Where Pain Research Is Headed and Why I’m Hopeful

By Dr. Lynn Webster

If you live with pain, you’ve probably heard promises that “something better is coming.” At this month’s Pain Therapeutics Summit in San Diego, you could see that promise taking shape. For two days, clinicians, scientists, companies and advocates compared notes on what’s working, what’s not, and what’s next.

Threaded through much of it was the National Institutes of Health’s Helping to End Addiction Long-Term (HEAL) Initiative -- an NIH-wide push launched in 2018 to accelerate better pain care and reduce opioid-related harms.

HEAL exists because of the opioid crisis; Congress gave NIH an initial $500 million in fiscal year 2018 to jump-start a coordinated research plan, and the NIH has since invested several billion dollars to keep the effort moving. In other words, HEAL is a rare silver lining: a tragedy spurring a sustained, practical response.

(The HEAL Initiative was not directly hit by any funding cuts in 2025. However, the Trump administration has proposed cutting the NIH budget by 40% next year, which could potentially impact HEAL funding.)

Since its launch, HEAL has grown into a national engine for discovery. NIH reports a cumulative investment approaching $4 billion, supporting more than 2,000 projects across all 50 states, and helping advance 40-plus new drugs and devices to FDA investigational status.

This is a sign that the pipeline is broader and closer to patients than it has been in years. Think of HEAL as scaffolding: trial networks, shared data standards, and coordinated teams that help good ideas climb faster from lab to bedside.

A decade ago, analgesic research often looked like isolated bets. Today, it feels more like a coordinated campaign. That doesn’t guarantee success, but it raises the odds that something useful will reach doctors and patients.

Just as important, what’s coming isn’t a single “miracle drug” but a wider toolkit. You’ll see more non-opioid medicines designed around the biology of different pain types; safer use of existing tools that can lower the need for higher doses when opioids are used; devices and neuromodulation approaches that calm overactive nerves or brain circuits; smarter drug delivery systems that make treatments last longer or act locally at lower doses; and digital health that captures how people actually live -- including their sleep, activity, and pain flares -- so that care decisions track real life, not just clinic visits.

The studies themselves are changing, too. Many people don’t have just one pain condition; they have overlapping problems. Newer trials are beginning to mirror that reality and to focus on outcomes you can actually experience -- walking farther, sleeping better, and participating more in life -- rather than only chasing a number on a pain scale.

Researchers are also building better signposts, such as biomarkers and other objective measures, to predict who will benefit from which therapy and who may be at risk of long-term pain after injury or surgery.

Signposts aren’t a substitute for what people tell us about their pain. In research and development, objective measures help compare treatments and identify who is most likely to benefit. Once a therapy reaches the clinic, those measures become guides, not verdicts, and should be read alongside the patient’s narrative so that care reflects how the person actually lives and feels.

HEAL has made these shifts a priority by funding large, practical datasets and endpoints that regulators and payers can use.

Here’s the clear-eyed part: many of the drugs and devices discussed at meetings like this will not make it past the investigational stage. That’s how science works. But when trials are well designed and data are shared, today’s misses can more quickly lead to tomorrow’s wins -- and the lessons won’t vanish into a file drawer.

Some analgesic candidates will cross the finish line, and even modest gains -- better sleep, fewer flares, less brain fog, or an extra hour of activity -- can change a life. Across millions of people, small wins add up to something transformative.

What does this mean if you’re living with pain right now? Expect more choices and more personalization. Conversations with your clinician may start to include options that didn’t exist a few years ago, and you may hear about clinical studies built around everyday life rather than rigid clinic schedules. If a trial is a good fit, participating in one will help move the field forward.

Most of all, there’s a reason for hope that is grounded in real progress, not hype.

None of this happened by accident. The NIH HEAL Initiative has been the engine behind much of it -- steady funding, coordination, and a focus on solutions that reach the bedside. Keeping that engine running is how promising ideas become practical relief.

Lynn R. Webster, MD, is a pain and addiction medicine specialist and serves as Executive Vice President of Scientific Affairs at Dr. Vince Clinical Research, where he consults with pharmaceutical companies.

Dr. Webster is the author of the forthcoming book, “Deconstructing Toxic Narratives -- Data, Disparities, and a New Path Forward in the Opioid Crisis,” to be published by Springer Nature. Dr. Webster is not a member of any political or religious organization.

5 Ways to Support a Loved One With Chronic Pain

By Crystal Lindell

Recently I wrote that one of the most important things you need to enjoy life with chronic pain is supportive loved ones.

But what does that look like in practice?

Below are some tips on how to realistically help loved ones who deal with chronic pain.

And if you’re the person in pain reading this, perhaps you can pass this on to your friends, family and other loved ones. Afterall, sometimes getting advice from a third party can help it land better.

Also, of course, if you have your own tips to share, we’d love to read them in the comments!

1. Keep in Touch With Them

If you care about someone with pain, maybe the most important thing you can do is to just stay in contact with them.

Having chronic pain makes it difficult to attend in-person events, but that doesn’t mean we lose the need for human connection. In fact, it just makes that need much stronger.

Sometimes friends fall off because they don’t see you as often, but other times it’s because they don’t want to have to talk to someone with chronic health issues. Those conversations can force them to face the fact that their own body is also fragile and mortal.

But if you actually care about someone, I encourage you to push past all that.

Texting and phone calls can be a lifeline for people with chronic pain — as can in-person visits.

Your interactions with them may be the majority of human interaction they have, and it can be enough to keep them going for another day.

2. Give Them Meals and Help with Chores

When I first started having chronic pain, one of my friends did one of the nicest things anyone has ever done for me – either before or since. She drove 2 hours to come visit me and then cleaned my entire apartment, including the bathroom.

It is not possible to express how grateful I was and how much of a difference that made in my ability to keep going through one of the darkest times in my life. Just having a clean space to exist was like having a weight lifted off my very painful ribs.

While healthy people can take for granted the ability to do daily household tasks like cooking meals and doing the dishes — a person with chronic pain knows how easy it is to fall behind on those things.

And when that happens, on top of the stress of dealing with a broken body, you also have to deal with a messy house. That can come with a lot of guilt and even physical discomfort.  

So, if you’re able to help them with housework in any capacity, that can also lift a truly heavy burden.

Having someone make or drop off meals once a week, or even once a month can also be a massive help. There’s also the option of sending meals with services like DoorDash or Uber Eats, or giving them food delivery gift cards.

It may seem like cooking and cleaning for someone is no big deal, but when you do it for someone with chronic pain, it can be as helpful as the best medication.

3. Don’t Be Offended If Someone Needs Rest

I need more sleep than the average person, I assume because my body is using so much energy to just exist with chronic pain. I also need more time to recover after big events like parties.

It can mean that I can’t respond to calls or text, and that I need a lot of time alone to sleep and rest.

But even my most well-meaning loved ones can take this need for rest as some sort of indictment — as though I just don’t want to be around them or to interact with them.

It’s not about them though, it’s about me and my defective body.

If someone you love has chronic pain and they need a nap, or a couple days to respond to a text, don’t take it personally. It probably just means they needed some extra rest.

4. Go to Doctor’s Appointments With Them

Chronic pain can make it more important than ever to have productive doctor appointments — but it can also make that task more difficult.

That’s why having a loved one attending doctor’s appointments with you is truly invaluable.

A second person being there to focus on what the doctor is saying and to ask questions on your behalf can mean the difference between finding treatments that actually work or not.

It also usually makes doctors take a patient more seriously when they know that a loved one is keeping tabs and will be holding them to account for their treatment outcomes.

So, if you’re able to go to doctor appointments with your loved one with chronic pain, I highly recommend doing so.  

5.  Be Accepting of their Use of Pain Medications

A lot of people face stigma for using pain medications, especially opioids.

But oftentimes, pain medication can become a point of friction between patients and loved ones, who don’t fully understand the importance of alleviating chronic pain.

Other people’s pain is always easy to endure, so it’s always easy to tell someone else that they don’t need to treat their pain.

While loved ones who say such things are usually well-meaning, those conversations can cause a lot of unnecessary stress for people in pain.

It’s best just to assume that if someone is using pain medication, then they need that pain medication.  

In the end, the best advice for supporting a loved one with chronic pain is to treat them how they want to be treated. And to accept that whatever they are going through is at least as bad as they are describing.

When you approach help from that mindset, you’ll often naturally find the best ways to support them.

Having support from loved ones can mean the difference between being able to endure a life with chronic pain or not. It’s just as important for their health as a good doctor is, and it can have just as much impact. 

3 Things You Need to Enjoy Life, Even With Chronic Pain

By Crystal Lindell

If you want to enjoy life again while also living with chronic pain, you need just three things.

1. An effective pain medication.
2. The ability to pace your activity level
3. Supportive loved ones

If you have all three of those things, it’s very possible to enjoy life while also enduring chronic pain. In fact, you could have a very happy life even with severe, debilitating pain every single day.

Unfortunately, of course, many chronic pain patients do not have all three of those things.

Even if they have access to opioids and other pain medications, they may not have the option to pace their activity levels due to things like work and parenting commitments. Or they may not have loved ones who show sympathy for what you’re going through and offer accommodations to make your life easier.

Sadly though, most doctors don’t recognize the importance of having all three things when they are treating chronic pain patients.

“Enjoying life” is usually not something doctors measure during treatments or appointments.  

Personally, I don’t think I have ever had a medical doctor ask me how much I’m enjoying life. Rather, they ask you to rate your pain level, and then either ignore you or send you off to another random specialist.

It’s why they don’t value the importance of prescribing pain medications that actually work, and why they rarely offer education for loved ones about how to better support the people in their life who have chronic pain.

It’s also why doctors rarely explain the importance of pacing your activity levels.

While I have had medical doctors tell me to quit working, I’ve had only one psychologist explain to me that instead of fully quitting, I could just cut back on some activities and plan more rest days.

In other words, stop pushing myself to the point of exhaustion before taking time to rest.

I assume that many doctors don’t grasp the concept of pacing, in large part because of their medical training. Residency scheduling makes it so that they are often working 24-hour shifts, with little time to recover before the next one.

In other words, the exact opposite of pacing.

When you have chronic pain, you can’t live that way though. Of course, technically, you can live that way, but you won’t enjoy life if you do.

If you accept the fact that you need to rest your body from time-to-time, you can actually do more activities in the long run.

However, under a capitalist system that prizes work, sometimes that is just not possible, no matter how much you want to pace yourself. In fact, the same applies to the other two things you need to enjoy life: Sometimes doctors just won’t give you pain medication and sometimes loved ones just will not support you.

There is good news though.

Even if you don’t have all three of those things, you can still find some joy in a life with chronic pain, as long as you are very stubborn and tenacious.

You just have to find alternative pain medications, like kratom or cannabis. And insist on creating a life that allows for pacing, whether that means changing jobs or moving in with family to help with daily life tasks. 

Then you have to educate your loved ones on how they can better accommodate you – and be prepared to pull back if they are mean or rude about it.

When I first developed chronic pain, I genuinely thought life was not worth living. That was more than a decade ago, and I’ve experienced countless joys since then: trips to Europe, meeting the love of my life, getting cats, and hugging my new niece.

Not to mention all the little joys, like fresh baked bread, cozy heated blankets on a cold winter night, and getting lost in a corn maze with my family.

I am very lucky to now have effective pain medication, a life that allows for pacing, and supportive loved ones. But I didn’t start that way. I rearranged my priorities to make it so. And it is possible that you can do the same.

You just have to stop trying to fight the pain, and instead learn to accept it. Then you can be free to live your life, while finding as many joys as you can along the way. 

Two-Thirds of Chronic Pain Patients Eat Comfort Foods to Help Them Cope

By Pat Anson

A slice of apple pie or a bowl of ice cream are comfort foods to many people, giving us a mood boost (not to mention a sugar rush) during times of stress, loneliness or anxiety.

For many people with chronic pain, comfort foods are also a way to cope and distract during pain flare-ups. A small study in Australia recently found that over two-thirds of people with chronic pain eat to feel better.

“People who live with pain every day need to find ways of coping. We think about medication, physiotherapy or heat packs as pain management strategies, but we don’t usually think about food in the same way. Yet two-thirds of our sample said they turned to food at least once a fortnight when pain flared,” says lead author Toby Newton-John, PhD, a clinical psychologist and Head of the Graduate School of Health at the University of Technology Sydney (UTS).

“Managing daily pain is incredibly tough, and medication often only goes so far. It’s understandable that people reach for something that feels good.”

The study, Eating to Feel Better: The Role of Comfort Eating in Chronic Pain, was recently published in the Journal of Clinical Psychology in Medical Settings.

Newton-John and his colleagues surveyed 141 adults with chronic pain, asking why they turn to food during pain flares. Given a choice of nine possible answers (and being allowed to select more than one) the results show that over half (51.8%) ate comfort foods to “give myself a pleasant experience,” followed by “distract myself” (49.6%) and “reduce my emotions” (39%).

“That was the somewhat unexpected finding,” Burton said in a press release. “Comfort eating wasn’t just for the purpose of distraction or numbing negative feelings, although those were important too. For many, eating comfort foods provided a nice experience in their day and something to look forward to. If you’re living with pain all the time, that moment of pleasure becomes a pretty powerful motivator.”

To be clear, not everyone in pain eats for distraction or pleasure. Nearly one in five (18.4%) said they tend to eat less when in pain, and a fair number said they eat as usual (11.3%), whether they’re in pain or not.

The frequency of comfort eating ran the gamut from multiple times a day (14.2%) to several times a week (19.9%), to never (18.4%).

The survey did not ask participants what foods they ate, but researchers believe pain can trigger cravings for certain foods.  

“There may also be a biological explanation. Research shows high-calorie foods can have a mild pain-relieving effect. Even in animal studies, rats in pain will seek out sugar. It seems it’s not just psychological. It's possible that there is a real analgesic property to these foods as well,” said co-author Amy Burton, PhD, a lecturer in Clinical Psychology at the UTS Graduate School of Health.

But eating for comfort comes at a cost. Nearly two thirds of participants in the study were obese (29.8%) or overweight (37.6%).  Newton-John warns that food-driven relief can become part of a vicious cycle.

“Short-term, high-calorie food makes people feel better. It reduces pain symptoms and enhances pain tolerance. Long-term, it can fuel weight gain and inflammation, which increases pressure on joints and makes pain worse; and that can trap people in a spiral that’s very hard to break,” he said.

Pain management programs usually focus on medication, physical therapy, and cognitive behavioral therapy. This research suggests a need to integrate diet and nutritional advice into pain management programs.

“We usually teach skills like relaxation, stretching exercises or how to pace activities, but we rarely talk about food in this context,” Newton-John says. “This work shows we need to help people recognise if they’re using food as a pain-management tool and give them alternatives.”

Previous studies have shown that healthy eating can reduce the severity of chronic pain. Regular consumption of vegetables, fruit, lean meat, fish, legumes/beans, and low-fat dairy products can lower pain levels and improve physical function, especially for women.

High fiber diets also reduce the risk of obesity, diabetes and cardiovascular disease, while promoting the growth of healthy bacteria in the gastrointestinal system to slow the progression of arthritis and reduce joint pain.

Ketamine Infusions Safe and Effective in Treating Chronic Pain

By Pat Anson

There are many pros and cons about the therapeutic effects of ketamine. When misused, the anesthetic drug can lead to tragedy – such as the accidental drowning death of actor Matthew Perry. And although ketamine is increasingly used to treat depression and other psychiatric disorders, the FDA “has not determined that ketamine is safe and effective for such uses.”  

Even ketamine’s use as a pain reliever has been challenged, with a recent study finding “a lot of uncertainty” about its effectiveness in treating difficult chronic pain conditions such as Complex Regional Pain Syndrome (CRPS). The authors of that study said they could find “no convincing evidence” that ketamine delivered meaningful benefits to people in pain.

A new study at the Cleveland Clinic debunks many of those findings. After following over 1,000 pain patients who received ketamine infusions, researchers concluded the infusions are safe and effective for people with chronic pain.

“We know millions of Americans are suffering from chronic pain and this research addresses critical gaps in pain management and shows a significant step forward in improving care for those patients who have otherwise exhausted all other treatment options,” said co-author Pavan Tankha, DO, medical director of Comprehensive Pain Recovery in the Cleveland Clinic’s Neurological Institute.

“The findings of the research represent a meaningful step toward improved quality of life and may accelerate access to this treatment option for patients all over the country.”

Tankha and his colleagues focused on outpatients who received low dose ketamine infusions – 0.5 mg/kg over 40 minutes for five consecutive days. Their findings, recently published in the journal Regional Anesthesia & Pain Medicine, show that over 90% of patients completed all five treatment days, demonstrating the feasibility of outpatient infusions.

Although pain relief in most patients “did not reach clinically meaningful thresholds,” up to 46% reported improvements in their pain, daily functioning, sleep, anxiety, depression, fatigue and quality of life. The improvements were sustained over 3 and 6-month follow up periods, with 80% of patients returning for additional infusions, a telling sign the treatment has benefits.

The research also demonstrated that low-dose ketamine has minimal side effects. Hallucinations, the most common side effect, were rare. No serious adverse events were reported by any patients.

“This study provides evidence for ketamine's role in chronic pain management,” said co-author Hallie Tankha, PhD, a clinical pain psychologist in the Cleveland Clinic’s Primary Care Institute.

“This is in line with my clinical experience as a pain psychologist, as patients often describe ketamine infusions as ‘life changing.' I'm encouraged by treatments that can be integrated into comprehensive care approaches, and this study demonstrates ketamine can be safely and effectively implemented in pain management settings.”

Researchers say their findings demonstrate that ketamine infusions can be part of a pain management program, when combined with behavioral therapies and patient education. The findings also give hope to millions of pain sufferers with complex conditions that have not responded to conventional treatment.

“Given the limited evidence for ketamine infusion protocols in chronic pain and existing access barriers, these real-world findings may help inform patients, payers, and healthcare systems about the potential of standardized KIT (ketamine infusion therapy),” researchers concluded.  “Our findings support integration into multidisciplinary pain centers and lay the groundwork for generating evidence needed for policy and coverage decisions.”

Although the FDA has not approved the use of ketamine in treating pain, some professional medical organizations have for certain conditions. The American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, and the American Academy of Pain Medicine have guidelines that support ketamine infusions for CRPS, chronic neuropathic pain and short-term acute pain. 

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.