interview Survey. They found that the questionnaire achieved an excellent level of consistency for people with chronic pain and those without. They concluded that the consistency equaled reliability.

"Clinicians need to know that a positive depression screening is just as reliable in their patients with chronic pain as patients without chronic pain, and they should not hesitate to offer mental health supports to any patient with unmet mental health needs," De La Rosa said. "These conversations require sensitivity to ensure patients feel supported by these conversations rather than stigmatized.”

She also lamented that many clinical trials for depression exclude chronic pain patients. De La Rosa hopes that will change.

"This study provides robust evidence that there would be no scientific problem with including folks living with chronic pain in depression research to help develop treatments capable of meeting the needs of this uniquely underserved population," she said.

The study reinforces De La Rosa's previous research, which found that while 1 in 5 people with chronic pain have depression, more than half of those with clinically significant depression also have chronic pain.

Another recent study estimated that about 40% of chronic pain patients have clinical symptoms of depression or anxiety. The depression rate is even higher for those who have fibromyalgia or chronic pelvic pain.

How To Tell if Your Dog Is in Pain

By Jacqueline Boyd

If you live with a pet, you might feel like you can almost read each other’s minds.

You might even have experienced your pet responding to your emotional state. Animals seem to have impressive skills at detecting our state of health too.

However, new research suggests that many dog owners are not skilled in recognising pain in their pets as they might like to think. This could have significant consequences for the behaviour, health and welfare of our pets.

As a migraineur, I am amazed at how my dogs cope with me when a migraine hits. They seem to recognise the pain, distress and incapcacity that comes along with a migraine and respond with more gentle interactions than usual. I hope that when the situation is reversed and they are unwell or in pain, that I too can recognise it.

So, how can you recognise if your pet is in pain and what should you do if you think they are?

Signs of Pain

It is easy to assume that an animal in pain will make some noise about it and show obvious physical signs. This might be the case if they are in acute pain as the result of severe injury for example. However, animals often disguise pain as a survival mechanism, and many signs of pain show only as subtle changes in behaviour.

Humans do seem to be able to recognise basic animal emotional states such as anger, fear or joy, through facial and body expressions. But we are less good at linking these cues to more complex emotional states including pain, anxiety and frustration.

The recently published study assessed how good people are at recognising signs of pain in dogs. This was carried out via an online questionnaire completed by 530 dog-owners and 117 non-owners. 

Participants were given a list of 17 types of dog behaviour. They were asked to rank how likely  the behaviour types indicated their dog was in pain, based on their prior knowledge and experience. In reality, all 17 types of behaviour listed suggest a dog is in pain.

The signs of pain provided included obvious behavioural changes such as hesitant paw lifting, reduced play behaviour and changes in personality. Participants were good at recognising these prominent behaviour changes were linked with pain. 

However, they didn’t realise more subtle indicators such as yawning, lip and nose licking and changes in facial expressions including looking away and increased blinking. These are all warnings that a dog may be suffering.

Notably, participants without dogs were actually more likely to recognise that freezing or turning the head or body away are associated with pain than dog owners. This suggests that dog owners may become complacent in their observations of their dog’s behaviour.

The Link Between Pain and Behaviour

The study participants were also asked to assess the potential relevance of pain in three written canine behaviour cases. The participants were not told this, but two were suffering from painful conditions, one outwardly obvious, and one more subtle. The third case was not linked to a painful condition.

Dog owners noted that pain was likely in the case with obvious signs of movement problems – hopping and lifting of legs. This was higher for dog owners than non-owners. In the case where pain signs were more subtle (night restlessness and “shadowing” family members), there was no difference in the ability of dog-owners and non-owners to identify the behaviour as signs of pain.

However, the dog owners with previous experience of pets with a painful condition seemed to be better at recognising signs of suffering. This applied to overt changes in movement as well as body language. This suggests that prior experience can be valuable in developing skills when its comes to pet behaviour.

What is interesting from this study is that there were some discrete differences between dog-owners and non-owners in recognising signs of pain. However, owning a dog was no guarantee that someone would be better able to identify subtle pain indicators.

Previous studies have shown animal species may show pain in different ways. For example rabbits often freeze, which might be considered a fearful response. Facial grimace scales are also increasingly being used to assess pain for a range of species including cats and horses. These assessment tools track minute muscular movements in the face such as tightening eyes.

What To Do If Your Pet Is in Pain

Recognising signs of pain in your pet is critical so you can respond quickly. This may also help reduce the risk of dog bites, which are often linked to the dog struggling with chronic pain.

Pain can lead to increased noise reactivity too, where dogs flinch or bark loudly in response to sudden, unusual or loud noises.

If you suspect your pet might be in pain because of a sudden change in their behaviour or movement, seek veterinary advice. Soreness can manifest outwardly such as lameness, lethargy or a lack of desire to exercise or play, but it can be easy to miss more subtle signs such as altered blinking, momentary pauses or freezing.

Research indicates that dog owners should be alert to altered sleep patterns, restlessness, clinginess and unusual licking or chewing their body. Even changes in a dog’s ear position, coat quality, texture, or how their coat lies on their skin can indicate underlying discomfort. Reluctance to being touched in specific areas of a dog’s body might also be a sign of discomfort that needs veterinary investigation.

So if you think your dog needs training or a session with a behaviourist because of a gradual or sudden alternation in their behaviour, it’s worth ruling out whether your pooch is acting strangely because they’re in pain first.

Jacqueline Boyd, PhD, is a Canine Consultant and Senior Lecturer in Animal Science at Nottingham Trent University.

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

How Emotional Distress Makes Chronic Pain Worse

By Pat Anson

Many chronic pain sufferers bristle at the notion that pain is “all in their head” or that it has psychological origins.

They’re not going to like some recent headlines in the news:

“Chronic pain is not just in your head, but it is in your brain”

“Mental defeat can worsen chronic pain, researchers say”

“This Common Mental Disorder Has a Strange Link to Severe Chronic Pain”

“New Study Finds Link Between Difficulty Identifying Emotions and High Chronic Pain Levels”

Yikes. It’s almost like the headline writers wanted to insult pain patients, as much as they want to inform them.

I found the last headline intriguing though, if only because it introduced me to a new word: alexithymia.

Alexithymia is a personality trait characterized by difficulty in identifying or describing emotions. If someone is always “at a loss for words” and can’t express their feelings to others, it could mean they have alexithymia. 

About 10% of the population has alexithymia, which is more common in men (no surprise there), and people who have autism, post-traumatic stress, or depression.

Researchers at Johns Hopkins Medicine wondered if there was a connection between alexithymia and chronic pain. They enrolled over 1,450 people with various chronic pain conditions in a two-year study to answer a chicken-and-egg question: Does chronic pain cause alexithymia or does alexithymia make chronic pain worse? 

“Prior studies have shown that alexithymia tends to be higher in people who have chronic pain. However, we did not know whether alexithymia leads to worse pain, or whether worse pain leads to alexithymia. We also have not had a good understanding of why these two distinct processes were related,” said senior author Rachel Aaron, PhD, Associate Professor of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine.

Aaron and her colleagues had patients fill out questionnaires to see how well they identified their feelings and described their emotions. They also asked participants about their pain, anxiety and depression levels.

The research team then used statistical modeling methods to see if emotional difficulties could predict pain outcomes.

The study’s findings, recently published in the journal American Psychological Association, show that patients with higher levels of alexithymia at the start of the study developed greater psychological distress one year later. That emotional stress had a profound impact. After two years, those same patients had greater pain interference – meaning their daily functioning and quality of life were worse. 

Alternatively, researchers found that chronic pain did not predict or cause alexithymia. That supports evidence that emotional processing difficulties are a risk factor, but not a consequence of chronic pain.

“Greater difficulties identifying one’s own feelings can lead to greater symptoms of psychological distress, including symptoms of depression and anxiety,” says Aaron. “This in turn can lead to greater difficulties managing chronic pain. These findings highlight the role of considering alexithymia in psychological treatment for chronic pain, and how it might lead to psychological distress.”

Aaron led a previous study, which found that 40% of adults with chronic pain have clinical symptoms of depression or anxiety.

How do you treat alexithymia? Various types of psychotherapy can be used, such as Cognitive Behavioral Therapy (CBT) or Emotion-Focused Therapy (EFT), to help patients recognize and express their emotions in healthier ways. Creative therapies can also be used to help people express their feelings through journaling, art, music and dancing. 

There are no drugs that specifically treat alexithymia, although antidepressants and anti-anxiety medications can treat co-occurring conditions like depression or PTSD, which may help improve emotional processing. 

Doctors More Likely to Use Negative Terms for Sickle Cell Patients

By Crystal Lindell

Sickle cell patients are more likely than other patients to have negative descriptions in their medical charts, such as “noncompliant” and “noncooperative,” according to a new study published in JAMA Network Open.

The results are concerning because prior research has shown that such descriptors make doctors less likely to aggressively treat pain, a common symptom of sickle cell disease. The genetic disorder causes red blood cells to form in a crescent or sickle shape, which creates painful blockages in blood vessels. About 100,000 Americans have sickle cell disease, primarily people of African or Hispanic descent.

Researchers at the University of Chicago used artificial intelligence to analyze electronic health records and clinician notes for over 18,000 adult patients. They looked for seven negative words in patient charts: aggressive, agitated, angry, nonadherent, noncompliant, noncooperative, and refuse.

The descriptive words for sickle cell patients were then compared to those of four other groups without sickle cell disease: Black patients, patients diagnosed with chronic pain, patients diagnosed with opioid use disorder (OUD), and non-Black patients. 

They found that patients with sickle cell disease had higher odds of having negative descriptions than Black patients, non-Black patients and patients with chronic pain, but had similar odds of negative descriptors as patients with opioid use disorder. Non-Black patients had the fewest negative descriptors than the other patient groups.

Black patients with sickle cell disease, chronic pain, and OUD had the highest frequency (19%) of negative descriptors in their medical notes.

The researchers said their findings suggest there is bias against patients with sickle cell disease, particularly when opioids are involved.

“Although patients with sickle cell disease routinely use opioid medications to manage their chronic pain, the vast majority do not have an opioid use disorder,”  said senior author Monica Peek, MD, a Professor for Health Justice at University of Chicago Medicine. 

“It is a testament to the strength of their character that they do their best to live full lives while managing debilitating pain with the minimum amount of medication. And yet, within health professions and society as a whole, there is a persistent bias that stereotypes these patients primarily as ‘drug-seekers’ rather than regular people managing a chronic disease.”

The bias and stigma have real life consequences: If a doctor or nurse sees negative descriptors in a patient’s chart, they are less likely to effectively treat their pain.

When it comes to terms like “noncompliant,” the issue can be a bit of a chicken-egg situation — it’s difficult to know what came first. 

Prior research has shown that patients with sickle cell disease who experience discrimination in health care are less likely to follow physician recommendations. These same patients may then be labeled as “noncompliant,” which could perpetuate discriminatory behavior against them. 

The researchers said that clinicians should work to understand why a patient may not want to take a medication or has trouble adhering to treatment, and then adjust their treatment plan to support the patients from there. And they should avoid using negative terms in patient charts.

People With Chronic Pain Are Almost Twice As Likely to Smoke

By Pat Anson 

Cigarette smoking in the U.S. has fallen dramatically over the last few decades, from 45% of the adult population in the 1960’s to less than 10% in 2024. The decline was steep and across the board for both men and women, and for every age group.

But while fewer Americans are smoking overall, the rate of decline is much slower for people with chronic pain, according to a new study.

“We know that cigarette smoking rates overall are going down, which is good,” says co-author Jessica Powers, PhD, an Assistant Professor of Psychology at the University of Kansas. “But what these results show is that the decline isn’t happening as fast for people with chronic pain. People with chronic pain are about twice as likely to smoke cigarettes and to use other types of tobacco products, including e-cigarettes, and to use multiple products together.”

Powers and her colleagues analyzed a decade of smoking data from the National Health Interview Survey, which monitors the health of the U.S. population through face-to-face interviews with 27,000 adults every year. 

Their findings, recently published in the American Journal of Preventive Medicine, show that cigarette smoking among individuals with chronic pain declined marginally from 17.7% in 2014 to 13.1% in 2023. Smoking rates actually increased among chronic pain sufferers who use e-cigarettes.

“We’re seeing a lot of data showing that those with chronic pain are much more likely to use tobacco — cigarettes, e-cigarettes and other types of nicotine or tobacco products,” Powers explained in a news release.

The 13.1% smoking rate for people living with chronic pain is almost double the 7.5% rate for people who don’t have pain. The smoking rate is even higher for people with more frequent or disabling pain.

The study did not examine why people with chronic pain are more likely to smoke, but there are two likely reasons: 

One is that smoking provides a pleasurable distraction from pain and serves as a coping mechanism. The other is that nicotine helps reduce pain signalling. 

“We know pain drives tobacco use. Tobacco has short-term pain-relieving properties, so a lot of people find it helpful in the moment, but it actually causes negative effects in the long term. Tobacco smoking can actually make pain worse,” said Powers. “People get caught in this really vicious cycle where pain is driving smoking, smoking makes the pain worse, which makes it really hard to quit.”

Previous studies have also shown a strong association between smoking and chronic pain. A large UK study in 2020 found that smoking has a long-lasting effect on pain, even after people quit. Former smokers reported higher levels of pain than people who never smoked, and their pain levels were similar to current smokers.

Studies have also found that smoking increases your chances of having some chronic pain conditions, such as degenerative disc disease, fibromyalgia, back pain, and neck pain.

Pain and Shame: Workers With Chronic Pain Often Feel Pressured to Perform

By Beth Schinoff and Elana Feldman

Your back pain gets worse as you sit through a long meeting. Your wrist pain flares when you’re typing furiously to meet a tight deadline. During a busy shift at the grocery store, you feel a migraine coming on.

If that sounds familiar, you’ve got plenty of company. About 1 in 4 U.S. adults suffer from chronic pain. The share who say they are in chronic pain either on most days or every day in the past three months is growing: It jumped by nearly 4 percentage points to 23% of U.S. adults in 2023, up from 19% in 2019.

Chronic pain is not only hard on workers trying to do their jobs, but it also takes a toll on employers and the economy as a whole by costing an estimated US$722 billion in lost productivity each year.

As management scholars who study how people feel at work, we wanted to understand why chronic pain so often makes it impossible for employees to do their work – and even to keep their jobs.

Pushing Through the Pain

With this in mind, we teamed up with two other management researchers, Kimberly Rocheville of Creighton University and Njoke Thomas of Boston College, to conduct a study that Academy of Management Journal published online in January 2026 and will include in an upcoming print edition.

We interviewed 66 people between 2019 and 2021. All of them said that they were in chronic pain – meaning pain that lasts for at least three months. They were all U.S. workers and at least 18 years old. They lived all over the country, in relatively more urban than rural areas. Our sample was 78% women because women tend to experience more chronic pain than men and tend to be more open to talking about their pain.

This professionally diverse group included lawyers, grocery store workers, teachers, police officers and health care professionals. They experienced many different kinds of pain, such as back pain, migraines, arthritis and fibromyalgia.

We found that this wide array of workers and white-collar professionals pushed through their pain because they felt pressure to have what we call an “ideal worker body”: a body that is healthy and strong enough to do anything their job requires.

Regardless of what job they had, people described a surprisingly similar pressure to perform despite their pain. From warehouse workers to lawyers, people felt they had no choice but to walk without a limp, lift heavy things and sit still during meetings.

Many of these people felt compelled to be ideal workers who put work before everything else in their lives. Previous research has found that these expectations can harm their mental health. We found that it can harm your physical health too.

Hiding Their Pain

Because they were in chronic pain, all of the participants in our study said their body wasn’t healthy and strong enough to do everything their job required when it required them to do it.

Even though they were more than intellectually capable of doing their work, they felt ashamed that their bodies fell short. This led them to hide their pain. They took the stairs, instead of the elevator, to seem more like their co-workers who felt fine. They avoided managing their pain in ways their colleagues could see, such as by applying ice to areas of their body that were in pain.

Ironically, trying to make it seem like their bodies were ideal worsened pain for all 66 of the people we interviewed. Most of them eventually reached a point where their pain became so intolerable that they could not function at or outside of work.

Some of them ultimately had to leave their jobs and found other ones that were more compatible with their chronic pain symptoms. In a few cases, they exited the workforce entirely.

This is not unusual. Chronic pain is the leading reason for workers becoming eligible for long-term disability benefits.

Breaking the Cycle

A few of the people we interviewed told us that they managed to escape the damaging cycle of shame and pain.

Why were they able to break free?

First, they found doctors who told them their pain was real. Getting a clear diagnosis and having a medical professional recognize their physical limitations helped them understand that they could never look healthy and strong as expected, no matter how hard they tried.

This released them from the pressure of trying to do so.

Second, most of these people had employers who cared more about what they did – the work itself – and less about how their body looked and moved, even if this meant finding a new job or even changing their profession. As a result, they felt free to ask colleagues for help, stretch during meetings, use dictation software instead of typing, or keep the camera off during Zoom calls so they could lie down when their backs were aching.

They also came up with creative ways of working that were more efficient and better for their bodies. For example, an ultrasound technician told us that she learned to scan patients using both her arms instead of constantly using the same arm. A deli worker said she started using a cart to move heavy meats around the store.

Although we focused on how pressure to be strong and healthy can hurt workers with chronic pain, we believe our findings could matter to everyone – no matter their size, strength, age or employment status.

After all, it’s possible to feel social pressure to conceal aches and pain when you’re in public settings of any kind. And failing to move around when needed or take care of your body in other ways can make you vulnerable to more pain.

Beth Schinoff, PhD, is an Assistant Professor of Management in the Alfred Lerner College of Business and Economics at the University of Delaware.

Elana Feldman, PhD, is an Associate Professor of Management in the Manning School of Business at UMass Lowell and a former Visiting Scholar at Harvard Business School.

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

Why Chronic Pain Often Leads to Depression

By Jianfeng Feng, Trevor Robbins and Xiao Xiao

Chronic pain has long been known to be associated with depression.

Among adults with chronic pain, around 40% exhibit clinical symptoms of depression. But why is it that only some people with chronic pain develop depression?

Researchers have long been wondering why this happens – and what goes on in the brain. If we can answer this question, we may be able to prevent depression from developing.

Our recent article, published in Science, suggests the answer to this question does indeed lie in the brain.

To conduct our study, we analysed neuroimaging brain scans from 14,462 participants from the UK Biobank cohort. We compared the following groups of participants: people with chronic pain for at least seven years who did not have symptoms of depression, and people with chronic pain who also developed depressive symptoms.

For the latter, the depressive symptoms were present either for the entire seven-year period, or they developed after two years or four years. This enabled an analysis of the development of depression associated with chronic pain, using brain imaging.

These neuroimaging analyses revealed something surprising was taking place in the brain – specifically in a structure called the hippocampus. The hippocampus has important functions in learning and memory.

In the participants who reported chronic pain without depressive symptoms, they showed modest increases in hippocampal volume and improved memory performance. This is consistent with the brain attempting to cope with the stress of the pain.

In contrast, people experiencing both chronic pain and depression exhibited reduced hippocampal volume and impaired cognitive performance. Further analyses of these scans suggested these changes developed progressively over time. This indicates that the hippocampus may initially adapt to persistent pain, but it gradually becomes vulnerable when pain continues over long periods.

Importantly, similar patterns were observed across multiple categories of chronic pain – including back, stomach, knee and hip pain, as well as headaches. This suggests that the findings were not specific to a single type of chronic pain condition.

We then studied how these brain changes unfolded in people with chronic pain by using rodent animal models. This research found that in animals there was a similar sequence of changes in the volume of the hippocampus, accompanied by increased neural activity. Moderate improvements in cognitive functioning occurred initially, but this was then followed by anxiety-like behaviour, which later transitioned to depressive-like symptoms and poorer memory.

The hippocampus has long been known to be involved in emotional memories and is highly susceptible to chronic stress. The hippocampus’s plasticity (the ability to form new nerve cells) is known to be involved in coping with chronic stress.

Chronic stress has also been implicated in exacerbating apoptosis (nerve cell death) and suppressing adult neurogenesis – the process of producing new nerve cells in the hippocampus.

We found that a region of the hippocampus known as the dentate gyrus – one of the few areas where new brain cells continue to form in adulthood – emerged as the critical regulatory hub and the pivot for the transition from chronic pain to depression.

Early in the pain process, newly generated neurons in the dentate gyrus showed increased activity – suggesting the brain initially mounts a protective response to persistent pain. Over time, however, immune cells, known as microglia, became abnormally activated and disrupted normal neural signalling in the hippocampus.

This abnormal microglial activation appeared to mark the tipping point at which the brain’s initially protective response to pain began to fail.

Importantly, an antibiotic treatment, minocycline, suppressed abnormal microglial activation and reduced depression-like behaviour in the animal models. This treatment also preserved the structure of the hippocampus and cognitive function.

Treating Pain and Depression

Our findings suggest that a treatment such as minocycline could help prevent depression in people living with persistent pain — particularly if treatment is introduced early.

Of course, other psychosocial, socio-economic and genetic factors play a role in the perception of pain. Therefore, it’s likely that in some people these factors will exacerbate chronic stress and the experience of pain.

However, there are other evidence-based ways to reduce the risk of depression. In another collaborative study between Fudan University and the University of Cambridge, it was shown that seven healthy lifestyle factors, including good sleep, exercise and diet, could reduce the risk of depression by 57%. Importantly, these lifestyle factors were also associated with increased hippocampal volume, consistent with our new study.

Mindfulness training may be another strategy. This focuses on being present in the moment and minimising distraction from competing thoughts and memories. The practice is shown to improve working memory and increase hippocampal density.

A recent review showed that mindfulness meditation experts have increased brain grey matter, including the hippocampus. Mindfulness meditation training was also shown to lead to increased hippocampal volume.

Mindfulness practice has also been found to be beneficial for improving quality of life – not only when coping with chronic pain – and for reducing symptoms of stress and depression.

Our discovery has answered an important question that has long puzzled researchers. We showed the key role the brain’s hippocampus plays in why some chronic pain sufferers develop depression. This discovery also points to potential treatments that may prevent depression in people with chronic pain.

The brain’s coping mechanisms that we discovered may also apply more generally to other conditions where the brain has to cope with chronic stress – such as in psychological trauma.

Jianfeng Feng, PhD, is a Professor of Science and Technology for Brain-Inspired Intelligence at Fudan University.

Trevor Robbins, PhD, is a Professor of Neuroscience at the University of Cambridge.

Xiao Xiao, PhD, is an Associate Professor of Science and Technology for Brain-Inspired Intelligence at Fudan University

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

More Kids Are Going to ERs for Dental Pain

By Farrell Brenner and Angela Y. Zhang, KFF Health News

Eight-year-old Jonah woke up one May morning with a swollen face and a toothache. He refused the pain medication that his mom, Geneva Reynolds, tried to give him. He didn’t sleep or eat and cried constantly.

Within a few days, Reynolds became so desperate that she and her husband had to physically restrain Jonah, dumping pain medication down his throat as he screamed in pain.

“It broke our hearts,” said Reynolds, who lived in Georgetown, Kentucky, at the time. “And I remember just thinking that it shouldn’t have to come to that.”

JONAH REYNOLDS

Reynolds couldn’t find a dentist with an opening who could treat Jonah, who is autistic and often resists dental exams due to hypersensitivity and anxiety.

Over the course of five days, Reynolds took Jonah twice to a nearby emergency room as he struggled with persistent pain and a fever due to a likely infected tooth with an exposed nerve.

The ER had no dentists; both times, the family was sent home with only pain medication and an ice pack.

Across the nation, more children are entering ERs for preventable tooth problems. Dentists, hygienists, and researchers attributed that trend to a shortage of pediatric dental care professionals in rural areas and worsening oral hygiene since the covid-19 pandemic. 

Tens of thousands of kids end up in the hospital for dental emergencies each year, according to Melissa Burroughs, senior director of policy and advocacy at the national health nonprofit CareQuest Institute for Oral Health.

ER visits for tooth problems unrelated to physical injuries rose almost 60% nationally for children under 15 years old from 2019 to 2022, according to a report released late last year by CareQuest. 

And local data reflects that national trend: At Children’s Hospital Colorado in the Denver area, nontraumatic dental cases, such as cavities or gum infections, in its ER increased 175% from 2010 to 2025, according to hospital spokesperson Sarah Bonar. In Kentucky, where Jonah lives, children’s visits to the ER for dental problems rose 72% from 2020 to 2024, according to the state.

Policy changes under the Trump administration are poised to worsen the trend. President Donald Trump’s 2025 federal budget reconciliation law, known as the One Big Beautiful Bill Act, called for billions in cuts from Medicaid, which may force states to limit or drop dental coverage from the public insurance program for those with low incomes or disabilities. 

New eligibility requirements for Medicaid in some states could affect kids’ access to dental care, even though children are guaranteed dental coverage under the program. Research shows that when parents lose Medicaid, even kids with coverage are more likely to have untreated cavities and less likely to go to a dentist.

The Trump administration has also promoted skepticism about fluoride. Decades of research show that fluoride in drinking water and topical fluoride treatments dramatically reduce tooth decay and prevent cavities. 

In recent months, the Food and Drug Administration warned health professionals against the use of fluoride supplements and the Environmental Protection Agency released an assessment of “potential health risks of fluoride in drinking water.” 

Health and Human Services Secretary Robert F. Kennedy Jr. has called fluoride a “neurotoxin” and “industrial waste.” A 2025 study in JAMA Pediatrics linked high levels of fluoride with lower IQ in children — but only at concentrations far exceeding the recommended level in public drinking water.

Donald Chi, a pediatric dentist at the University of Washington who studies fluoride hesitancy, worries that these anti-fluoride stances will further erode trust in fluoride treatment. Since the start of 2026, lawmakers in at least 15 states have introduced bills prohibiting or limiting fluoride in public drinking water. Utah and Florida in 2025 became the first states to enact fluoride bans.

“Will that have an effect on cavity rates?” Chi asked. “Absolutely.”

Severe Dental Cases Rise

Pediatric dentists Katherine Chin and Chaitanya Puranik said they are treating more patients like Jonah at Children’s Hospital Colorado. More severe cases have become more common, too. Puranik said he used to typically see patients with only one cavity, but now his patients are often coming in with tooth decay throughout their mouth.

During the pandemic, many dental offices closed temporarily, and studies show children also increased their sugar intake, a major risk factor for cavities. Severe cavities that lead to tooth extraction can affect children’s developing jaws, sometimes causing long-term problems with talking or sleeping.

Millions of people live in dental care shortage areas in the U.S., with scant dentists within driving distance. On top of that, only 1 in 3 dentists treat Medicaid patients, due to low reimbursement rates, which are on average less than 40% of their typical dental charges, according to the American Dental Association.

Children with intellectual or developmental disabilities may especially struggle to access quality dental care. Few general dentists have sufficient pediatric training to care for kids with disabilities such as Jonah, who are easily overwhelmed or need to be sedated for an exam, according to KFF, a health information nonprofit that includes KFF Health News. 

Over 26% of children have special health care needs, and those children are twice as likely to have unmet dental needs. Their parents are also more likely to report challenges finding a dentist.

When he was younger, Jonah would not let his parents brush his teeth, which led to cavities in his baby teeth, his mother said. After Jonah’s first visit to the ER, Reynolds found a general dentist with an opening. But unlike a trained pediatric dentist, she said, the dentist did not know how to examine Jonah in a way he could tolerate and wasn’t prepared to provide sedation. Jonah left without treatment and was soon back in the ER when his fever returned.

ERs Rarely Provide Solutions

Bradley Weitz, a pediatrician in Washington County, Maine, said he is fielding “the most horrifying cavities” at Down East Community Hospital.

ERs are often ill-equipped to treat dental concerns, Weitz said. Similar to the ER Jonah went to in Kentucky, Down East has no dentists on staff. Weitz often finds himself prescribing antibiotics as a temporary measure.

“But a month later, they’re back again because it’s flaring up again,” Weitz said.

As a potential solution, states such as Maine and Alaska are proposing to use money from the $50 billion Rural Health Transformation Program to develop the oral health workforce or to create specialized dental care centers, which can better serve children with special health care needs on short notice. 

But those initiatives won’t address the loss of coverage anticipated from Medicaid cuts. California last year awarded $47 million in state grants to develop or expand over 120 dental facilities to serve patients with special health care needs.

Jonah’s dental emergency cost Reynolds a week of work from her job as a dog groomer and Jonah three days of third grade, plus hundreds of dollars in out-of-pocket costs.

Eventually, Reynolds found an oral surgeon who extracted the tooth. But even that went poorly, she said. When Jonah became upset over a needle stick, the surgeon threatened to hold him down, Reynolds said. She said the surgeon left quickly after the procedure and never gave her a clear diagnosis of what caused Jonah’s pain. 

The procedure did resolve his toothache, but Reynolds said more professionals should know how to handle cases like Jonah’s, with sensitivity to the families. Four years later, forcing Jonah to take his pain meds still lives fresh in her memory.

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

Sounds Are More Intense When You Have Chronic Pain

By Crystal Lindell

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

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

However, new research seems to support my experience.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Many Rotator Cuff Surgeries May Be Unnecessary

By Pat Anson

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

The answer, unfortunately, is yes. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

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