Review Finds THC More Effective Than CBD for Chronic Pain

By Pat Anson

An updated systematic review found that cannabis products with relatively high levels of THC (tetrahydrocannabinol) may provide small improvements in chronic pain; while those containing high levels of CBD (cannabidiol) and little or no THC had minimal effect on pain.

Researchers at the Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University reviewed 25 short-term cannabis studies involving over 2,300 patients with chronic pain. Their findings are published in the Annals of Internal Medicine. 

CBD-based gummies, tablets, oils and other products have long been marketed for various health issues, but researchers say they demonstrated almost no improvement in managing pain. 

“This may be surprising to people,” said lead author Roger Chou, MD, in a press release. “Conventional wisdom was that CBD was promising because it doesn’t have euphoric effects like THC and it was thought to have medicinal properties. But, at least in our analysis, it didn’t have an effect on pain.” 

Chou, who was lead author of the controversial 2016 CDC opioid guideline and its 2022 update, said the small improvement in pain was on the order of a half point to a point on the zero-to-10 pain scale. While providing modest pain relief, THC-based products also had a higher risk of side effects, such as dizziness, sedation and nausea.   

There are several caveats to the review which make it unhelpful, at best, in determining whether THC or CBD are effective pain relievers. 

One, many of the clinical trials were deemed to be biased or of low quality. They mostly involved patients with chronic neuropathic pain, which means they don’t necessarily apply to patients with other types of pain.

Second, most of the studies involved pharmaceutical-grade cannabis-based medicines, such as dronabinol and nabilone, which are approved for nausea, vomiting and as an appetite stimulant. None of them are approved for pain relief.  

Third, those pharmaceutical medicines are based on synthetic THC, not plant-derived THC or CBD. So basically, the researchers studied products that most cannabis consumers don’t use

“This raises critical questions about generalizability: Can findings from standardized formulations inform real-world use of diverse, cannabis-derived, state-regulated products?” asks Ziva Cooper, PhD, from the UCLA Center for Cannabis and Cannabinoids, in an editorial also published in the Annals of Internal Medicine.   

Copper says the review demonstrates the need for better evidence and less reliance on clinical trials. The inclusion of observational studies and patient reviews of products obtained in dispensaries would better capture real-time evidence of current cannabis use and outcomes. 

“There are opportunities for novel approaches to understand cannabis-related health effects. Rigorous randomized controlled trials (RCTs) are the gold standard for determining the safety and efficacy of cannabis and cannabinoids for therapeutic end points,” Cooper wrote. 

“Yet, these studies are resource-intensive, challenging due to federal regulations, and slow to adapt to a rapidly evolving marketplace and patient behavior. Expanding the scope of study designs to consider complementary strategies is urgently needed.”

Chou says the wide variety of cannabis products on the market makes drawing conclusions about their effectiveness difficult.

“It’s complicated because cannabis products are complicated,” he said. “It’s not like taking a standardized dose of ibuprofen, for example. Cannabis is derived from a plant and has multiple chemicals in addition to THC and CBD that may have additional properties depending on where it’s grown, how it’s cultivated and ultimately prepared for sale.”  

Better cannabis research is one of the reasons the Trump Administration is moving to complete the process of reclassifying cannabis from a Schedule I controlled substance to a Schedule III drug with accepted medical uses.

Because cannabis has long been illegal under federal law, it has stifled research into its health benefits, leaving patients and doctors in the dark on its potential uses. This review does nothing to shine a light on the issue.  

‘Stop This Insanity’: Pain Patients Condemn DEA for Cutting Rx Opioid Supply Again

By Pat Anson

Thousands of people have left public comments in the Federal Register, most of them sharply critical of the Drug Enforcement Administration’s plan to reduce the supply of opioids and other Schedule II controlled substances in 2026.

If enacted without any changes, the DEA’s proposal would be the 10th consecutive year the agency has reduced aggregate production quotas (APQs) for manufacturers of opioid pain medication. 

The biggest cut next year would be in the supply of oxycodone – a reduction of 6.24% – a pain medication that is already in short supply, according to the American Society of Health-System Pharmacists.

“When cutting the production of this medication, you are harming millions of innocent victims, whose life has been taken from injury/illness and rely on pain medication daily to survive and have a quality of life,” wrote Charl Revelo. “We are not criminals. We are innocent pain patients.”

Revelo is one of over 5,000 people who left comments in the Federal Register – a hefty turnout, given that the DEA only allowed 15 days for comments, about half the usual comment period for quota proposals. December 15 was the last day public comments were accepted.

Over the past decade, DEA has reduced the supply of oxycodone and hydrocodone by over 70 percent –  citing a decline in “medical usage” and fewer requests from drug manufacturers. 

But “medical usage” does not reflect a decline in medical need. Chronic pain has actually risen in the U.S. and now affects about 60 million people, including 21 million with high-impact pain – pain strong enough to limit daily life and work activity.

Despite the increase in medical need, doctors are not writing as many prescriptions for opioids as they used to, in part because they fear investigations for “overprescribing” by the DEA and other law enforcement agencies. 

“Declining prescribing does not reflect declining need. It reflects restricted access, pharmacy shortages, and policies that have pushed patients off medically necessary treatment. These quota reductions will increase harm, not reduce it,” wrote a poster who preferred to be anonymous. 

“The current atmosphere of fear around prescribing of opioids is very likely to account for the apparent reduction in use. If doctors are afraid to prescribe these medications, that leads to a decrease in prescriptions,” wrote Jonathan Rogers. “This situation has led to chronic pain patients seeking other treatment, including kratom, methadone from clinics that are set up for addiction treatment and not pain management, and adulterated street opioids.”

“Please STOP reducing the amount of opioids. Pain patients are suffering & your actions - continuing to reduce opioid production year after year - is fueling the dangerous black market & putting Americans who are desperate for pain relief at great risk. It’s irresponsible & speaks to your motives,” wrote an anonymous poster.

“Do not reduce the production of opioids. They are a necessary medication to treat patients. The previous reductions, laws, lawsuits by anti-opioid persons, and incarcerations of medical providers is already causing so much suffering and death of pain patients,” said another anonymous poster. 

“This insanity with cutting back and ultimately doing away with opioids is criminal,” wrote Brooke Moon. “Please allow doctors to practice medicine and prescribe what they deem is necessary for the treatment of pain. The suffering of millions of innocent pain patients doesn't need to continue. Please stop this insanity!”

Missed Deadlines

Several posters pointed out the DEA has repeatedly missed a December 1 deadline in the Controlled Substances Act for setting annual production quotas. That puts a strain on drug manufacturers and contributes to shortages. 

“My mother recently died of cancer and was unable to get her pain medication and died in agony. That is on you,” wrote Peter Wilson, who suffers from chronic back pain.

“You need to get your annual quotas for medications before the deadlines expire. You need to do your job and make sure there are adequate quotas of legitimate pain medication for patients who desperately need it. Don't blame this on the pharmaceutical companies whose hands are tied by your inability to come up with reasonable quotas in the allotted time.”

Other posters support a proposal for the DEA to hire a Chief Pharmacy Officer (CPO) and put that person in charge of quota allotments. A CPO would be more familiar with the drug supply system and manufacturing deadlines.

“They should have a CPO because the DEA and DOJ can't seem to stay on track by themselves. They are allowed to miss the deadline, but in a normal person's world, you would be reprimanded for missing the deadline,” said an anonymous poster.

“The DEA definitely needs to hire a Chief Pharmacy Officer to take control of the quota disaster. DEA cites lack of staffing as one of the reasons it can not get the next year's quota in by December 1. Hiring a CPO would assure that the quotas are in by the deadline and that someone knowledgeable would make an informed, reasonable decision on the amounts,” wrote another anonymous poster. 

Even with a shortened public comment period, the production quotas for 2026 will likely not be finalized until after January 1. The last time production quotas were that late was in 2024, when the quotas were not published until January 3. Drug shortages spiked to record levels in the first few months of that year, including opioid pain medications covered under the quota system.

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

By Neen Monty

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

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

• Two GP visits.

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

• My fortnightly IVIG infusion.

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

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

• A psychologist appointment.

That’s seven appointments in ten days.

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

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

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

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

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

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

Instead of empathy, I get blamed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which is 100% wrong in every case.

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

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

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

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

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

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

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

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

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

But only one showed me any empathy at all.

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

Not my problem-ism.

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

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

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

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

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

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

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

A Doctor’s Appointment Can Feel Like Criminal Court for Pain Patients

By Crystal Lindell

This week I had an appointment where I was worried that I would have to submit to a urine drug test. And if anything went wrong, it could ruin my life.

It wasn’t a criminal court date or a meeting with a probation officer. It was with my doctor.

Every six months, I have to see the doctor who prescribes my opioid pain medication for a check-in. I’m actually very lucky that I only have to see him twice a year, because many patients are required to go in much more frequently.

But those two appointments each year cause me so much stress that I have trouble functioning. There is always the fear that if something doesn’t go according to plan, my opioid prescriptions could be cut off. And when a doctor has that much power over you, it’s rational to worry about how things will go.

So, in the weeks leading up to the appointment, I stress about everything that could go wrong.

Chief among my worries is that I haven’t had health insurance since 2022, so now a lot of my previous medical bills are in collections. Mind you, even when I had insurance, a lot of my medical bills went to a collections agency because, between co-pays and deductibles, the bills were in the thousands of dollars.

I always worry that this be the visit when my doctor finally cuts me off from care because of unpaid bills. Or maybe it will be the front-desk receptionist who confronts me about the overdue bills. What do I do if they refuse to see me as a patient because I am late paying? While it’s a decision that would fully be within their rights, it would ruin my life.

I have good reason to fear this. In 2008, I got an HPV vaccine from a doctor, and the shot came with a $150 co-pay. I had just finished paying thousands of dollars in medical bills for my gall bladder removal surgery, so I was having trouble paying for the vaccine.

And then, out of the blue, I got a letter from that doctor’s office saying that they were cutting off my care because of the unpaid bill. And I was no longer allowed to get care at any of the doctors in that hospital system.

I was shocked and sad, and also thankful that I was moving out of the area soon. But the experience scared me and left me constantly worried that even small unpaid medical bills could result in a doctor abandoning me.

Money isn’t the only stress factor when it comes to these appointments. There is also the chance of a urine drug test going wrong. While my doctor has not ordered one in a while, it’s always a possibility.

Now, you might assume that since I take my medications as prescribed, there should be nothing to worry about when it comes to peeing in a cup. But if anything does go wrong, I could lose access to the medications that I need to function. Like if there’s a false result on the screening, which happens more often than you might think.

So, I stress.

A lot of people assume that drug tests only look for non-prescribed or illicit substances. That what they are really looking for is cocaine and heroin. But the tests go far beyond that, and they are constantly adding substances to check for. While they have never tested for kratom in the past, I have no idea if it will suddenly be added to the screening, and what would happen if I tested positive for it.

The real reason most doctors order drug tests is they want to make sure you are taking your opioid medication as prescribed. If the medication isn’t found in your urine, that means you might be selling or diverting it. 

Again, not a problem for me. But still, the act of being forced to pee in a cup for the sole purpose of policing my compliance with the doctor is always going to feel punitive.

All of these worries are rolling around in my brain when the day of the appointment arrives. I have to wake up earlier than normal to shower and make the drive to the doctor’s office. It’s almost two hours each way because he works at the closest university hospital, and my complex medical needs require more than a local primary care doctor can handle.

My body hates waking up early, and my chronic pain often flares up in rebellion if I don’t get enough sleep. So, I have to ease into functioning while waiting for my pain medication to kick in.

All of this stress is compounded by the fact that on the day of this particular appointment it was snowing, with a mix of rain and sleet hitting the ground in just the right way to make all the roads extremely icy.

I knew this was going to make driving difficult, but I also knew that if I canceled my appointment, I risked not being able to get my next pain medication refill. So I prepared myself for an extremely treacherous drive and planned to leave a full hour early

Before I was set to leave, my fiancé went to the local Casey’s gas station to fill up the car for me. When he came back he sounded like he had been to war: “You can’t drive to your appointment in this weather! People were literally spinning out in the Casey’s parking lot!”

Ugh. Fine. I decided to suck it up and call my doctor’s office to see what my options were because I knew the weather was too bad to drive.

I assumed that I would need to completely reschedule, because he’s usually booked out for months. But when I called, the receptionist said that in the notes my doctor had said that I could do the appointment virtually if needed.

I once heard that wearing different colored socks brings good luck, and thus I have done this many times throughout my life on stressful days. And this time, it actually worked!

I was able to do a very easy telehealth call, from the comfort of my own home! Everything went extremely well. He told me that he had seen the weather, and that I had made the right call to stay off the roads that day. I had spent all that time stressing for nothing. 

But it shouldn’t take a pair of mismatched socks to get compassionate care. Millions of chronic pain patients are constantly stuck navigating these types of appointments because of the war on opioids. Unfortunately, many of them end up living the things that I feared. 

Of course, in six months’ time, I will have to go to his office again, and I’m sure I’ll go through all the same stress before that appointment too. Hopefully by then I’ll have some sort of health insurance, and ideally it will be a clear summer day..

Until then, I’m just happy that my doctor decided to rule in my favor. In an ideal world, a doctor’s appointment shouldn’t feel like a verdict.

Mixed Findings on Effectiveness of Medical Cannabis

By Pat Anson

Some new studies are muddying the water even more on whether medical cannabis is an effective treatment for pain, anxiety, insomnia and other health conditions. 

The first study, a JAMA review of over 120 clinical trials, medical guidelines and meta-analyses (studies of studies), found that there is not enough scientific evidence to support most of the conditions that cannabis is commonly used to treat.

Over one in four (27%) adults in the United State and Canada have used cannabis for medical purposes. And over 10% of people in the U.S. have used products containing cannabidiol (CBD) for therapeutic purposes.

But researchers say that widespread use is driven more by perceptions, anecdotes and promotion than it is by scientific evidence.

"While many people turn to cannabis seeking relief, our review highlights significant gaps between public perception and scientific evidence regarding its effectiveness for most medical conditions," says lead author Michael Hsu, MD, a psychiatrist and health researcher at UCLA Health. “Patients deserve honest conversations about what the science does and doesn't tell us about medical cannabis.”

Hsu and his colleagues found that FDA-approved cannabis-based medications, such as dronabinol and nabilone, are effective for HIV/AIDS-related appetite loss, chemotherapy-induced nausea, and pediatric seizure disorders such as Dravet syndrome and Lennox-Gastaut syndrome.

But for most other conditions, the evidence remains either inconclusive or lacking. Over half of medical cannabis users take it for chronic pain, but current medical guidelines recommend against cannabis as a first-line treatment for either chronic or short-term acute pain.

The researchers also highlighted the potential health risks of cannabis. High-potency cannabis containing over 10% THC has been linked to higher rates of psychotic symptoms and anxiety disorder. Daily use of cannabis, particularly of inhaled or high-potency products, is also associated with higher rates of coronary heart disease, heart attack and stroke compared to non-daily use.

About 29% of people who use medical cannabis also met the criteria for cannabis use disorder.

The review emphasizes that doctors should screen patients for cardiovascular disease and psychotic disorders, and evaluate them for potential drug interactions, before recommending THC-containing products for medical purposes.

Medical Cannabis Reduces Opioid Use

But another study, published in JAMA Internal Medicine, suggests that medical cannabis is an effective treatment for chronic pain because it reduces the use of prescription opioids.

Researchers at Albert Einstein College of Medicine and Montefiore Health System evaluated 204 adults in New York State’s Medical Cannabis Program who were prescribed opioids for chronic pain between 2018 and 2023.  

At the start of the study, most participants reported high levels of pain (an average of 6.6 on the zero to 10 pain scale) and were taking an average daily dose of 73.3 morphine milligram equivalents (MME). By the end of the 18-month study, the average daily dose fell to 57 MME, a 22% reduction.

“Our findings indicate that medical cannabis, when dispensed through a pharmacist-supervised system, can relieve chronic pain while also meaningfully reducing patients’ reliance on prescription opioids,” said lead author Deepika Slawek, MD, an associate professor of medicine at Einstein, and an internal medicine and addiction medicine specialist at Montefiore. 

The reduced use of opioids suggests that chronic pain sufferers can be slowly weaned off opioids with medical cannabis. For example, participants who received a 30-day supply of medical cannabis reduced their opioid use by an average of 3.5 MME compared to non-users.

“Those changes may seem small, but gradual reductions in opioid use are safer and more sustainable for people managing chronic pain than stopping suddenly,” said Slawek.

Since the study occurred during a time period when opioid prescribing overall fell by nearly 50% in the United States, we asked Dr. Slawek if that could have influenced the findings. She said researchers adjusted their modeling data to account for that as best they could.

“The only way that we will be able to get definitive answers on whether medical cannabis reduces opioid use is to conduct randomized trials, which are very difficult to do in the U.S. specific to cannabis,” Slawek told PNN in an email. “We believe that by using causal inference modeling in this study, we were able to add the highest quality evidence possible that cannabis may reduce opioid use in patients with chronic pain.” 

The scientific data for medical cannabis is improving. According to an analysis by the National Organization for the Reform of Marijuana Laws (NORML), the number of cannabis research studies grew for the fifth consecutive year, with over 4,000 scientific papers involving cannabis published so far in 2025.

“Despite the perception that marijuana has yet to be subject to adequate scientific scrutiny, scientists’ interest in studying cannabis has increased exponentially in the past decade, as has our understanding of the plant, its active constituents, their mechanisms of action, and their effects on both the user and upon society,” said NORML Deputy Director Paul Armentano. 

“It is time for politicians and others to stop assessing cannabis through the lens of ‘what we don’t know’ and instead start engaging in evidence-based discussions about marijuana and marijuana reform policies that are indicative of all that we do know.”

According to NORML’s analysis, over 37,000 scientific papers about cannabis have been published since 2015. That means over 70% percent of all peer-reviewed scientific papers about cannabis have been published in the past ten years alone.    

The studies are growing and so is the anecdotal evidence. A recent survey of 1,669 medical cannabis users in the UK found that nearly 89% of those with chronic pain reported somewhat improved or significantly improved quality of life.

Feline Good: A Sense of Purpose Helps Me Manage Chronic Illness

By Crystal Lindell

Every morning, at around 5 a.m., my very fat orange cat Goose starts his daily routine: Screaming at the top of his lungs in an effort to wake up me and my partner.

He’s hungry and he doesn’t care if we’re asleep – it’s time for cat breakfast.

Trust me when I tell you that we have tried a number of workarounds to help avoid this daily cat alarm clock.

We have attempted to ignore his screams. We have tried feeding him a bigger meal later at night before bed. And we have left dry food out overnight.

We even gave him a late-night catnip snack in hopes that it would help him sleep later into the morning.

Goose doesn’t give a shit about any of that. He still gets up at 5 a.m. every single morning so that we can feed him.

Turns out, though, this daily ordeal may actually be helping me manage my chronic pain from Ehler-Danlos syndrome.

GOOSE AND CRYSTAL

New research from Cigna shows that having a strong sense of purpose can help offset the effects of chronic disease. And every single morning, Goose makes sure that I know that my purpose is to take care of him.

Cigna researchers found that while adults with chronic conditions usually have much lower vitality scores than those who are not sick, the same does not hold true when they also have a strong sense of purpose. 

Adults with chronic conditions and a strong sense of purpose actually have a significantly higher vitality score — nearly matching the scores of people without health issues. Cigna defines vitality as the ability to pursue life with health, strength and energy. 

People with a strong sense of purpose are significantly more likely to have vitality than those who do not (89% vs. 61%). They are also five times more likely to say they feel energized (63% vs. 13%) and nearly three times as likely to look forward to each new day (86% vs. 31%).

Notably, having a strong sense of purpose is linked to greater ownership of physical health — 84% of adults with strong purpose say they feel in control of their health vs. 55% of those without strong purpose. People with a strong purpose are also more likely to get regular exercise, sleep better, and to see their doctors for regular checkups. They also have less anxiety and depression.

“Having a sense of purpose gives people energy and helps them feel happier and healthier,” says Stuart Lustig, MD, National Medical Executive for Behavioral Health at Cigna. “When you know what matters to you, you’re more likely to bounce back from tough times, build strong friendships, and take care of yourself, which impacts your overall physical health.”

It can be easy to shrink into yourself when you’re dealing with chronic health problems, especially when it comes to chronic pain. And truth be told, one of the reasons I resisted my fiancé’s pleas to get a cat in the first place is that I was worried I wouldn’t be able to take care of the cat on bad pain days. 

But as fate would have it, having Goose actually helps me get through the bad pain days —  especially when he is waking me from a deep sleep by screaming for breakfast. In fact, Goose and his cat sisters give my life meaning and make me feel needed every morning, even on the days when I don’t feel like I have much to give.

Of course, you don’t have to get a cat to have a sense of purpose. You don’t even need to have a constant level of activity. Small, gentle acts of generosity can go a long way. 

There are many things in my own life beyond my cats that help me see the world outside of myself and my chronic pain. I also care for my elderly grandma, babysit my niece, volunteer at a local animal shelter, and cook for my family on a regular basis. I also write these columns, which gives me a very direct connection between my pain and my purpose. 

Finding purpose can happen in a million small ways, throughout the days and years. As the old saying goes, it’s better to give than to receive.  And ultimately, when you give, you do, in fact, receive.  

Study Shows Anger Makes Chronic Pain Worse

By Crystal Lindell

A new study claims that the angrier someone is about their chronic pain, the worse their pain will be. But to be honest, the whole thing kind of pisses me off.

All kidding aside, the research published in The Journal of Pain, looked at four distinct “multidimensional anger profiles” in pain sufferers.

Researchers followed 735 adult patients with different types of chronic pain, assessing how they experience, express and control anger, and how strongly they feel about being wronged by their situation. About a third of the participants completed follow-up assessments 5 months later.

They found that people with medium to high levels of anger and feelings of “perceived injustice” had some of the most severe pain. They reported greater pain intensity, more widespread pain, and higher levels of disability and emotional distress. 

In contrast, people who seemed to manage their anger more effectively and viewed their condition with less resentment tended to have less pain..

However, the researchers did not clarify which treatments the patients had access to or how being denied treatment impacted their pain. Instead, they encouraged doctors to make an “early assessment” of patients that emphasizes “the need for tailored, anger-focused, patient-specific interventions.”

One of the biggest issues I have with this study is that it sets up doctors to blame the patient’s demeanor and mood for their physical pain – something they are often already prone to do. 

I can hear the in-office conversations now.

“Have you tried being less angry?” the doctor asks, as though he’s offering an actual treatment option to the patient sitting on a cold exam table.

The question would rightly be infuriating, which would then just lead the doctor to type in their notes that the patient’s pain is partly caused by their inherent anger and sense of injustice.

Leaving the insulted patient in a state of untreated limbo. 

Yes, people whose pain is left untreated or poorly treated are more likely to be justifiably angry overall. And they are especially more likely to feel like their pain is unjust.

In fact, anger is a very appropriate response to such suffering. It inspires you to push those around you to help you find relief. And unfortunately, it’s often required to get real help from medical doctors. 

In the study's conclusion, the authors admit as much.

"Anger is not inherently harmful - when adaptive, it can be a strong motivator, helping individuals set boundaries and navigate challenges," wrote lead author Gadi Gilam, PhD, a psychologist and neuroscientist at the Hebrew University of Jerusalem. "Rather than eliminating anger, interventions should harness this adaptive potential while mitigating its harmfulness."

Perhaps they could also focus on interventions that actually treat physical pain? Especially since the most effective treatment for many types of pain – opioids – has been severely restricted over the last decade.

Anyone who tells you they’d be calm and accepting while dealing with chronic pain, while at the same time knowing there was an effective treatment they weren’t allowed to have, is lying to you.

It’s actually very normal to be angry in that situation and to feel a strong sense of injustice. The situation itself is not just. 

I have long said that lack of sleep will make you crazy so much faster than you expect, and a version of that applies to pain as well. Unrelenting pain will make you angry so much faster than you expect.

Rather than trying to treat the anger, doctors should focus on the source, and treat the pain itself. 

7 Gift Ideas for People with Chronic Illness

By Crystal Lindell

Black Friday marks the unofficial start of the holiday shopping season, and that means hunting for the perfect gifts for those we love.

Below are some gift ideas for loved ones with chronic pain and illness. It’s a gift list you can trust because it’s all based on my own experiences of living with daily pain myself for over a decade.

All of these items also make a great addition to your own holiday wish lists, if you have chronic condition yourself. 

1. Comfy Clothes

The #1 must-have fashion item for people with chronic pain is any clothes that are super comfortable. 

When you have chronic pain, clothing comfort just takes precedent over the latest trends. 

I personally have re-purchased these comfy pants more than 7 times over the last few years. I love how soft they are, and I love that they have pockets! 

But any comfy clothes, from sweat shirts to pajama pants, make a great gift for those with chronic pain. 

Find Women’s Jogger Pants on Amazon 

2. Heated Blanket

There’s nothing better than getting under a cozy heated blanket when you’re dealing with chronic pain. Even if someone already owns one, there’s always a need for one more! 

This heated blanket is my favorite and not only do I own two myself, I’ve also purchased it as a gift for loved ones over the years. And all of them always come back to tell me how much they love it! 

Find this Heated Blanket on Amazon

3. Reminders of Your Love

Little trinkets like a keychain can be a great way to give a constant reminder of your love for someone. Every time they see it, they can think of how much you care about them. 

This keychain features the phrase, “May you always have one more spoon.” It’s a reference to the Spoon Theory, which uses spoons to illustrate the limited energy that people with chronic pain and illness often have. 

It doesn’t have to be a key chain though. A special coffee mug or a bracelet can also make great gifts! 

Find the Spoon Theory keychain on Amazon 

4. Lego

Of course, it doesn’t have to be Lego specifically, but any sort of home-based hobby activities are great for people with chronic pain. 

I personally love this Lego Cat because I’m a huge cat person as well as a huge Lego fan. 

But you can also get your loved ones art supplies, crafting tools, or any other projects they can work on at home.

And bonus points if they can do it from the couch on bad pain days. 

Find the Lego Tuxedo Cat on Amazon 

5. A Good Book

Some days, a pain flare means I don’t have the energy to do anything other than read a book. So having good ones around that I know a loved one recommends is always welcome! 

I recently read The Frozen River by Arial Lawhon, and I really enjoyed the cozy winter setting and completely immersive 1700s plot. 

But you can really buy any book that you’d recommend to share as a gift with your loved ones. 

Also be sure to check out PNN’s holiday reading guide, which has books to help you better understand and treat many chronic pain conditions.  

Find The Frozen River on Amazon 

6. Bread Machine

While a bread machine may not seem like a gift typically associated with chronic pain, it’s actually perfect.

A good bread machine makes it super easy to whip up homemade bread, even when you’re also dealing with a pain flare. You just toss the ingredients in, hit start and presto! A perfect loaf of homemade bread!

It’s also great for anyone on a restrictive diet, since you can easily customize the ingredients. There’s even a setting for a gluten-free loaf! 

Find the Bread Machine on Amazon 

7. Gift Cards

Of course, when in doubt, it’s always a good idea to go with a gift card, especially if you’re shopping at the last minute — because the cards can be instantly delivered via text. 

That way your loved one is guaranteed to get the perfect holiday gift, because they pick it out themselves!

Happy shopping this holiday season!

Find Gift Cards on Amazon

We hope you have happy holidays, and many low pain days in the year ahead! 

PNN makes a small commission, at not additional cost to you, on items purchased through Amazon. 

Does Mindfulness Really Help with Chronic Pain?

By Neen Monty

“Mindfulness” is one of those words that’s been stretched so far it’s almost lost its meaning. We’re told it will calm our nerves, ease our pain, and maybe even transform our lives. 

But what is mindfulness, really? And what can it actually do for people living with chronic pain?

The popular definition goes something like this: Mindfulness is the practice of focusing your awareness on the present moment, without judgment.

Does that make sense to you? It didn’t make sense to me the first time I heard it. It sounds so simple… but it’s not so simple to do.

Most people think mindfulness is meditation. It’s not. Mindfulness is a state of awareness, a way of relating to your thoughts and sensations, while meditation is a tool that helps you develop that state. Meditation is how we practice mindfulness, the training ground for the skill of self-awareness.

Clear? As mud…

Okay, let me try again. At its core, mindfulness rests on two ideas:

1. Paying attention to the present moment.

2. Doing so without judgment.

That second part is the hardest. It can take a lot of practice. But in practical terms, living mindfully is living in the present moment. It’s not wasting time worrying about a future that may never happen, or dwelling on a past that can’t be changed.

The Difference Between Pain and Suffering

Let’s use pain as an example. Being mindful doesn’t mean ignoring pain or pretending it’s not there. It means noticing it: “I feel pain right now” and stopping there.

What we usually do next is the problem: “Oh no, it’s back. The pain is so bad! It’s going to get worse. I can’t take this anymore.”

Those thoughts are the suffering part. They layer emotion, fear, and meaning on top of the physical sensation of pain.

Mindfulness helps peel that layer away. Pain still hurts, but without the extra story, the extra worry, the panic, the hopelessness and the emotional response. It’s just pain.

Pain then becomes something we can observe, without emotion, rather than something that swallows us whole. This distinction isn’t just philosophical. Brain imaging studies show that mindfulness changes the way we process both thoughts and sensations.

Meditation strengthens brain regions that regulate attention and emotion, such as the prefrontal cortex and anterior cingulate cortex, while reducing reactivity in the amygdala, the brain’s alarm system. Other reviews confirm that meditation produces measurable neurobiological changes that are associated with greater emotional stability and self-regulation.

Over time, meditation helps the mind become less reactive. We learn to notice sensations, thoughts, and emotions without immediately trying to fight or fix them. 

Instead of launching into fight or flight, we remain calm and in control. Meditation, in that sense, is kind of the laboratory in which mindfulness is trained.

The Limits of Mindfulness

Does mindfulness cure pain? No. It does not.

Systematic reviews and meta-analyses find that mindfulness training has only small effects on pain intensity. What it does reduce is distress — the anxiety, fear, and emotional turmoil that often surrounds chronic pain.

That distinction matters. Mindfulness was originally designed as a treatment for stress and anxiety. And therefore, its benefits for pain are more indirect. It helps people who are fearful of pain or overwhelmed by it, to regulate their emotions and cope better.

But, if you’re already calm and accepted your pain without fear, mindfulness won’t make the pain go away. It won’t have much effect at all on your pain.

Most importantly, mindfulness is not a treatment for severe pain. You cannot be mindful and you cannot meditate, when you’re in severe pain. Mindfulness is not an intervention for 8 or 9/10 pain. That’s pure cruelty. I would even call that medical negligence.

Mindfulness is a treatment for fear and anxiety in the setting of chronic pain. In that sense, mindfulness may be helpful for someone in mild to moderate pain, where there is a lot of negative emotion surrounding that pain – such as fear, anxiety and catastrophising.

Mindfulness is a psychological tool, a treatment for fear and anxiety that’s been repurposed for pain. 

And often oversold as something it’s not.

Why Mindfulness Is Still Worth Trying

Even within those limits, I still believe mindful living is the best way for me to live. It doesn’t make my pain stop. My pain is caused by disease, pathology and biology, not by anxiety or fear.

Mindfulness does make my days quieter. It keeps me from being dragged into fear or frustration. I don’t worry about the future and don’t dwell on the past. Mindful living keeps me grounded. In the present moment. Because that’s where life is happening – the here and now.

That’s what mindfulness is, living in the present moment.

Mindfulness won’t fix what’s broken in the body. Mindfulness cannot fix pathology. But it can help restore what pain often breaks in the mind: calmness, control, and your sense of peace in the middle of chaos.

And sometimes, that’s enough.

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.”

5 Tips for Surviving the Holiday Season with Chronic Pain

By Crystal Lindell

The holiday season kicks off this week, but for people with chronic pain, this time of year can be difficult to navigate. 

Below are some tips for surviving the season while also dealing with chronic pain and illness. You can trust that they actually work, because all of them are gleaned from my own experiences of surviving the holidays while dealing with chronic pain myself.  

1. Check Your Pharmacy Schedule

A lot of pharmacies are closed on holidays or they close early, so if you have refills scheduled on those days, it’s best to plan ahead. Make sure you know when they are open so you can get your medications.

If you have a refill scheduled for a day when your pharmacy is closed, you may want to ask your doctor if they can send in any refill prescriptions the day before the holiday.

In my experience, a lot of doctors are surprisingly accommodating about this. Of course, if they refuse, you can ration out your medication a little so that you have enough to cover the holiday.  

2. Embrace Pre-Made Food

One of the most draining tasks over the holiday season is cooking. So, I highly recommend embracing pre-made food options.

Whether that means grabbing pre-made sides from the grocery store or ordering a fully prepared holiday feast from a local restaurant, outsourcing the labor of cooking can be a huge help if you have chronic pain.

Obviously though, buying pre-made food does usually cost more than cooking from scratch, but if you’re really in a pinch, I do have one more suggestion: Order takeout.

Fast food is usually inexpensive and quick, which means you’ll have more time and energy to actually enjoy the holiday season with loved ones.

Later, when you look back on those memories, it won’t matter if dinner was tacos or chicken wings, as long as you were all together. 

3. Include Rest Days in Your Holiday Plans

If you have multiple family functions to attend, try your best to plan days of rest into your schedule. 

Put “Rest” on your calendar as though it were any other required activity. And if it conflicts with other events, don’t be afraid to say that you just can’t make it. 

I know that saying “no” is easier to suggest than actually accomplish, especially when it comes to family. So if you do get pressured into doing multiple events in a row, just do your best to schedule an equal number of guilt-free rest days afterward. Emphasis on the “guilt-free.”

For example, if you have plans on Christmas Eve and Christmas Day, try to use Dec. 26 and Dec. 27 to recover. And I don’t mean, spend those days cleaning up, I mean actual rest.

When you’re dealing with chronic illness, providing your body with rest is just as important as providing food. 

4. Wear Compression Socks on Long Trips

Swollen feet and ankles are a common side effect of both chronic illness and many prescription medications.

So, if you’re traveling this holiday season — whether it’s a three-hour flight or a one-hour drive — I highly recommend wearing compression socks during your trip. Aside from preventing swelling, they can also help prevent dangerous blood clots.

5. Use Gift Bags

Wrapping gifts is a lot more time consuming than people usually like to admit, so do yourself a favor and just use gift bags instead. And save the ones you get, so you can reuse them next year.

Gift bags don’t have to be expensive either. If you head over to Dollar Tree, you can find a wide assortment of gift bags for just $1.25 each. 

The holiday season can easily turn into a series of stressors and pain triggers, but if you plan ahead and allow yourself some grace, you still can enjoy it — even with chronic pain. 

Winter Taught Me a Better Way to Cope with Chronic Pain

By Crystal Lindell

We’ve already had our first snowfall here in northern Illinois. Regardless of the official day winter begins next month, the first snow marks the start of winter for us.

And when you have chronic pain, the season brings with it cursed gifts, offering both a time of guilt-free rest and more days of ache.

During the summer, there’s a guilt that accompanies any days spent inside, even if you’re doing it because your pain is too intense to allow for anything else. Watching TV all day makes me feel like I am personally wasting the warm weather and sunshine.  

But that is not the case in winter. Instead, the long nights and cold days allow me to embrace the comfort of staying in, curled up under layers of blankets. 

I already have my Christmas tree up, and the warm glow makes being a couch potato seem almost magical.

And since the sky turns midnight blue at 5 pm, it suddenly feels almost natural to go to bed early. 

These are things my chronic pain-riddled body enjoys year-round. But in the winter, societal expectations allow me to indulge in the impulse to take full rest days or even rest weeks, without feeling the summertime angst about it.

The change in seasons also brings with it lots of changes in barometric pressure, which means all those cozy evenings come with a downside.

My body always knows when it’s about to snow, or sleet or both. It also feels every temperature change as it happens. Anytime it goes from -10 degrees to 40 and back again, my ribs feel it. 

The result is often multiple days spent with the type of excruciating pain that barely even responds to opioid pain medication.

Over the years, I have found that the only treatment that works for those pain flares is to accept them. I can’t stress myself out about it, because it only serves to escalate the pain. So I have to try to stay as calm as possible. My body can’t handle activity under those circumstances.

Which brings me back to those guilt-free rest days that winter supplies in ample amounts. And embracing things instead of trying to fight them.

Growing up in the Midwest, I was often taught that winter was a season to be fought and denied. Just a few months that we all had to endure until the “real” weather came back. Most people here spend the winter complaining, cursing, and just trying to survive.

A few years ago, I took a trip to Montreal, Canada in January, and witnessed an entirely different approach. Despite the fact that the holiday season was well behind us, the city was filled with winter festival activities, ice statues, colorful lights, and just a general sense that the dark and cold days were actually a good thing.

The experience has since shaped my own approach to the coldest months of the year. I do my best to appreciate the gifts that gray days and eternal nights bring. It’s a time for all of us to rest, refocus, and embrace the downtime the cold weather affords us.

Embracing pain has the same effect. When you learn to let it exist, it is paradoxically easier to keep it confined to smaller flare ups.

Weather forecasters predict many of us are in for a particularly harsh winter this year, with more snow and colder temperatures. 

But that doesn’t mean it has to be a slog.

When we take the winter season as it is, it can bear its gifts of rest and time. And who among us doesn't need more of both?

Chronic Pain Raises Risk of High Blood Pressure

By Pat Anson

Having untreated or poorly treated chronic pain is known to raise the risk of serious health problems, including high cholesterol, elevated pulse, arteriosclerosis, and heart attack..

So it should come as no surprise that chronic pain also increases the risk of high blood pressure, according to a new study by the American Heart Association, which found that the extent and location of the pain may determine the level of risk. 

Someone with chronic widespread body pain, for example, has a 74% higher risk of developing high blood pressure; while chronic headaches are associated with a 22% higher risk and chronic back pain has a 16% higher risk.

“The more widespread their pain, the higher their risk of developing high blood pressure,” said Jill Pell, MD, Professor of Public Health at the University of Glasgow in the UK and lead author of the study published in the journal Hypertension.

“Part of the explanation for this finding was that having chronic pain made people more likely to have depression, and then having depression made people more likely to develop high blood pressure. This suggests that early detection and treatment of depression, among people with pain, may help to reduce their risk of developing high blood pressure.”

Pell and her colleagues analyzed over 13 years of health data from more than 200,000 adults enrolled in the UK Biobank Project. Participants completed a baseline questionnaire that asked if they had experienced pain in the last month that interfered with their usual activities. 

They also noted if the pain was in their head, face, neck/shoulder, back, stomach/abdomen, hip, knee, or all over their body. If they reported pain, they indicated whether pain persisted for more than three months.

Depression was measured based on participants’ responses to questions about the frequency of a depressed mood, disinterest in activities, restlessness or lethargy. Inflammation was measured with blood tests for C-reactive protein (CRP).

At the end of the study period, nearly 10% of all participants developed high blood pressure, which is considered a blood pressure measurement higher than 130/80 mm Hg or 140/90 mm Hg.

Compared to people with no pain, people with short-term acute pain had a 10% greater risk of high blood pressure, while those with chronic localized pain had a 20% higher risk.

When comparing sites of pain, there was a wide variation in risk levels:

• 74% higher risk for chronic widespread pain

• 43% higher risk for chronic abdominal pain

• 22% higher risk for chronic headaches

• 19% higher risk for chronic neck or shoulder pain

• 17% higher risk for chronic hip pain

• 16% higher risk for chronic back pain

Depression and inflammation accounted for 11.7% of the association between chronic pain and high blood pressure.

The findings highlight the need for good pain management to prevent or reduce the risk of hypertension and other health problems.

“When providing care for people with pain, health care workers need to be aware that they are at higher risk of developing high blood pressure, either directly or via depression. Recognizing pain could help detect and treat these additional conditions early,” Pell said.

Pain Relievers Can Cause High Blood Pressure

Another consideration is the need for further studies on the role of pain medicine in high blood pressure. Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure and worsen pre-existing hypertension. They can also interfere with the effectiveness of some blood pressure medications. 

The effect is more pronounced with some NSAIDs over others. Aspirin, for example, appears to have less effect on blood pressure than naproxen, which can cause the body to retain salt and water, leading to fluid buildup and hypertension. 

Opioids can cause both low and high blood pressure, depending on the dose and duration of use. Sudden discontinuation of long-term opioid use is associated with increased blood pressure

“Chronic pain needs to be managed within the context of the patients’ blood pressure, especially in consideration of the use of pain medication that may adversely affect blood pressure,” said Daniel Jones, MD, Dean and Professor Emeritus at the University of Mississippi School of Medicine.

One limitation of the study is that participants were middle- and older-aged adults who were mainly white and of British origin – therefore the findings may not apply to people from other racial or ethnic groups, or who live in other countries.

Other contributing factors is that participants reporting pain were more likely to be women, have an unhealthy lifestyle, larger waists, higher body mass index (BMI), more long-term health problems, and live in areas with higher unemployment, lower home and car ownership, and more overcrowding.

Opioid Prescribing Down Significantly for U.S. Nursing Home Residents

By Pat Anson

Opioid prescribing to U.S. nursing home residents declined significantly over the past decade, the latest sign that efforts to limit access to opioid medication are impacting patients who need them for pain relief.

Researchers at University of California San Francisco (UCSF) looked at health data for nearly 3 million Medicare beneficiaries and found that the likelihood of nursing home residents receiving a prescription opioid fell from 48% in 2011 to 33.5% in 2022. 

The chances of a resident receiving a high daily dose above 50 morphine milligram equivalents (MME) also declined, from 25.1% to 21.9%. 

Over half of nursing home residents have chronic pain from arthritis, osteoporosis, degenerative disc disease and other age-related conditions. The average age of residents in this study was 84.

“We weren’t expecting to see a decline, especially for people who are actually reporting high incidence of chronic pain,” first author Ulrike Muench, an associate professor at UCSF School of Nursing, told the San Francisco Chronicle. “It might be a good thing that opioids are used less, but at the same time it raises concerns about potentially untreated pain for individuals who are in need of pain medications.”

The study is believed to be the first to examine opioid prescribing to nursing home residents after the release of the CDC’s 2016 opioid guideline. Although that voluntary guideline was intended only for patients being treated for chronic pain by primary care providers, it essentially became the default guideline for all patients and doctors of every specialty.

Opioid prescriptions to nursing home residents were falling even before the CDC guideline was released, with the decline affecting every racial and ethnic group. 

Opioid Prescribing to U.S. Nursing Home Residents

JAMA INTERNAL MEDICINE

“These reductions parallel national patterns in primary care and may reflect implications of opioid-related policies, such as the 2016 Guideline, extending beyond their intended setting. Some residents may have benefitted from opioid reductions, but others may face barriers to adequate pain control,” researchers reported in JAMA Internal Medicine.    

“We also observed that minoritized residents were consistently less likely to receive opioids and higher daily MMEs, suggesting that prescribing decisions may not be based solely on clinical need.”

White nursing home residents were significantly more likely to be prescribed an opioid for pain than residents who are Black, Hispanic, Asian or Native American, even though minority residents are more likely to have severe pain.   

Previous studies have also documented declines in opioid prescribing to cancer patients, as well as seriously ill patients in palliative or hospice care  – groups that were supposed to be exempt from the CDC guideline.

Eli Lilly Abandons Another Experimental Non-Opioid Pain Reliever

By Crystal Lindell

Eli Lilly's experimental non-opioid pain medication – named LY3857210 – had lackluster results in clinical trials, the latest setback for Big Pharma in developing alternatives to opioid analgesics.  

The pharmaceutical company told Fierce Biotech that the oral medication, which is a P2X7 inhibitor, "did not meet our high internal bar for success and is being removed from the pipeline for pain."

P2X7 inhibitors are being studied for their potential to relieve chronic pain and cancer-related pain by inhibiting inflammation and nerve signaling. 

But when Lilly tested LY3857210 in Phase 2 trials on patients with osteoarthritis and diabetic neuropathic pain, it performed no better than a placebo in relieving pain. 

The company originally purchased licensing for the drug from Asahi Kasei Pharma in 2021 for $20 million. The Japanese pharmaceutical company had already put the drug through Phase 1 testing when Eli Lilly stepped in.

Although it did not prove to be helpful for pain, Lilly said they were still exploring other uses for it.

In August of this year, Lilly also halted development of mazisotine, another non-opioid pain medication it was developing. Mazisotine blocks pain signals in peripheral nerves, but also had disappointing results in Phase 2 trials.

Lilly is still focused on finding non-opioid pain treatments. In May of this year, the company acquired SiteOne Therapeutics in a deal worth as much as $1 billion. At the time, SiteOne said it was “dedicated to the development of safe and effective pain therapeutics without the significant addiction potential and side effects of opioids.”

SiteOne had been working on a new class of non-opioid medications that target sodium channels in the peripheral nervous system to treat pain and other nerve conditions. Blocking pain signals in peripheral nerves before they reach the brain means the drug theoretically is less likely to lead to addiction or overdoses.

But that approach to pain relief has had mixed results. In August, Vertex Pharmaceuticals halted development of a drug called VX-993 after disappointing results in clinical trials.VX-993 is another non-opioid that blocks pain signals in peripheral nerves, but when given to patients recovering from bunionectomy surgery, it was only slightly more effective than a placebo.

VX-993 is similar to Journavx (suzetrigine), a non-opioid developed by Vertex that also works on peripheral nerves. Journavx was approved by the FDA in January to treat moderate to severe acute pain, despite results in clinical trials that showed it was no more effective than Vicodin.

Opioid Prescribing Falls in Canada, But Are Patients Better Off?

By Pat Anson

The number of patients prescribed opioids for pain in Canada has fallen over 11% in recent years, according to a new study published in the Canadian Medical Association Journal (CMAJ). The decline reflects trends in the U.S. and other Western nations, which adopted stronger guidelines to discourage opioid prescribing nearly a decade ago.

Like most studies of its kind, the new research only looked at the number of opioid prescriptions that were dispensed, and did not evaluate the health or quality of life of Canadian patients after access to opioids was reduced, or whether their pain improved using non-opioid pain therapies.

In 2022, about 1.8 million Canadians began taking an opioid to manage pain for the first time, 8% less than when the study period began in 2018.

“Our study provides valuable information on the progressive decline of prescription opioid dispensing for pain and high-dose initiations among new users, as well as the types of opioids prescribed and important geographic differences in these trends across Canada,” wrote lead author Nevena Rebić, PhD, a clinical researcher at Unity Health Toronto.

“Our findings suggest that national efforts to promote opioid stewardship and safer opioid prescribing for acute and chronic noncancer pain over the past decade have had an impact.”

“High-dose initiations” were defined as daily dosages that are above Canada’s recommended dose of 50 morphine milligram equivalents (MME) or lower. Less than 20% of new prescriptions in Canada exceeded 50 MME. Over half of the opioid prescriptions were for codeine.

Patients most likely to be prescribed an opioid were females, older adults, rural residents, and those living in lower-income areas.

Manitoba consistently had the highest rate of opioid prescribing, while British Columbia had the lowest among the six provinces that were studied. The lower rate in BC is somewhat surprising, given the province’s reputation as the being the epicenter of the “opioid crisis” in Canada.

Monthly Rate of Opioid Prescribing in 6 Canadian Provinces

SOURCE: CMAJ

Rebić and her colleagues cautioned that “ongoing monitoring is needed” to ensure that pain patients are not left suffering from inadequate pain management, rapid opioid tapering or discontinuation, or that they turn to street drugs for relief. The authors acknowledge that has occurred “in some cases,” without exploring the severity of the problem.

“If the (opioid) pain prescribing is better, then why do we still get letters from patients in extreme pain telling us they were cut off, tapered or refused medical care?” asks Marvin Ross of the Chronic Pain Association of Canada (CPAC), which has long criticized Health Canada and the authors of Canada’s medical guidelines for discouraging the use of opioids.

Ross said the new analysis of opioid prescriptions was “a waste of time, money and effort,” and called the researchers “inane pill counters” who lack clinical experience with patients.

“The purpose of prescribing a pill is to help the patient get better or to ameliorate their symptoms, so saying we prescribed 10% fewer pills tells you nothing about that. To focus on the number says nothing about achieving prescribing goals unless you begin from the bias that prescribing any of it is bad,” Ross told PNN in an email. 

In a commentary on the study also published in CMAJ, an anti-opioid activist claimed that addiction and other potential harms of opioids are being overlooked by Canadian doctors who still prescribe them too freely.

“Most clinicians have seen first-hand how well opioids can work when first given. But they are at their pharmacologic best in the initial days of treatment. Continue them for weeks, months, or years and the calculus becomes progressively less favourable,” wrote David Juurlink, MD, a clinical internist at Sunnybrook Research Institute, and a member of Physicians for Responsible Opioid Prescribing (PROP).

“In this way, opioids transition from effective analgesics to drugs required primarily to stave off a withdrawal syndrome they themselves created.”

According to a recent analysis by Health Canada, only 18% of fatal opioid overdoses in Canada in early 2025 involved a pharmaceutical opioid. The vast majority of deaths were linked to illicit fentanyl, fentanyl analogues, and other illicit opioids such as heroin.