Study Finds Tramadol Not That Effective for Chronic Pain

By Pat Anson

One of the most widely prescribed opioid painkillers in the world is not that effective at relieving chronic pain and increases the risk of serious side effects such as heart disease, according to a new study.

Tramadol is a synthetic opioid used to treat moderate to severe pain. It is widely perceived as a weaker and “safer” opioid, but the new research found otherwise.

“Tramadol may have a slight effect on reducing chronic pain, while likely increasing the risk of both serious and non-serious adverse events,” wrote lead author Jehad Barakji, MD, a researcher at the Copenhagen Trial Unit at the Centre for Clinical Intervention Research in Denmark.

“The potential harms associated with tramadol use for pain management likely outweigh its limited benefits.”

Barakji and his colleagues analyzed findings from 19 clinical trials of tramadol involving over 6,500 pain patients, making it the first study to assess tramadol’s efficacy and safety across a range of chronic pain conditions.

Five of the studies looked at the impact of tramadol on neuropathic pain; nine focused on osteoarthritis; four looked at chronic lower back pain; and one focused on fibromyalgia.

The findings, published in BMJ Evidence Based Medicine, show that while tramadol eased pain, the effect was small and below what would be considered clinically effective. Tramadol also appeared to increase the risk of cardiac events, such as chest pain, coronary artery disease, and congestive heart failure. 

Use of tramadol was also associated with a higher risk of neoplasms, an excessive growth of tissue that could be an early sign of cancer. However, researchers say the evidence of a tramadol-cancer connection was “questionable” because the studies analyzed were not long enough.

Non-serious side effects caused by tramadol include nausea, dizziness, constipation and somnolence.

Tramadol is considered a weak opioid because it does not bind directly to opioid receptors in the brain like other opioids do. Many patients say tramadol gives them little or no pain relief, but it’s often the only opioid their doctor is willing to prescribe.

In 2023, over 16 million prescriptions were written for tramadol in the United States, down from 25 million prescriptions a decade earlier. Tramadol is classified as a Schedule IV controlled substance in the U.S., indicating it has a low potential for abuse and addiction compared to other opioids.

The consumer watchdog group Public Citizen unsuccessfully petitioned the FDA and DEA in 2019 to upschedule tramadol to a more restrictive Schedule II substance, saying tramadol was “an increasingly overprescribed, addictive, potentially deadly narcotic.”

Tramadol is widely abused by youths in Asia and Africa, where it is often mixed with soft drinks, energy drinks and alcohol to induce euphoria.

Many Older Adults With Chronic Pain and Poor Health Can Regain Wellness

By Pat Anson

“You’re not getting older, you’re getting better.”

There’s some truth behind that cliché about growing old, according a novel study in Canada that found many older adults in poor health -- due to chronic pain and other chronic conditions -- can fully recover within just a few years.

“This isn’t just a story of resilience — it’s a roadmap for how we can help more older adults recover and thrive,” says first author Mabel Ho, PhD, a researcher at the Factor-Inwentash Faculty of Social Work at the University of Toronto. “Our findings highlight the powerful role of modifiable lifestyle and psychosocial factors in shaping healthy aging trajectories.”

Ho and her colleagues followed 8,332 respondents who were 60 years of age or older and in poor physical or mental health. Nearly one in five (18.7%) had chronic pain so severe it was considered disabling, while others had chronic illnesses such as diabetes, heart disease, hypertension, arthritis and osteoporosis.

Not surprisingly, many of the participants also felt depressed, unhappy, slept poorly, and led isolated lives with few social connections.

Their baseline health status at the start of the study was then compared to their physical and mental health after 3 years, to assess whether they had achieved “optimal well-being” – meaning they had no disabling pain, discomfort or limitations on daily activities, as well as good mental health, happiness and life satisfaction.

The research findings, published in PLOS One, show that nearly one in four older adults regained optimal well-being within just three years.

The researchers then sought to identify what factors increased the likelihood that older adults could recover their physical and mental health. Those who reported strong psychological and emotional wellness at the outset of the study were over five times more likely to achieve the high bar of “optimal well-being” when compared to those who struggled with their mental health.

Other factors significantly associated with recovery include a healthy body weight, regular physical activity, good sleep, not smoking, and participating in social activities.

“It’s incredibly encouraging to see that with the right supports and lifestyle, many older adults can reclaim full health, happiness, and independence -- even after serious health challenges,” says Ho.

The study suggests that age-related policies and programs should prioritize physical and mental wellness, to help show that recovery is not only possible for older adults, but common.

“Too often, the focus in aging research and geriatric practice is on decline and disability,” says senior author Esme Fuller-Thomson, PhD, Director of the Institute for Life Course & Aging at the University of Toronto. “Our findings disrupt that narrative. Older adults can and do bounce back—and we need to build systems that support recovery.”

By the end of the study, over 19% of those who had chronic disabling pain had achieved optimal well-being, while nearly 10% of those whose daily activities were limited progressed to no limitations. Over 12% of those who rated their physical health as poor to fair at the start of the study achieved a full recovery.   

Other factors strongly associated with optimal well being were higher education, home ownership, higher income, marriage, and having someone to show love and affection.

“We want this study to reshape how society views aging,” added Ho. “With the right environment, resources, and supports, older adults don’t just survive after struggling with health or well-being issues— they thrive.”

The study did not evaluate what medications or therapies helped older adults recover their health.

Medicare Pilot Program Will Use AI To Decide If Pain Treatments Are Worth the Cost

By Pat Anson

Medicare patients in six states who need epidural steroid injections, cervical fusions, spinal cord stimulators, arthroscopic knee surgery and other treatments for chronic pain will soon have their prior authorization requests reviewed by artificial intelligence (AI) to decide whether the treatments are worth the cost.

The Centers for Medicare & Medicaid Services (CMS) is launching a 6-year pilot program on January 1, 2026 called the Wasteful and Inappropriate Service Reduction Model --- known as “WISeR” for short.

WISeR will cover Original Medicare patients in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington who seek treatment for chronic pain, impotence, incontinence, and burns or wounds needing skin and tissue substitutes.

WISeR will review over a dozen treatments that CMS considers low-value, potentially unsafe, or suspicious because of prior reports of fraud and wasteful spending. The low-value treatments alone cost Medicare nearly $6 billion in 2022.

“CMS is committed to crushing fraud, waste, and abuse, and the WISeR Model will help root out waste in Original Medicare,” CMS Administrator Dr. Mehmet Oz said in a press release. “Combining the speed of technology and the experienced clinicians, this new model helps bring Medicare into the 21st century by testing a streamlined prior authorization process, while protecting Medicare beneficiaries from being given unnecessary and often costly procedures.”

Under traditional or Original Medicare, most covered services do not require prior authorization, but Medicare Advantage (MA) plans often do. For that reason, CMS is partnering with private MA plans that have more experience using AI and other advanced technologies to process prior authorization requests. If a request is denied by WISeR, the agency says it will then be reviewed before a final decision “by licensed clinicians, not machines.”

CMS claims that WISeR will “expedite decision making” and not change coverage for traditional Medicare beneficiaries, who “retain the freedom to seek care from their provider or supplier of choice.”

Those providers, however, will be incentivized with higher Medicare payments if they participate in WISeR and show they can reduce the use of low value treatments and help lower Medicare spending.  

Pain treatments that will be reviewed under the WISeR Model include these procedures:

• Electrical Nerve Stimulation  

• Deep Brain Stimulation for Essential Tremor and Parkinson's Disease

• Vagus Nerve Stimulation

• Surgical Removal or Ablation of Nerves

• Epidural Steroid Injections (excluding facet joint injections)

• Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fractures

• Cervical Fusions  

• Arthroscopic Surgery for Knee Osteoarthritis

• Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis

Many of these treatments have already drawn scrutiny for being ineffective or costly. Studies have found that spinal cord stimulation, for example, has no benefit for back pain; while epidural steroid injections, nerve blocks and nerve ablation have been found to have little or no benefit.

‘Perverse Incentives’

Not surprisingly, the WISeR Model has drawn criticism from physicians who perform the procedures, who decry the use of AI and algorithms to make healthcare decisions.

“We firmly believe that (WISeR) will jeopardize patient access to care, create more administrative burdens for physicians, offer perverse payment incentives for third-party vendors, and represent a substantial reversal of progress toward this Administration’s goal of prioritizing patients over paperwork,” a coalition of 23 neurosurgeon organizations wrote in a letter to Dr. Oz.

“Decision criteria to be used by participating vendors — including algorithms, scoring models, and evidence-based guidelines — remain a “black box,” leaving stakeholders with little to no insight into how prior authorization determinations will be made.”

Patient rights groups and some politicians say WISeR will create new roadblocks for Medicare patients needing treatment.

“While prior authorization is often described as a cost-containment strategy, in practice it increases provider burden, takes time away from patients, limits patients’ access to life-saving care, and creates unnecessary administrative burden,” Rep. Ami Bera (D) and Rep. Suzan DelBene (D) said in a recent letter to Dr. Oz.

“The use of prior authorization in Medicare Advantage shows us that, in practice, WISeR will likely limit beneficiaries’ access to care, increase burden on our already overburdened health care work force, and create perverse incentives to put profit over patients.”

About 12% of prior authorization denials by Medicare Advantage insurers were appealed in 2023, and more than 80% of them were overturned, according to the Center for Medicare Advocacy.

An HHS Inspector General's report in 2018 found “widespread and persistent” problems involving denials of care by Medicare Advantage. Another report in 2022 found 13% of denied requests actually met Medicare’s rules and should have been approved.

“(WISeR) is) a backdoor way of putting everybody in a Medicare Advantage plan,” Carrie Graham, executive director of the Medicare Policy Initiative told Cleveland.com. “It’s a first step to getting rid of, or downgrading, the freedom that traditional Medicare provides.”

5 Myths About Opioids That I Believed, Until I Needed Them

By Crystal Lindell

I had been enduring debilitating pain for months by the time I was given my first hydrocodone prescription for chronic pain in 2013.

At the time, I didn’t even know that hydrocodone was an opioid.

I had only heard of Vicodin being an opioid, and that was only because I lived near the Wisconsin border, where there are lots of Packer fans. The news that former Green Bay quarterback Brett Favre had to go to rehab for his Vicodin use was part of the local conversation.

But I had no idea that hydrocodone was the active ingredient in Vicodin.

It’s been over a decade now, and I have come to rely on opioids to manage the chronic pain I have in my right ribs, which is technically called “intercostal neuralgia.”

Before I needed opioids for pain relief, I used to buy into a lot of common cultural myths about them. Below is a look at what I used to believe, and how my views eventually shifted.

Myth #1: Only People Who ‘Misuse’ Opioids Have Physical Withdrawal

When I got my first hydrocodone prescription, I didn’t know it was a controlled substance with strict limits on how often you can get refills. And I definitely didn’t know that I would go through withdrawal if I stopped taking them abruptly.

My doctor prescribed 10mg pills and the label said: “Take 1-2 every 4-6 hours.”

So, that’s exactly what I did: Two pills every four to six hours.

My pain was (and still is) intense, but at the time I was still trying to keep pace with my pre-chronic pain lifestyle, which meant doing everything possible to push the pain away so that I could work and have a somewhat normal life.

But that meant that I ran out of my prescription early – something I was not aware was even a problem. When the doctor’s office said I would need to wait a couple days for a refill, I didn’t think it would be a big deal. Surely, I could easily ride out a couple of days without hydrocodone, no problem. After all, I had been taking them as prescribed.

Yeah. That’s not what happened. Turns out you actually cannot go from 40 to 80 mg of hydrocodone a day to zero.

I naively went to work that day, and still remember the trauma of spending the entire shift in the bathroom with diarrhea, nausea, horrible flu-like aches, and an odd feeling of anxiety.

Turns out, anyone can go through withdrawal from opioids. There is no magic spell that doctors can cast to give you immunity from it, just because you’re taking opioids exactly as prescribed. Your body doesn’t know the difference.

And that physical withdrawal is also not indicative that you have “a problem.”

In fact, it’s one of the reasons I think the entire conversation around addiction is often more nuanced than people want to admit. Taking a dose to combat withdrawal is often labeled as “misuse” – even though anyone can have withdrawal. 

And anyone who’s been through it knows that you’ll do almost anything to make it stop.

Myth #2: The Best Way to Stop Using Opioids Is Quitting Cold Turkey

There’s a common myth that the best way to stop using an addictive substance is to go cold turkey. That’s usually not true for things like nicotine and alcohol, and it’s also not true for opioids.

I used to believe in the common framing for this. That if you stopped using opioids cold turkey, made it through 72 hours of withdrawal, and then took just one dose, it would reset the whole process. You’d have to go through withdrawal all over again.

That’s not true. In fact, taking a dose after going longer than usual without one is often part of the tapering process that works best for getting off opioids. 

Ideally, you taper off slowly by lowering the amount you’re taking each day. So, if you’re on 40mg of hydrocodone a day, the best way to stop using it is to take 35mg daily for a week or so, then 30 mg, and so on until you get down to zero.

That’s the best way to reach success long-term and actually get off the medication, if that is your goal.

If you’re looking for more realistic tips on how to stop taking opioids, see “A Survival Guide for Opioid Withdrawal” that I wrote for PNN with my partner a few years ago. You can trust the advice because we learned it ourselves the hard way.

Myth #3: Opioid Doses Last as Long as Manufacturers Claim

I was eventually prescribed extended-release morphine pills for my chronic pain, and was told that each one should last a full eight hours. I was also told that hydrocodone should last four to six hours.

Unfortunately, neither of those things are true. So-called “extended release” morphine lasts about four hours, while the short-acting hydrocodone can stop working in just two or three hours.

So, it’s not wise to take another dose whenever your pain comes back. If you do that, you’ll end up running out of your prescription early every month.

Instead, you should expect to go through periods throughout the day when your pain starts to come back – and then you have to count down until your next dose.

Myth #4: Even One Dose of an Opioid Creates a High Risk of Addiction

Before I started taking opioids, I honestly believed the myth that just one 10mg dose of Vicodin could result in life-long addiction.

In reality, that’s nearly impossible. In fact, even among patients who take opioids long-term, the rate of addiction is still incredibly low. Estimates vary widely, but according to experts who have studied it, people who take opioids over long periods have addiction rates of 1 to 3 percent.   

Opioids are often framed as being so addictive that anyone can get hooked, so any exposure to them is dangerous and risky. In reality, low-dose opioids are incredibly safe, and most patients taking prescription opioids never develop an addiction to them

Myth #5: If Someone Is ‘Really’ in Pain, Doctors Will Prescribe Opioids

I am a little ashamed to admit this, but I used to think of a Vicodin prescription as an indicator of whether or not someone’s pain was actually severe.

If a doctor prescribed Vicodin to someone, that meant they were in “real” pain.

Boy, was I wrong.

While dealing with pain myself, I quickly learned that doctors will often ignore severe pain in patients because they don’t want to deal with the hassle of prescribing a controlled substance. That reluctance has only gotten worse since 2013. Much worse.

These days, doctors withhold opioid medication from post-op patients, cancer patients, palliative care patients, and even hospice patients. All of them are still in very real pain though.

Whether or not a doctor validates your pain with an opioid prescription has no bearing on how severe your pain actually is.

There’s a lot of misinformation about opioids and these are just some of the common myths perpetuated about them. While it’s understandable to believe them if you’ve actually never needed opioids, I encourage everyone to keep an open mind. After all, if you wait until you or a loved one needs opioids to see the truth, it may be too late.

Experimental Brain Implant Gives Long-Term Relief from Chronic Pain

By Crystal Lindell

An experimental brain implant that detects when someone is in pain and responds by stimulating the brain with tiny electrodes provided long-term relief from chronic pain, according to a small new study led by researchers at the University of California, San Francisco (UCSF) 

The preprint study, which has not yet been peer-reviewed, involved six patients with severe chronic nerve pain that did not respond to conventional treatment. The patients were hospitalized for 10 days so that researchers could put temporary electrodes in their brains to target areas involved in pain processing with deep brain stimulation (DBS). 

Of the six patients, five had clinically meaningful pain relief. Those five patients then had the experimental DBS implants permanently placed in their brains. Over the next six months, brain activity and pain signals were recorded to create a personalized “map” of each brain 

The system then used each patient’s unique brain signals (pain “biomarkers”) to decide in real time when to turn the low frequency stimulation on or off. Referred to as “closed-loop DBS,” the implants did not run continuously, but automatically adjusted when pain was felt and turned off when patients were asleep. 

Patients were also given sham placebo stimulation in brain areas outside the ideal location to serve as a comparison..  

The closed-loop DBS system worked better than the placebo treatment. Researchers say they identified several brain areas that gave quick pain relief when stimulated, and that they could accurately predict people’s pain levels just from their brain activity. 

On average, the DBS implants reduced pain intensity by 50 percent, while the sham treatment increased pain levels. Patients also were able to walk further after real stimulation – their step counts rose by 18 percent – compared to just one percent with sham treatment. For some patients, the benefits lasted over three years. 

“In five participants, we observed acute, rapid pain relief which translated into long-term efficacy after permanent closed-loop DBS for up to 3.5 years,” researchers reported. One patient who suffered from chronic pain after a stroke experienced “profound and durable pain relief.” 

The implant surgeries, however, were not trouble free. Two participants experienced serious adverse events related to surgery, but continued in the trial and experienced no serious adverse events related to stimulation. 

“Our study is limited by a small sample size, constraining the generalizability of these findings to other chronic pain syndromes. Although we observed initial evidence of sustained benefits up to 3.5 years, additional follow up is required to monitor for late-emerging tolerance,” researchers concluded.

Previous attempts to use deep pain stimulation for pain relief have been “inconsistent with poor long-term results.”  Those prior attempts, however, used a one size-fits-all-approach and did not target specific brain regions for each patient, as the UCSF study did..

DBS is being used to treat movement disorders associated with Parkinson’s disease, tremors, and other neurological conditions. It is also used to manage some psychiatric conditions. DBS is considered a treatment of last resort for patients that don’t respond well to medications or have severe side effects from them.

Childhood Trauma Raises Risk of Chronic Pain and Other Health Problems in Adults

By Crystal Lindell

A new study has found links between childhood trauma, chronic pain and several health problems in adults, according to research published in JAMA Network Open. 

Many previous studies have found that adverse childhood experiences (ACEs) increase the risk of chronic pain in adulthood. This study goes further, finding links between ACEs and severe pain, poor mental health, back and hearing problems, gastrointestinal issues, and hypertension at age 50.

However, it remains unclear how much of that association may be causation and how much is simple correlation. There is also a very real concern that the study will add to the stigma that chronic pain patients already face in the medical community. 

The research, which was conducted by a team of scientists at the University of Aberdeen, followed over 16,000 participants in the UK who were enrolled in the National Child Development Study.  All were born during one week in 1958 in England, Scotland or Wales, and were interviewed when they turned 50.

Researchers asked about their current health and whether they experienced any childhood trauma, such as abuse, neglect, bullying, divorce and financial stress, or if they had witnessed substance abuse, criminal activity or mental illness in their family.

While most studies report associations between ACEs and a single health outcome, researchers say this is the first research to look at a broad range of health outcomes.

They found that mental health problems and severe pain in adults had the strongest connections to childhood trauma. Men and women who experienced childhood adversity were more likely to suffer from depression, anxiety, and chronic pain at 50. 

Women who had an ACE were also more likely to have digestive problems, asthma or bronchitis compared to women who did not experience childhood trauma.

It’s important to note that the “higher risk” was often marginal, at best. For example, while 8.7% of men who experienced childhood trauma had severe pain at 50, that compares to 4.88% of men with severe pain at 50 who did not have an ACE. That’s just a 4% difference.

The same is true for women. Researchers found that 11.22% of women with childhood trauma had severe pain at 50, compared to 7.53% of women with no history of ACE. Again, just a 4% difference. Most researchers look for at least a 5% difference before calling an outcome “statistically significant.”

Little or no association was found between ACEs and migraine, hay fever or rhinitis, eyesight problems, or skin problems. 

Researchers found that the more trauma experienced, the greater the impact on health at age 50. People who experienced four or more types of childhood adversity had the highest risk of developing health problems as adults. Abuse, neglect, and family conflict had the most wide-ranging consequences. Just one adverse childhood event was found to increase the risk of dying before age 50.

The research was partly funded by Versus Arthritis, the UK’s largest charity supporting people with arthritis.

"This important research highlights the strong relationship between early childhood adversity and severe pain in adulthood. Findings suggest that our earliest experiences may be driving the health inequalities we know exist for people living with chronic pain,” Deborah Alsina, CEO of Versus Arthritis, said in a press release.

"Tackling childhood adversity is vital if our governments are serious about reducing the burden of chronic pain for the next generation."

Early Intervention and Prevention

Researchers say the study highlights the importance of preventing childhood trauma and providing early support to at-risk families.

"Going forward, screening for ACEs in primary care settings, and targeted interventions for at-risk individuals, may help reduce the burden of chronic pain, mental ill-health, and other poor health outcomes,” said lead author Gary Macfarlane, PhD, Chair of Epidemiology at the University of Aberdeen.

"While 'broad spectrum' interventions remain important to ameliorate the impact of ACEs, a targeted approach, considering types of ACE, could address specific vulnerabilities — particularly mental ill-health and severe pain.”

That’s an important goal, but for adults already suffering from health issues that could be linked to childhood trauma, that doesn’t offer much help. 

In the real world, studies like this are very often used to dismiss the health problems people suffer. That's especially true for chronic pain. 

Patients are often told their pain was caused by childhood trauma, and doctors use that as an excuse to invalidate their symptoms and withhold treatments like opioid pain medication. This gets especially frustrating when a history of childhood trauma is then used to claim that a patient is more likely to abuse opioids. 

Many doctors seem to believe that if childhood trauma is the direct cause of a health issue, then the only real treatment is mental health services. This can contribute to the stereotype that chronic pain is “all in your head” or that patients are “just looking for attention.”

There is also the question of causation vs correlation. For example, many health conditions are hereditary, including those that cause chronic pain, like arthritis and Ehlers-Danlos Syndrome.

Parents who grew up with those health problems may be more likely to have negative experiences with their children. Chronic pain drains time, money and energy, which then impacts someone's ability to be a present parent. So a parent with chronic pain may be more likely to neglect their child, not out of malice but out of necessity, as they deal with their own health issues. 

Then when the child grows up and has chronic pain, it seems like it could be related to childhood trauma when it may be actually be a case of simple genetics. 

While it is important to find better ways to respond to children who have experienced trauma, it’s also important that such research is not used to dismiss adults dealing with health issues. For many adults, the current trauma of living with chronic pain is more pressing than what they experienced in childhood. 

Chronic Pain Surged in U.S. After Pandemic

By Pat Anson

Rates of chronic pain and disabling pain surged in the United States after the Covid pandemic, reaching the highest levels ever recorded, according to a new study.

In 2019, about 20.5% of Americans (50 million people) had chronic pain and 7.5% had high-impact pain, which is pain strong enough to limit daily life and work activity.

Pain prevalence remained stable during the pandemic, and by some measures even declined, but in 2023 the chronic pain rate surged to 24.3% of Americans, while high-impact pain rose to 8.9% of the population.

That brought the total number of people who have chronic pain to 60 million, with 21 million having high-impact pain.

“We found that chronic pain, already a widespread health problem, reached an all-time high prevalence in the post-pandemic era, necessitating urgent attention and interventions to address and alleviate this growing health crisis,” wrote co-authors Anna Zajacova, PhD, at Western University in Ontario and Hanna Grol-Prokopczyk, PhD, at the University of Buffalo..

The study is based on results from the 2019, 2021 and 2023 National Health Interview Surveys (NHIS), a federal survey conducted every two years. A preprint of the study was released last year and has now been published in the peer-reviewed journal PAIN.

The 2023 surge in pain was observed in all age, gender, racial/ethnic groups, education levels, and in both rural and urban areas.

Pain increased in almost all body areas, including the back and neck; arms, shoulders and hands; hip, knees and feet; headache or migraine; and in the abdominal, pelvic, and genital areas. The lone area where pain declined was in the jaw or teeth.

Why did pain increase after the pandemic, but not during the pandemic — when people saw doctors less often and postponed or cancelled many health procedures?

One possible explanation is that Covid relief payments, expanded unemployment benefits, and eviction moratoriums eased financial stress.

Working from home and commuting less also lessened physical demands, while giving remote workers more opportunities for self-care.

PAIN journal

“The big question is why we saw this substantial increase in pain prevalence after the pandemic. We examined the role of long COVID and found that it explained about 13% of the increase,” said Grol-Prokopczyk. “None of the other measures we examined — including changes in income or physical health conditions — explained the increase.

“We speculate that abrupt termination of pandemic-era policies, such as remote work arrangements and expanded unemployment benefits, may have played a role.”

In addition to long Covid, researchers also noted an uptick in rates of health conditions that can cause pain, such as arthritis, cancer, cardiovascular disease, diabetes, depression, and anxiety.

The finding of an increase in pain rates conflicts with an FDA analysis that predicted the “medical need” for hydrocodone, oxycodone and other pain relieving Schedule II opioids would decline by 5.3% in 2023. The FDA also predicted a 7.4% decline in the medical use of opioids in 2024 and a 6.6% decline in 2025.

Those FDA projections are important because they are used by the DEA to establish annual production quotas for opioids, which have fallen for nine consecutive years. Since 2015, the DEA has reduced the supply of oxycodone by 68% and hydrocodone by 73%.

When short-term, acute pain is poorly treated, it can have long-term consequences for patients who may transition to chronic pain. Healthcare visits for non–Covid health issues declined dramatically in 2020 and 2021, particularly at hospitals and emergency departments, which are often the first site of care for acute pain management.

Researchers say the lack of adequate and timely pain management during the pandemic may have contributed to more people having chronic pain and high-impact pain in 2023.

“These findings highlight the importance of expanded epidemiological and clinical research on chronic pain to better understand population-level drivers of pain, and to improve national pain prevention and treatment efforts for the many Americans at risk of or affected by pain,” said Grol-Prokopczyk.

Brains Control Pain Differently, Depending Where It’s Felt

By Crystal Lindell

Different parts of the brain are more active when relieving pain — depending on where the pain originates — according to a new Australian study. The finding could lead to more targeted and effective treatments that utilize the body’s own pain relief system.  

Researchers  at the University of Sydney made the discovery while studying the placebo effect. They used MRI brain scans to monitor 93 healthy participants, while exposing them to painful heat on various parts of the face, forearm and leg. 

Before the test, participants were given a placebo analgesic cream and told it would help relieve their pain. In reality, the “lidocaine” cream was a placebo and researchers secretly lowered the temperature of the heat, tricking the participants to believe the cream was easing their pain. 

The heat stimulus was applied to the placebo-treated area, as well as a separate untreated area for comparison. Up to 61% of participants reported less pain in the area where the cream was applied, typical of a placebo response.

The MRI scans showed how the brain responded to the placebo effect. Researchers found that upper parts of the brainstem were more active when relieving facial pain, while lower regions of the brainstem were engaged for arm or leg pain. 

“This is the first time we’ve seen such a precise and detailed pain map in the human brainstem, showing us that it tailors pain relief to the specific part of the body that’s experiencing it,” lead author Lewis Crawford, PhD, a Research Fellow at the University of Sydney, said in a press release. 

Understanding which brainstem areas are linked to different parts of the body may open new avenues for developing non-invasive therapies that reduce pain.   

“The brain’s natural pain relief system is more nuanced than we thought,” said Crawford. “Essentially, it has a built-in system to control pain in specific areas. It’s not just turning pain off everywhere; but working in a highly coordinated, anatomically precise system.”     

“We now have a blueprint for how the brain controls pain in a spatially organised way,” said senior author Luke Henderson, PhD, a Professor in the School of Medical Sciences and the Brain and Mind Centre. “This could help us design more effective and personalised treatments, especially for people with chronic pain in a specific area of their body.”

It is important to note that none of the “healthy” participants had chronic pain, and thus these results may only apply to short-term, acute pain that is treated with a placebo.

Nevertheless, the study challenges long-held assumptions about how pain relief works. Instead of relying on medications that target opioid pain receptors in the brain, researchers say receptors in the brainstem could be targeted with cannabinoids. 

“Opioid-based pain relief typically activates central areas of the brain and can affect the whole body, whereas the cannabinoid circuit that we identified appears to operate in more targeted regions of the brainstem,” said Crawford. “This supports the idea that cannabinoids may play a role in localised, non-opioid pain control.”

Most oral pain medications today – including acetaminophen, ibuprofen and opioids – work by telling the brain to relieve pain throughout the entire body. This research opens the door to more targeted therapies that relieve pain in specific parts of the body.

What Having Chronic Pain Teaches You About Doctors

By Crystal Lindell

There’s an old story often shared in my family about my great uncle Jim. It’s a story I’ve heard since I was a kid, as a warning. 

You see, when Jim was 39 years old, he was told to take “heart medication.” 

But Jim felt fine, so he ignored the doctor’s orders and never took the pills. And then, one night, while his wife – my aunt Sylvia – was watching TV, Jim went upstairs, fell asleep and died. He never even made it to his 40th birthday. 

I never met Jim, but his early and unexpected death sent shock waves through generations of my family. And his story eventually morphed into family folklore, where the moral was that if a doctor gives you medication, you need to take it. 

It is with this mindset that I first approached my doctor appointments back in 2013 when I developed chronic pain in my right ribs. 

I didn’t know the cause – and to be honest, I still don’t really know for sure how it started – but I did know that I was in a lot of pain, and I was very scared. 

So when the doctors started loading me up with prescriptions, I filled every single one of them. Within a couple months, I had a line of pill bottles and patches on my nightstand spanning everything from gabapentin and amitriptyline to lidocaine and other medications I can’t even remember now. 

And I took all of them exactly as prescribed. 

The only problem was, the lessons of the past did not apply to my situation. The medications were prescribed by a team of doctors who were just throwing stuff at the wall to see if anything would stick. 

Taking them in combination caused horrible side effects. I was always on the verge of falling asleep, and I started gaining weight so fast that my clothes would stop fitting in the span of a week. 

Not to mention the fact that they also weren’t even doing the one thing I needed: None of them were helping my chronic pain. 

It wasn’t until I eventually went to the Mayo Clinic about a year later that I realized the flaws in my logic.

It was there that a doctor told me to just stop taking half the medications I was on. When I questioned her, she was shocked that I had not thought to stop any of them sooner. 

It sounds naive in retrospect, but that was the first time I started to realize that doctors were not gods. And that doctors are sometimes guessing when it comes to treatments.

It was a lot to process, because it also meant that I had to reckon with the fact that I could no longer just blindly follow whatever treatment they were giving me. Rather, I was going to have to figure out a lot of this for myself. 

There’s a common myth that if you ever get sick, a doctor will save you. But when you develop any sort of chronic health condition, you realize that doctors are just humans too. They come into appointments with prejudices, egos, bias, and flawed information. They also often disagree with other doctors.

This can be extremely difficult to navigate because when it comes to your health, a lot of treatments really are about life or death. And filtering out which ones are life and which ones might be death is dangerous business. Doctors are definitely needed to guide us, but they can’t be relied upon to do it alone. 

There’s an old saying about doctors: “There’s a reason they call it a practice.” Even doctors are still learning about the complexity of our bodies. Because as I said, they are not gods, and as such, they can’t be relied upon to be our saviors. 

In the end, we have to save ourselves. 

It’s not quite as comforting to see the world that way, with the knowledge that nobody is coming to save us. But it’s more realistic. And a lot more likely to actually save you. 

The Strange Denial of Complications Caused by Poorly Treated Pain

By Drs. Forest Tennant and Scott Guess

There has been no shortage of controversy, scandal and fraud regarding the opioid and pain crises of the past decade. One standout in the debate over opioids and pain treatment has been a lack of an honest, objective discussion of the benefits of pain care.

A basic tenet in medical practice and therapeutics is what is called the “risk-benefit” ratio. This is a simple analysis of whether a specific drug or therapeutic measure has more benefit than risk.

For example, the risk-benefit of drugs taken during pregnancy is well-known and established. But strangely, the debate over whether opioids have more benefit than risk in the treatment of pain has never been broached.

None of the parties involved, especially the anti-opioid zealots, will discuss any benefit that opioids may bring. In fact, essentially their only discussion is that opioids are a risk for overdose and addiction, so they have no benefit and shouldn’t be used.  

This risk is overrated and overstated in relation to opioids prescribed and monitored by a physician. According to the CDC, total opioid overdose deaths in the US (including deaths from illicit opioids) were 24 deaths per 100,000 population in 2023.

That compares to the overdose death rate for prescribed opioids, which was 4 per 100,000 population. That is a raw number for prescribed opioids.  Some data reports opioid deaths among physician monitored chronic pain patients to be as low at 0.1 per 100,000 population. 

In other words, the overdose risk of evidence with prescription opioid is minuscule.

Pain has a number of pathological complications that benefit from opioid therapy. In addition to physical relief, there are humanitarian benefits, such as a reduction in suffering, and the ability to mentally and physically function as a productive person.

When poorly treated or left untreated, chronic pain has profound negative and deleterious effects on the cardiovascular and endocrine (hormonal) systems. Pain puts the cardiovascular system into overdrive, which raises blood pressure and pulse rates. Coronary artery spasm may also result from severe chronic pain.

We can personally attest to prescribing blood pressure medication and nitroglycerin to many pain patients at risk of cardiac arrest or heart failure.

Hormonal suppression and deficiency of cortisol, testosterone, estradiol and other hormones are also common in undertreated chronic pain patients. Cortisol levels can drop below levels that sustain life. We have administered emergency cortisone to pain patients who were severely ill, debilitated, and near collapse because they had inadequate cortisol levels.

Among Dr. Thomas Addison’s eleven reported original cases of Addison’s Disease in 1855, about half had serious intractable pain conditions such as adhesive arachnoiditis.

Chronic pain has also been found to alter blood glucose and lipids (cholesterol). Sleep deprivation is another major problem in pain patients.  And anorexia with malnutrition is common.

Given the medical complications induced by pain, one would logically think that there would always be a discussion of risk-benefit when discussing opioid therapy. But we’ve never heard or seen such a discussion in medical literature or in political circles.

As if denial of benefits over risks weren’t bad enough, an even stranger denial has occurred. We have searched the major medical textbooks used in medical schools today, and couldn’t find a single word that chronic pain is a risk for hypertension and cardiac disease, much less hormonal deficiencies.

Isn’t it time we quit denying that chronic pain has medical complications that can be easily treated with opioids and other medicinals? The risks of opioid therapy simply don’t outweigh the benefits. 

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.   

Scott Guess, PharmD, operates an independent pharmacy and clinic in Atascadero, CA that specializes in pain management and arachnoiditis.

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

Most Pain Patients Stop Using Medical Cannabis Within a Year

By Crystal Lindell

A small new study found that most pain patients taking medical cannabis stopped using it within one year. 

The research – which was published in PLOS One  – looked at 76 patients diagnosed with chronic musculoskeletal pain, such as back, shoulder and knee pain. The patients were all certified for medical cannabis use at the Rothman Orthopaedic Institute in Pennsylvania between 2022 and 2024

By the first 3-month check-in, 44.7% (34 patients) had already stopped using medical cannabis, which researchers described as “a considerable early drop-off.” 

“This early discontinuation could point to initial expectations not being met, potential side effects, or insufficient symptom relief, which are common reasons for discontinuation in medical treatments,” wrote lead author Sina Ramtin, MD, who was a Research Fellow at the Rothman Institute. 

“Despite the growing acceptance of MC (medical cannabis) as a therapeutic option for chronic musculoskeletal pain, significant gaps remain in understanding its long-term efficacy. While some patients report significant pain relief, others experience dissatisfaction, intolerance, or prefer more definitive treatments, such as surgery or joint injections.” 

By one year, another 10 patients stopped using medical cannabis, which resulted in a total discontinuation rate of 57.9% (44 patients).  

Age was the biggest factor researchers found that separated those who continued using medical cannabis from those who didn’t. The patients who discontinued cannabis tended to be older (mean age of 71.5 years) than those who continued with cannabis therapy (64.5 years).

The researchers think age-related concerns about cognitive side effects, dizziness, or drug interactions may have played a role in decisions to stop using cannabis. Another possible explanation for the high discontinuation rate in elderly patients is that they are more likely to have more advanced pain conditions, such as degenerative disc disease and osteoarthritis, which are more difficult to treat.

The origin of pain, health insurance, and a patient’s race did not seem to have a significant impact on cannabis use, although a higher proportion of patients in the discontinued group reported low back pain. The research team attributed this to “the complexity of managing chronic pain conditions with medical cannabis alone.” 

Interestingly, the researchers did not find much difference in the health outcomes between those who continued using medical cannabis and those who didn’t. They looked at physical and mental health scores for patients, and found that there were no significant differences between the two groups.

“These findings suggest that while MC may offer benefits for some patients, further research is needed to better understand the long-term effects of MC on pain management and patient satisfaction, as well as the factors influencing treatment adherence,” the authors said. 

There has been a strong push over the last decade to reduce the use of prescription opioids, leaving patients little choice but to experiment with “alternative” pain treatments such as medical cannabis. Research like this reinforces the idea that cannabis is not always a perfect option for treating chronic pain.

“The relatively high early discontinuation rate indicates that MC may not provide immediate or sustained relief for all patients and highlights the need for better patient selection and management strategies in the early stages of treatment,” said Ramtin.

Also, while the study doesn’t delve into this, the cost of medical cannabis is often a huge barrier for pain patients. Medical cannabis can be much more expensive than the cash price of generic opioids, and is usually not covered by insurance.

Many of the patients in the study may have found more relief with opioids, but it’s unclear how many were given that option. 

At the end of the day, patients deserve a real choice when it comes to how they treat their pain. That means having access to different medications and therapies. Only then will people truly be able to find what works best for them.  

When Headlines Lie: Misleading News About Opioids and Chronic Pain

By Neen Monty

The headline in Physician’s Weekly screams alarm:

“Rising Use of Potent Opioids in Chronic Pain Management”

And then the sub heading:

“Long-term opioid use for chronic pain doubled, with potent opioids rising, underscoring the need for stronger guideline adoption”

Terrifying, right? We must do something!

But now, read the article. It’s based on a study recently published in the European Journal of Pain on the prevalence of long-term opioid therapy (LTOT) when treating patients with chronic non-cancer pain.

The Dutch study looked at opioid use over a ten-year period, from 2013 to 2022, using a large dataset drawn from primary care records in the Rotterdam region. This database covered more than half a million patients and included data from over 240 general practitioners.

The researchers focused on adults aged 18 and over who had been prescribed opioids continuously for at least three months. They tracked how common LTOT was over time, and also explored which diagnoses, co-existing conditions, and other medications were associated with it. They reported their findings using basic descriptive stats and calculated LTOT prevalence per 100 patient-years to show trends over the decade.

And what did they find?

“The prevalence of LTOT increased twofold from 0.54% (95% CI: 0.51–0.58) per 100 patient years in 2013 to 1.04% (95% CI: 1.00–1.07) in 2022. The proportion of LTOT episodes solely involving potent opioids slightly increased between 2013 and 2022”

In plain English, the prevalence of long-term opioid use by patients at the end of the study was just over 1%.

Yes, that’s right: 1%.

And the prevalence increased by just half a percentage point over a decade.

Hardly a crisis. Hardly anything to scream about.

But we can’t have that! We need a clickbait headline to demonize opioids and stop their prescribing! So, instead of reporting accurately on the very small increase in opioid prescribing, they focus on the “twofold” increase. Trying to manufacture a crisis where there is none.

It’s true, the prevalence of LTOT did double, from half a percent to one percent. And that’s what the headline highlighted, to try and make it sound like there is an opioid crisis in Europe. There is not.

This tactic is often used in presenting medical research – using relative percentages rather than the actual numbers. That is because relative percentages -- “Opioid Use Doubled!” -- sounds worse than “Opioid Use Increased by Half a Percent.”

It’s a trick that researchers and the media use all the time.

Why do this? It’s dishonest. It’s deceptive. And it destroys our trust in science. They are trying to manufacture a crisis when there is none.

Why not research and report an actual crisis? Instead of making one up?

The Physician’s Weekly headline exemplifies the worst of scientific spin: inflating tiny fractional changes and omitting context. It potentially harms patients by reinforcing the myth that opioids don’t work long term and should be withheld. That myth persists because of misleading reporting like this.

Finally! An Honest Headline

It was nice to see some accurate reporting in Scimex, an Australian online news portal that tries to help journalists cover science. Instead of the usual deceptive, sensationalist headlines, this one tells the truth:

“Pain Reprocessing Therapy (PRT) could help those with mild chronic back pain”

This was so refreshing to see! Because it’s so very, very rare.

Most reporting on PRT glosses over a critical point: It has only been studied in people with mild, non-specific back pain. An average of 4 on the zero-to-10 pain scale.

That nuance is often lost in the hype about alternative treatments like PRT, cognitive behavioral therapy, mindfulness and TENS.

You do not treat 8/10 back pain the same way you treat 4/10 back pain.

What happens when people are misled about PRT? It gets recommended to people with severe, pathological pain — often with clearly identifiable causes — and everyone acts surprised when it doesn’t work.

Let’s be clear:

• PRT is not for severe back pain

• PRT is not for pain caused by pathology

• PRT is not a cure-all

But you wouldn’t know that from most headlines about PRT, such as “New therapy aims to cure back pain without drugs, surgery” and “A New Way to Treat Back Pain.”

Then you read the small print: All the participants in PRT studies had non-specific back pain from an unknown cause. And they had mild pain.

The researchers are often complicit, cherry-picking and hyping their own data. Why? Because they need funding. Because they’re writing a book. Because professors have to "publish or perish" to keep their jobs. Because it’s easier to mislead the public than to admit a therapy has limits. And you don’t get to be a guru if your therapy only works for a minority of patients with mild pain.

This kind of spin harms people with severe chronic secondary pain. It feeds the narrative that if you're still in pain, then it’s your fault. You didn’t try hard enough. You’re catastrophizing. You need to retrain your brain.

It feeds the stigma that all chronic pain is mild and easily curable. And that anyone who says their pain is severe has psychological problems.

No. Maybe their pain is caused by pathology, like tissue damage or herniated discs. Maybe their pain is nociceptive or neuropathic.

This is why chronic pain patients must be included on every research team. Someone with real-world, high-impact chronic pain would never let this kind of misrepresentation slide. And the rest of the team wouldn’t be able to claim ignorance.

We need more honesty and integrity in research and the media. We need headlines that reflect the actual findings. We need conclusions that match the data, not some predetermined narrative. Right now, most media coverage doesn’t even try.

Read the study, then read the headline. They rarely match. That’s how we ended up with a generation of healthcare providers who think opioids are bad, all chronic pain is primary pain, and that PRT is some miracle therapy.

It’s not. PRT may be helpful to people who are depressed or have anxiety, but should not be a first-line treatment for everyone. It’s only been tested in people with mild back pain for which there is no known physical cause. It has not been shown to work for people with severe pain or structural pathology.

But the researchers usually gloss over that. And the headlines and conclusions rarely reflect those facts or spell out who PRT is for and who it is not for.

Because here’s the truth: Pain Reprocessing Therapy is not a treatment for chronic pain. It’s a treatment for anxiety and depression.

That’s the real headline.

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

Neen is dedicated to challenging misinformation and promoting access to safe, effective pain relief. She has created a website for Pain Patient Advocacy Australia to show that prescription opioids can be safe and effective, even when taken long term. You can subscribe to Neen’s free newsletter on Substack, “Arthritic Chick on Chronic Pain.”

FDA Approves First New Fibromyalgia Drug in 15 Years

By Pat Anson

Fibromyalgia sufferers who have yearned for new treatments finally have one. Tonix Pharmaceuticals says the Food and Drug Administration has approved Tonmya for the treatment of fibromyalgia in adults -- the first new FDA-approved therapy for fibromyalgia in over 15 years.

Fibromyalgia is a poorly understand chronic pain condition that affects about 10 million Americans, most of them women. It causes an array of symptoms, such as widespread body aches, fatigue, insomnia, mood disorders and brain fog.

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

“The FDA approval of Tonmya as a first-line treatment for fibromyalgia represents a landmark advancement for the millions of people in the U.S. suffering from the debilitating pain this condition causes,” Seth Lederman, MD, CEO of Tonix, said in a press release. “At Tonix, we recognized the transformative potential of pursuing a new approach with Tonmya for fibromyalgia, a chronic overlapping pain condition, that has gone without innovation for many years.”

Tonmya is more of a sleep aid than an analgesic. The tablet is a new, faster-acting formulation of an old drug: cyclobenzaprine hydrochloride (Flexeril), a muscle relaxant that was originally developed as an antidepressant. Tonmya is meant to be taken before bedtime sublingually, to be dissolved under the tongue for rapid absorption into the bloodstream.

Tonix believes that improving sleep quality, specifically restorative sleep, is the key to reducing fibromyalgia symptoms. Poor sleep not only worsens pain, but causes anxiety and depression, which are common features of fibromyalgia. Pain, insomnia, and mood disorders become a vicious cycle when fibromyalgia is poorly treated.

In a Phase 3 clinical study, fibromyalgia patients taking Tonmya reported better sleep and less fatigue after three months, which coincided with at least a 30% reduction in pain in about half of patients. Tonmya was generally well tolerated, with fewer side effects than the other three fibromyalgia medications.

It’s notable that all of the FDA-approved drugs for fibromyalgia are neither new or novel. They were originally developed for other purposes — to relieve depression or seizures — and are simply being repurposed as fibromyalgia treatments.

“The chronic pain of fibromyalgia is debilitating to every aspect of a person’s life, including causing sleep disturbance and fatigue, all of which can negatively impact someone’s ability to carry out their daily activities,” said Sharon Waldrop, founder of the Fibromyalgia Association. “For over 15 years, this community has been underserved and waiting for new treatment options. This approval is a promising step forward and brings renewed hope to millions.”

Tonmya is expected to become available in the fourth quarter of 2025.

Living With Chronic Pain Teaches You to Ignore the Haters

By Crystal Lindell

When I first started having chronic pain in 2013, one of the major hurdles I faced was that I suddenly had a lot of trouble handling my full-time job. Doing a 90 minute commute each way, managing stress, traveling for conferences – all of it became infinitely more difficult. 

A lot of bosses probably would have immediately started to look for ways to let me go at that point, but I was lucky enough to have one who didn’t. He was an incredible mentor, friend and advocate for me – both within the company and with third parties. 

In fact, I would often rave about him to others, bragging about how empathetic and compassionate he was about the whole situation. 

A few years later, my boss started to have really bad knee pain, to the point that he eventually needed a knee replacement. 

Before he could have the surgery though, we had to cover a week-long industry conference at an exhibition hall together, and the whole experience left him very drained. He was suddenly experiencing chronic pain. 

Near the end of the week our team was having dinner, and he leaned over to tell me something. 

“I’m sorry I was not more compassionate to you about your health problems. It’s so awful. I go to bed tired, I wake up tired. The pain is always there. It’s horrible. I should have been nicer,” he told me.

I was stunned. 

This was someone who I had always categorized as being among the most compassionate about my chronic pain. And here he was – now faced with it himself – feeling as though he should have been even nicer. 

I always point to that story when I talk about why I don’t take it personally when others judge how I manage my life with chronic pain. Until you’ve been through it, it’s really hard to truly understand what it’s like to live with it – and what you’d do to make it stop. 

Even the most compassionate people often find that they were not compassionate enough. That it’s worse than they previously understood. 

And most people are not compassionate. On the contrary,  over the years a lot of people have been really judgemental about my health choices. People love to offer unsolicited advice, talk behind my back, and make rude comments like these: 

“She just wants to get high all day.”

“If you really wanted to get better you’d take up running/yoga/pilates and lose weight.”

“How bad could it be? She’s just lazy.”

But one thing I’ve noticed repeatedly is that when life hands them a health problem of their own, they are quickly humbled. 

People who thought I wasn’t doing enough to get better suddenly feel overwhelmed by something as routine as an MRI.

People who thought I took too many pain pills suddenly ask me for tips on how to get their doctor to prescribe pain medication. 

People who sneered at my kratom use suddenly want a tutorial on how to use it. 

People who called me childish for advocating for universal health care suddenly realize that the health insurance industry doesn’t care if they live or die. 

And people who thought I wasn’t doing enough to further my career quit their jobs and stopped working altogether. 

To be honest, I get it. It’s really hard to conceptualize a life with chronic pain or any chronic health issue until it happens to you. And it’s easy to judge how someone else is handling it. 

So when they are humbled, I never say “I told you so.” Instead, I offer sympathy, and whatever advice they ask for. 

And I tell them the most important thing you can tell someone with chronic pain: You are not crazy, you are not alone, and you can still live a very fulfilling life regardless of your health issues. 

Before that happens though, before they are humbled, when they are still healthy and offering judgements, I do something else – I ignore them. Because I know that no matter what they say, they wouldn’t handle my chronic pain any better than I do. 

To quote one of the most famous song writers of our generation: 

“Haters gonna hate, hate, hate, hate, hate. Baby, I'm just gonna shake, shake, shake, shake, shake. I shake it off, I shake it off.”

A Pained Life: When Disaster Strikes

By Carol Levy

I am watching a TV show. A tornado hits the main character's house. Suddenly, her house and all her possessions are scattered everywhere, broken and crushed, her house virtually demolished.

I watch as she looks through the detritus, more and more frantic in an effort to find something – anything -- that wasn't broken or totally destroyed.

“How can you recover from something like that? She lost everything,” I thought to myself.

My eyes start to tear up, my stomach clutches. This feels familiar.

Then it hits me. Trigeminal neuralgia did the same thing to me.

People often try to comfort disaster victims with heartfelt, but meaningless cliches: "You have your health" or "At least you're safe.”

The same words were said to me about my pain, even the line about still having my health. Well, yes, trigeminal neuralgia only caused severe pain to my face. The rest of me was physically whole. But was I healthy? No.

“There's always a chance they'll find something to help you,” was something else I heard -- even after 14 brain surgeries, including one that was 100% experimental. I have tried all there is to try. My neurosurgeon made that very clear to me.

This all started when I was 26, just beginning life. 

I wanted to be a singer.  The year before the pain began, I was in two musicals. It was in the lowest rung of professional theater, but it was what I wanted to do. The pay was less than what it cost me for the gas I used to get to the theater, but a paycheck is a paycheck.

With all my hopes and dreams of becoming a professional singer, and two whole shows on my resume, I packed my bags and moved to New York City, like so many other young people with the same dream.

For most of the first 6 months, I had a job as a receptionist. My boss promised me time off for auditions and classes. I was living my dream, holding the hope and fantasy of success in my hand.

Then, out of the blue, the pain started. Constant, spontaneous and triggered. Just a light touch from a wisp of hair could set it off. I didn’t know when the spontaneous pain would come, and had no control over the constant pain.

Soon, it affected my left eye. Any bright light or use of my eye caused breathtaking pain. The rest of me was fine, but I was now 100% disabled by pain.

It kept me virtually housebound, going out only for groceries, doctor's appointments, and the pharmacy. I stayed in as much as I could. Either the pain was so great I couldn't go out, or the fear of it being triggered kept me its prisoner.

Most of us are fine one minute, then wham, the pain strikes.

Our pain is like a tornado. For some, it comes on suddenly like a whirling dervish. For others, like the buildup to a tornado, it slowly gathers strength before demolishing who we were, what we had, and what we wanted to be. 

The pain took so much from me. The hopes and dreams I had before the pain were turned into rubble, yet I couldn’t let them go.

After a tornado the Red Cross comes in, neighbors and churches offer help.

But I find that isn't the case when it comes to chronic pain. Instead, people tend to look away or mouth platitudes, all while pretending our lives haven't been devastated.

I have had the pain for over 40 years. I still don't accept it. I keep looking for the life I expected to have.  It's never there.

Ultimately, the TV character finds one of her treasured belongings in the wreckage of her home.  She is ecstatic and relieved.  She suddenly sees the rest of the damage as merely a chore she has to deal with.

Maybe, just maybe, one day I can do the same.

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