When a Pain Flare Steals a Special Day

By Crystal Lindell

Sunday was a boringly normal day for me — as someone who deals with chronic pain on a daily basis. 

When I woke up, it felt like someone had replaced my ligaments with concrete and I was being stabbed in the ribs. I limped to the bathroom. And for breakfast, I had four different pain-relieving drugs and a bottle of water.

After that, I laid back down and slept for another three hours.

I got up just long enough to eat lunch, which of course included a side of more pills. I grabbed my pillow and laid down on the couch in the living room, where I slept for another 2 hours.

It was a pretty routine pre-thunderstorm pain flare for me. Thankfully, I was off work, so I was able to spend the day resting.

The only problem was, Sunday was also my fiancé’s birthday.

He loves me. And he also deals with chronic pain. So he was more than happy to hang out with me on the couch all day while we watched bad 90’s movies.

He was also cool with going to pick up the toilet paper we needed and the Chinese food we got for dinner to celebrate his special day.

But I felt like crap about all of it.

I hate that I spent his entire birthday dealing with a pain flare.

He always does the dishes, and I wanted to do them for him on Sunday to give him a break, but I couldn’t. He also feeds all of the cats first thing every morning, and I wanted to do that for him as well. But again, I couldn’t.

He loves going to play basketball at the court behind our house, but I couldn’t do that with him either.

It sucked. All of it.

Eventually, the thunderstorm came, the pain relieving drugs I was taking started working, and I was able to function a little bit – but by then it was 10 pm and my fiancé was ready for bed.

Part of the issue is that I’m also tapering down on 7-OH in anticipation of the upcoming ban. Before the ban was announced, I was able to take as much 7-OH as I needed on bad pain days.

But these days, I have to use it sparingly, if at all.  The goal is to get off of it before the DEA declares it an illegal Schedule One controlled substance. The only thing worse than losing access to 7-OH would be to also have to go off of it cold turkey.

But that means I’m losing days of my life again to pain. Sometimes, it’s just a random Tuesday that I lose, and it’s no big deal. 

But other times, it’s an “August 9th” that I lose – and then I miss out on a special day.

Most Chronic Pain Conditions Never Get Better

By Crystal Lindell

Most chronic pain conditions remain stable over time, with few patients getting worse and even fewer getting better. 

That’s according to a new study in JAMA Network Open that tracked over 1,477 patients with long-term non-cancer pain. The patients were being treated at specialized pain clinics in France.

The researchers used a cell phone app to track patients’ self-reported bodily comfort, sleep, and mood every week for six months. They excluded “pain intensity” from the list of things they tracked because it is "increasingly recognized as an incomplete proxy for the chronic pain experience.”

Most of the participants were middle-aged, overweight, professional women. About a fifth were on sick leave due to pain. 

Most had been dealing with pain for over five years, mainly from conditions like fibromyalgia and musculoskeletal pain. A large majority had a history of other medical conditions, including anxiety, depression and substance use disorders.

The primary medications that patients took were antidepressants, paracetamol (acetaminophen) and antiepileptic drugs; while the main nonpharmacological treatments were neuromodulation and physical therapy. 

The study authors were trying to find ways to predict which patients would improve and which ones may get worse. They hoped to use responses to basic questions at the start of the study, such as age, sex, pain severity and medical history, to help develop models that would predict how patients would fare.

Unexpectedly, most of the patients remained the same throughout the course of the study, with bodily comfort, sleep and mood remaining unchanged. Only 4.1% of patients improved, and just 10.2% got worse.

Researchers concluded that the most realistic outcome for the remaining 85% is to keep them stable. 

"These findings suggest that chronic pain… is better conceptualized as a stable digital state with rare transitions,” the researchers said. “In tertiary care, where patients are referred precisely because prior treatments have failed, preventing further deterioration over 6 months represents a meaningful therapeutic achievement.” 

Ideally, this type of research could be used to help doctors more realistically assess and treat chronic pain. For example, if their chronic pain is stable, patients shouldn’t have to see a pain specialist every four weeks to get their prescriptions renewed. And treatments should focus on keeping patients comfortable.

Sadly though, the results also suggest that most chronic pain conditions are never really cured or get better, even when treated at a specialized pain clinic.

My hope is that we will continue to find treatments and therapies that meaningfully improve chronic pain. After all, in an ideal world, chronic pain would not remain stable – it would go away.

THC and CBD Edibles More Effective at Pain Relief Than CBD Alone

By Pat Anson

Yet another study has found that cannabis products containing both THC and CBD are more effective in treating chronic pain than products made with CBD alone.  

Researchers at the University of Colorado Boulder enrolled 243 people with chronic low back pain to evaluate the pain relieving effects of marijuana edibles over a 14-day period. Participants visited a dispensary of their choice and selected a THC-dominant edible, a CBD-dominant edible, or an edible that contained both CBD and THC.

Of the 243 participants, 97 selected CBD-dominant products, 112 chose THC/CBD products, and only 36 selected a THC-dominant product. They were told to take the edibles as often as they wanted for two weeks.

The study findings, published in the journal Biomedicines, show that pain levels were modestly lower for participants who selected THC-dominant products or edibles containing both THC and CBD. No comparable reduction was reported among those using CBD-dominant products.

After 14 days, the most significant reduction in pain intensity was -14.4% for those who took THC/CBD edibles, followed by THC-dominant edibles (-7.9%), and CBD-dominant edibles (-1.9%).

Because there was no uniformity in the frequency or doses of THC and CBD that participants took, researchers say their findings should be viewed with caution. 

But overall, there was a greater benefit from using products with both THC and CBD, suggesting there is a synergistic effect between the two substances in reducing inflammation, one of the primary causes of chronic pain.

“These findings indicate a complex interrelationship between THC and CBD, with THC-associated reductions in daily pain intensity attenuated by increasing doses of CBD, and products containing both THC and CBD associated with longitudinal reductions in pain intensity,” researchers said. 

“Statistically, the use of CBD-dominant products was not associated with any reductions in pain intensity at the daily or longitudinal levels, and these associations did not change regardless of how often participants used their products.” 

THC (tetrahydrocannabinol) is the psychoactive ingredient in cannabis, while CBD (cannabidiol) is a non-psychoactive compound believed to have health benefits. About 3 times as many participants in the study chose CBD-dominant edibles over THC-dominant ones, suggesting they wanted to avoid sensations of getting “high.”

“Many individuals see CBD as an attractive alternative therapy for mitigating chronic pain compared to THC. This may be the result of CBD not producing the intoxicating effects that are associated with THC. Yet, the use of CBD-dominant products and increasing doses of CBD were not associated with reductions in pain intensity in the present study,” researchers concluded.   

Previous studies of cannabis products have shown that the pain-relieving benefits of CBD alone are minimal, at best. 

A recent review of studies found that cannabis products with relatively high levels of THC provide small improvements in chronic pain, while those with high levels of CBD have minimal or no effect on pain.         

In a 2019 study of self-reported data from over 3,300 cannabis users, researchers said THC was more effective than CBD alone in treating chronic pain, insomnia and other medical conditions. Cannabis products containing higher doses of THC provided the most relief.

Another small study conducted in Israel found that microdosing small amounts of THC significantly reduced pain levels in patients suffering from neuropathy.

Researchers Find Genetic Variants That Increase Risk of Fibromyalgia

By Pat Anson

The origins and causes of fibromyalgia have long baffled patients, doctors and researchers. Over the years, fibromylagia has been blamed on everything from gut bacteria and childhood trauma to a brain disorder and weakened immune system.

Through it all, fibromyalgia remains a poorly understood disorder characterized by deep tissue pain, headaches, fatigue, anxiety, depression and insomnia. Nearly 3% of the world’s population has fibromyalgia, with females making up 75% of cases 

An international team of researchers has now identified over two dozen genetic variants that play a role in the development of fibromyalgia. Their findings, published in Nature Medicine, suggest the nervous system plays an important causal role.

The team analyzed genetic data from more than 2.5 million adults around the world, including 55,000 who had been diagnosed with fibromyalgia. Researchers looked for genetic differences in people with and without fibromyalgia to find the genes that were most common in those with the condition.

This helped them identify genetic variants in 26 regions of the DNA genome that appear to play a role in fibromyalgia’s development. Many of the genes implicated in these regions are involved in brain and nerve function, and are associated with fibromyalgia’s physical and psychiatric traits.

"This work changes how we think about fibromyalgia at a fundamental level. For decades, patients have been dismissed or told their pain is simply psychological. Our findings confirm the condition has a clear biological basis," said co-senior author Michael Wainberg, PhD, an investigator at the Lunenfeld-Tanenbaum Research Institute and Assistant Professor of Psychiatry at the University of Toronto.

Of the 26 genetic variants identified, the one most strongly linked to fibromyalgia risk was within the gene HTT. Different mutations in the HTT gene cause Huntington's disease, a severe, progressive and fatal neurodegenerative disorder.

Further genetic analysis revealed moderate-to-strong positive associations between fibromyalgia and several psychiatric disorders, namely depression, suicidality, ADHD and PTSD. These correlations help explain the high comorbidity between fibromyalgia and these emotional states.

The study also revealed substantial genetic overlap between fibromyalgia and a range of painful conditions, including low back pain, migraine and irritable bowel syndrome. The researchers think shared biological mechanisms within the nervous system may make people susceptible to several of these conditions, explaining why they often appear together.

"We know that chronic pain syndromes cluster together in individuals and families and are genetically similar. Targeting the shared mechanisms underlying them could potentially benefit a whole cluster of disorders," said co-senior author Frances Williams, PhD, Professor of Genomic Epidemiology at King's College London.

"The findings also help us better understand why fibromyalgia so often occurs alongside conditions such as anxiety and depression, bringing us closer to understanding the condition as a whole."

Genetics alone do not determine whether someone develops fibromyalgia. Researchers suspect that even people who carry many of fibromyalgia’s genetic variants require other risk factors, such as arthritis, to trigger fibromyalgia.

"This study provides important new insights into why some people develop fibromyalgia syndrome and identifies biological pathways that could lead to new treatment approaches. One of these pathways is already the focus of drug trials for Huntington's disease, raising the possibility that existing pharmaceutical research could eventually benefit people with fibromyalgia,” said Williams.

Williams and her colleagues have founded the Chronic Pain Genomics Consortium to investigate other chronic pain syndromes, starting with pelvic pain. The consortium sees fibromyalgia as only the beginning of a broader exploration of the landscape of chronic pain conditions.

Palmitoylethanolamide (PEA): A Natural Treatment for Intractable Pain

By Dr. Forest Tennant and Ingrid Hollis 

Palmitoylethanolamide (PEA) is a naturally occurring biochemical produced by the body for pain and inflammation control. It is also available as an over-the-counter dietary supplement. 

This article is presented with our belief that essentially every person with intractable pain should try a PEA supplement in a therapeutic trial.  Several companies market PEA supplements and researchers have determined effective dosages. 

PEA is the only medicinal that simultaneously fights inflammation at the site of an injury, as well as neuroinflammation in the central nervous system (CNS).  It helps heal damaged glial cells that are responsible for intractable or constant pain. 

About two dozen double-blind clinical studies have shown that PEA is more than just a placebo. German researchers say PEA is an effective and well-tolerated treatment for hundreds of patients with chronic pain.    

Our experience is not as extensive, but we have found that about 80% of patients experience good results if PEA is used for four to six weeks, providing relief for both chronic and intractable pain.  In most patients, PEA progressively wears down baseline pain. 

Starting dosage is 600 to 1200 mg twice a day.  This dosage can be increased if needed.  

Some PEA products contain luteolin, a polyphenol found in many fruits, vegetables and herbs that has anti-oxidant and anti-inflammatory properties. This is excellent as luteolin boosts the effectiveness of PEA, and also helps prevent the reactivation of the Epstein-Barr virus. 

One can simply add PEA to their current pain relief program.  Opioids and other pain medications need not be stopped. 

No serious side effects have been reported from taking PEA. As a natural biochemical, it is quite safe to take.  

If you have chronic or intractable pain, try a 1-to-2-month therapeutic trial of PEA. You have much to gain and nothing to lose. 

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

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

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

Non-Opioid Journavx Is Being Prescribed Off Label for Chronic Pain

By Crystal Lindell 

Here’s some news that many pain patients could have predicted: A non-opioid medication recently approved for acute, short-term pain is already being prescribed off-label for chronic pain. In fact, it’s prescribed more often for chronic pain than opioids!

Suzetrigine, which goes by the brand name Journavx, was approved by the Food and Drug Administration in January 2025. Unlike opioids, Journavx blocks pain signals in the peripheral nervous system, not in the brain, so it doesn’t have the same “liking” effects of opioids, which can lead to dependence or addiction.

Developed by Vertex Pharmaceuticals, Journavx was the first new medication for acute pain in over two decades, and is primarily intended for post-operative pain or emergency trauma care. 

But 15 months later, new data published in Epic Research shows that Journavx is often being prescribed for chronic, long-term pain instead.

The researchers studied health records for more than 3.6 million U.S. adults who received a new prescription for either Journavx or an opioid between February 2025 and April 2026.

They found that chronic pain accounted for 33% of the Journavx prescriptions. By comparison, opioids were prescribed just 6.7% of the time for chronic pain.

Opioid prescribing was concentrated in patients who had surgery (48.8%) or acute pain (19.8%), which together accounted for over two-thirds of the opioid prescriptions.

Only 10.2% of the Journavx prescriptions were for surgery and 31.8% were for acute pain.

"Suzetrigine adoption has been concentrated in specialties that manage chronic and surgical pain longitudinally rather than in the acute-care settings where opioids are most commonly initiated," the study found.

The Epic researchers found that patients prescribed Journavx were often older and more likely to be female than patients prescribed opioids. Specifically, 43% of Journavx patients were 65 or older, compared with 31.4% of opioid recipients. 

Off-label prescribing of a medication is perfectly legal and, in some cases, appropriate. But drugs are rarely put through clinical trials for those off-label purposes.

Results from clinical trials suggest that Journavx is a mild pain reliever, at best, for acute or chronic pain.

In Phase 3 clinical studies of acute pain after minimally invasive surgeries, Journavx was no more effective than a low-dose combination of hydrocodone and acetaminophen, more commonly known as Vicodin.

In a Phase 2 study, Journavx was essentially no better than a placebo in relieving chronic back and hip pain caused by lumbosacral radiculopathy.

Journavx is priced by Vertex Pharmaceuticals at a wholesale cost of $15.50 for a 50mg pill. When taken twice a day for acute pain, that works out to $420 for a one-week supply. By comparison, a supply of 100 Vicodin tablets costs about $142.

Journavx is currently only available in an oral formulation, which severely limits its use for post-surgical pain, where injectable or intravenous analgesics are often preferred. 

Chronic Pain Can Happen to Anyone

By Crystal Lindell

There’s this thing about chronic pain that people without it like to ignore: It could happen to anyone.

When you’re still healthy, the very concept of “pain that never ends” feels impossible.

Unfortunately, not only is it possible, it’s likely.

Between injuries, illness, genetics and bad luck, you never know how long you’ll have your health. You could be in a car accident tomorrow that permanently damages your back. You could get cancer and the treatment permanently damages your nerves. You could fall off your bike. Stumble on a Lego. Slip on some ice. 

Suddenly, the body you thought you could count on doesn’t function like it used to. You can’t do the activities you once did, you have no energy, and the medical bills are piling up. Even the concept of time feels different because you’ve lost your stamina and simple tasks take forever.

In an instant, you could lose your job, your social life, and even your personality.  

People spend decades trying to prevent such fates. They eat healthy, stay active, take vitamins, practice yoga -- all in an attempt to avoid the inevitable.  

Perhaps some of those efforts would be better spent making the world a better place for people living with chronic pain or chronic illness. After all, if you know it will likely happen to you, shouldn’t you prepare for the day you will join them?

There are so many ways society could better serve people with chronic pain and illness.

There’s the obvious ones, like universal healthcare and universal basic income. But there are also the things you don’t even notice when you’re still healthy. Things like a better public transit system for when you’re in too much pain to drive. Or government funded food delivery programs for when you’re in too much pain to cook.

There’s also the fight for better pain care. Access to opioid medication or even 7-OH might sound frivolous today, when you’re still walking around in a healthy body. But one day, when you need them, you’ll regret that it took so long for you to care.

I understand why people live in denial about their body’s eventual decline. It’s much easier to get through the day that way. But if you take the time to care about things like affordable healthcare and disability rights today, it will be that much easier to get through your painful tomorrows.

We should be building a world that plans for our bodies to age and get injured, instead of building a world around denial of that fact. It’s only when we truly accept our fate, that we can actually make our lives better.

Banning 7-OH Will Ruin My Life

 By Crystal Lindell

When I got the news that 7-OH will likely be illegal in the United States within the next month, I was on a break at the new job I was able to get because of 7-OH.

I opened my texts to see a message from PNN editor Pat Anson:

“7-OH to be banned nationwide in early August according to DEA filings.”

He’s always been great at breaking news. 

When I saw the words though, I wanted to throw up. I started shaking and was overcome by a cold sweat. Then I fought back tears because I had to get back to work.  

I had to get over the shock and dissociate to get through the rest of my shift at the gas station where I work. I spent the next few hours legally selling customers cigarettes, beer, and lottery tickets. 

Then I went into my car and cried.  

7-OH has truly been a life-changing drug for me and many people I know and love.

I have intercostal neuralgia, which is nerve damage in my ribs. When you have the same thing in your face it’s called trigeminal neuralgia – which is colloquially called the “suicide disease” because so many people who have it kill themselves or want to.

As someone with the intercostal variety, I’m here to tell you that having that kind of pain in your ribs doesn’t make it any less horrible. I have long considered suicide as a potential treatment option.

For many years I was able to find some semblance of stability with a cocktail of opioid and OTC pain medications. I know how lucky I am to be among those who can still get an opioid prescription. But while the opioids have kept the suicidal-level pain at bay, they have never allowed me to actually live.

7-OH does that.

It’s not an exaggeration to say that it has given me my life back. It’s been even more effective than hydrocodone or morphine for me. It instantly treats my pain while also combating fatigue. 

Losing access to 7-OH will be devastating for me. 

I am worried I will no longer be able to work full-time, and that I will then lose the health insurance I only just got. Without work and insurance, I will be back to living below the poverty line, and relying on food pantries. 

But none of that has anything to do with why I think 7-OH should remain legal.

7-OH should remain legal because – as an adult – I should have the legal right to put whatever I want into my own body, and it is no one else’s business how I do that.

That’s it. That’s the only reason needed. Anything else is irrelevant.

This is a bodily autonomy issue. I should be the only one who controls my own body, especially my own medical decisions. 

Not to mention the fact that nicotine and alcohol are legal despite the fact that they are both very addictive and sometimes deadly. Why single 7-OH out? Especially considering how safe it is in comparison to those drugs. 

AKA Betrayal

What’s worse is the outright glee from some leaf kratom advocates, who think banning 7-OH will somehow let them be seen as the golden child.

I feel so betrayed by them. The American Kratom Association in particular pushed for this and they have made a deal with the devil. When 7-OH is banned nationwide, it’s likely that leaf kratom is next. It’s already happened in several states.

I will never again use a single kratom product from any of the companies that support the AKA.

For now, I plan to taper down and hopefully get off 7-OH without going into withdrawal. And I am going to look into different substances that may give me a similar effect. 

I’m also hopeful that the 7-OH manufacturers are working on new formulations of kratom alkaloids that will still be available after the ban. 

And I am clinging to the 1% chance that the DEA backtracks on this, as they did in 2016, after initially announcing plans to make mitragynine and 7-hydroxymitragynine illegal Schedule One drugs. 

I know we cannot count on that though.

Honestly, writing this column feels futile. I know it won’t do anything to stop the ban on 7-OH from coming. But I do feel it’s important to at least create a record of my objections. 

I want it plainly stated that a ban on 7-OH will be detrimental to my life, and to the lives of thousands of others who have found relief from this drug.

But how do I convince people to care about my life? Why do I even have to do so? Shouldn’t caring about other people’s well-being be something that comes naturally?

It’s degrading that I have to beg the world for pain relief. That I have to plead for a medication that allows me to live my life, work a job, care for my cats, love my fiancé, and aid my elderly relatives.

It disgusts and depresses me that we live in a country that would deny me those things.

Chronic Pain Made Kathie Lee Gifford Suicidal

By Crystal Lindell

Kathie Lee Gifford has revealed to People that while struggling with chronic pain, she wanted to die.

The retired singer and talk show host told the magazine that she remembers praying: "Lord, if this is all you have left for me, I want to go home.”

“I wanted to die a few times. I wasn't going to hurt myself. I wasn't going to kill myself. I just didn't want to be here — as blessed as I am," she said.

The 72-year old Gifford struggled with chronic pain due to a slew of health issues over the last couple years, including a total hip replacement. 

After that procedure, she then had to have another surgery after she fractured her hip again trying to play with her grandchildren.

There’s more. Gifford also broke her arm after rolling over it awkwardly one night. She had yet another bone break when she fell on uneven pavement. Then she realized her depth perception was off, so she had cataract surgery on her eyes.

Based on the types of injuries she had — including multiple broken bones — it sounds like she may have been struggling with accepting her aging body’s limitations.

It is crushing to realize that as our bodies age and deteriorate, we can’t do all the things we used to do when we were healthy.

Gifford said her pain made her self-isolate by staying home more, which made her remember something her late husband, NFL and broadcasting legend Frank Gifford, said before he died at age 84 in 2015.

"Frank said to me before he passed, 'When I go somewhere, I know what people are expecting from me. I want to be Frank Gifford when I go out,'" she recalled. "I want to be Kathie Lee, the person they expect. I don't want to disappoint people. But when you're in pain, it's so debilitating, and everything's a grimace.”

Indeed, as many chronic pain patients can relate, pain will turn you into a different person. It will  chip away at your personality, and all the things that you assumed made you who you were. Deciding it’s easier to just stay home and isolate themselves is an all too common reaction. 

“I've had emotional pain many times in my life, but never this chronic physical pain where you literally want to go home to Jesus," Gifford said about her darkest days.

That comparison of emotional pain to physical pain was especially interesting to read, and something I have definitely thought myself multiple times over the years. There is something about never ending physical pain that will make suicide feel almost welcome.

The way Gifford described her suicidal thoughts as a desire to “go home to Jesus” makes it seem like she gave it serious thought.

Gifford also talked about how chronic pain impacted her ability to be a grandmother, after she welcomed five grandchildren in three years.

"I couldn't carry them, I couldn't love on them, I couldn't run and play with them," she explained. "All I could do was sit there and sing and write silly songs with them."

As a chronic pain sufferer myself, it’s validating to hear that even the rich and famous are no match for the absolute hell that comes with daily pain.

You would think that having a net worth of tens of millions of dollars, as well as access to any treatment possible, would be enough to insulate them. But chronic pain will humble anyone it touches.

Gifford did say she was doing better these days, thanks to her surgeries, 6 days-a-week physical therapy, and stem cell therapy. She’s now able to run "all over the place" with her grandkids.

"They're all fantastic," she says. "I'm hoping, Lord willing, that I have many, many years with them."

Of course, many of us don’t have access to things like stem cells, physical therapy, or joint replacement surgery. Aside from how expensive all of those things are, they also require the ability to take time off work and lots of support from loved ones.

That’s why it is so inhumane for doctors and the government to withhold the one inexpensive treatment that works for many of us: opioids.  

Part of the thought process for refusing to prescribe opioids is basically that pain patients should just suck it up and deal with their pain. But even rich and famous celebrities -- with all the advantages in the world -- struggle with chronic pain.

We need to remember that chronic pain can have life-threatening consequences to our health, and it should be treated with the same urgency as heart disease, cancer or any other potentially fatal condition. 

Gifford is fortunate that she didn’t succumb to suicidal thoughts, but she also had endless resources to help her through it. The rest of us are not so lucky. Which is why we need access to treatments that actually work. 

Melatonin Can Help Reduce Chronic Pain

By Pat Anson

Many chronic pain sufferers know how beneficial a good night’s sleep can be. Restorative sleep reduces pain levels, along with fatigue, anxiety and stress.

A new study in Australia suggests that melatonin not only helps with sleep, but is just as effective at reducing chronic musculoskeletal pain as non-steroidal anti-inflammatory drugs (NSAIDs). 

The study, published in the journal PAIN, looked at health data for over 2,000 patients in 23 controlled trials who took melatonin supplements. Participants included people with low back pain, osteoarthritis and fibromyalgia, as well as those recovering from joint replacements and spinal surgeries. 

“For many patients, pain doesn’t exist in isolation and is closely tied to poor sleep,” said lead author and PhD student Kangchao Wu in the Musculoskeletal Research Hub at the University of Sydney. “Melatonin appears to target both, which makes it particularly useful for people managing chronic pain.

Using a zero to 100 pain scale, researchers say melatonin modestly reduced musculoskeletal pain by about nine points, with the most rigorous studies showing pain levels dropping nearly 10 points, a level similar to those of NSAIDs. Melatonin was not as effective in reducing post-operative pain.

Notably, researchers did not find evidence of a dose-response relationship, meaning no single “best” dose of melatonin can be recommended. 

“The level of pain relief we observed is comparable to some conventional treatments, but this does not mean melatonin should replace them,” Wu said. “Rather, it may offer a safer additional option within a broader pain management plan.”

Melatonin is a natural hormone produced by the pineal gland in the brain. During the day the pineal gland is inactive, but at night it begins to produce melatonin and helps us sleep.

Melatonin supplements are widely promoted as sleep aids. However, their role in reducing inflammation – a major contributor to chronic pain – may be just as important. Melatonin has antioxidant and anti-inflammatory properties, which may reduce the central sensitization and inflammation underlying chronic pain.

In Europe and Australia, melatonin requires a prescription, while in the United States melatonin supplements can be purchased over-the-counter.

“Melatonin is already in people’s homes, it’s inexpensive, and we know it’s safe,” says Wu. “What’s exciting is that melatonin may also help manage chronic pain, opening the door to reducing reliance on medications that come with more risks.”

Melatonin is generally well tolerated, with mild, short-term side effects such as nausea, dizziness and headaches. Melatonin is considered safe for short-term use of less than three months. 

A recent study found that adults with insomnia who used melatonin for at least a year were more likely to be diagnosed with heart failure, be hospitalized, or die from any cause. The study did not establish a cause-and-effect relationship, meaning health conditions raising the risk may have already been present. 

The ‘Skunky’ Smell of Cannabis May Help Treat Fibromyalgia

By Pat Anson

THC and CBD get all the attention, but there’s another compound in cannabis that could someday be harnessed to treat chronic pain: terpenes.

Terpenes are the aromatic compounds that give plants like lavender, sage and eucalyptus their distinctive smells. In cannabis, terpenes give the plant its “skunky” aroma.

Researchers at the University of Arizona Health Sciences have identified four terpenes in cannabis sativa that may offer a new way to treat chronic pain: geraniol, linalool, beta-caryophyllene, and alpha-humulene.

In studies on laboratory mice modeled to simulate fibromyalgia and post-operative pain, all four compounds produced substantial pain-relieving effects. Geraniol delivered the strongest results, followed by linalool, beta-caryophyllene, and alpha-humulene.

The findings, published in Pharmacological Reports, builds on previous research at the U of A that showed the pain-relieving potential of cannabis terpenes in treating inflammation and chemotherapy-induced neuropathic pain. 

“Our research is showing that terpenes are not a good option for reducing acute pain resulting from an injury, such as stubbing your toe or touching a hot stove; however, we are seeing significant reductions in pain when terpenes are used for chronic or pathological pain,” said John Streicher, PhD,  Professor of Neuroscience in the U of A College of Medicine Pharmacology. 

“This study was the first to investigate the impact of terpenes in preclinical models of fibromyalgia and post-operative pain and expand the scope of potential pain-relieving treatments using terpenes.”

Fibromyalgia is a poorly understood musculoskeletal disorder that causes widespread body aches, brain fog, chronic fatigue, and anxiety. There are only four FDA-approved drugs for fibromylagia, which many patients consider ineffective or have too many side effects.. 

“With fibromyalgia, there isn’t much understanding of what the pain state is, and there are not a lot of great options for treating it,” Streicher said. “Our findings show that terpenes may be a viable treatment option for fibromyalgia pain, which could potentially have a large impact and make a difference for an undertreated population.” 

Post-surgical pain straddles the line between short-term acute pain and chronic pain that lasts at least 30 days. When poorly treated, post-operative pain can cause physiological changes that sensitizes the body’s pain signalling system and causes other side effects.

“Opioids do a good job controlling post-surgical pain, but they can cause constipation that can increase the chances of post-surgical complications such as adhesions,” Streicher said. “We are always looking for better options, and this study suggests that terpenes could be a novel therapeutic for post-operative pain.” 

Terpenes are already used in essential oils to promote relaxation or reduce pain and inflammation. Scientists still have much to learn about their therapeutic benefits.

“Nature is incredible at making unique chemical structures, and many of these chemicals are unknowns when it comes to their abilities to aid in human health, diseases and disorders,” said said Todd Vanderah, PhD, director of the U of A’s Comprehensive Center for Pain & Addiction 

“A great current example is medication semaglutide, sold under the brand name Ozempic, which has a chemical structure that was isolated not from a plant, but from an animal that is prevalent in the Southwest, the Gila monster. These discoveries from natural products through research such as Dr. Streicher’s can result in very useful medications.”

Terpenes derived from cannabis are an essential ingredient in Exilby, a cannabis extract developed by a German biopharmaceutical company. Exilby was recently approved by European regulators as a treatment for chronic low back pain. It has also been given a Breakthrough Therapy designation by the FDA, which will speed up its development and review in the U.S.

3 Tips for Surviving Summer Heat with Chronic Pain

By Crystal Lindell

While the official summer season started June 21, here in northern Illinois it has definitely felt like summer for almost three months already.

And with summer weather comes lots of heat, humidity, and thunderstorms – all of which can be tough to deal with when you live with chronic pain.

But there are some things you can do that make surviving the hottest months of the year a little more bearable, even if your body is doing its best to make your life miserable.

1. Learn How Weather Impacts You

I can always feel when a summer thunderstorm is coming. All of my joints hurt more, and the intercostal neuralgia pain in my ribs becomes so intense that it’s difficult for me to stay upright. 

But then, when the rain finally falls, there’s a relief that often envelops my body, as though the swelling is being released.

One thing I have noticed is that when I talk to fellow chronic pain sufferers, many of them don’t even realize that their pain is flaring because storms are coming. The flare may begin when the sky is bright and clear, and the storm itself is still a few hours away.

Learning how weather impacts your body can be very helpful when it comes to predicting and navigating flare ups. Try keeping a diary, either digitally or on paper, of your pain flares. Then compare local weather patterns to the flares to see if they are storm-related. You can look up past weather patterns for your area on Weather Underground. 

When you get really confident in the patterns, you can start to look at the weekly weather forecast as a sort-of pain forecast, which can then help you better plan out your commitments. 

For example, perhaps you’ll schedule your lunch with friends when you know it’s not going to rain for a few days. Or you can reschedule your dentist appointment if you see a storm coming.

2. Embrace Rest on Sunny Days

I’m not sure how things go in the rest of the country, but here in the Midwest everyone feels the need to be as active as possible whenever the weather heats up. It’s because we spend most of the year dealing with freezing temperatures and snow.

There’s a Midwest guilt that comes over us if we ever feel like we are wasting a good weather day. It’s like we are worried that if we don’t show enough appreciation for 80 degrees, we’ll face the punishment of an early winter.

When you have chronic pain though, summer can be especially difficult to deal with. Changes in pressure and humidity can cause inflammation and increased pain, while the heat can be more difficult to tolerate.

So, even if it’s sunny outside, try to remember that rest is both helpful and necessary. It’s good to “waste” a sunny day inside with air conditioning, if that’s what you need to feel your best. 

3. Wear Compression Socks

Personally, I’m a fan of compression socks all year round, but when the temperatures get past about 75 degrees Fahrenheit, they become a staple in my outfits.

Heat is one of the main causes of fluid buildup in your ankles, which in turn causes swelling. It’s more likely to happen if you have certain health conditions, or take medications like gabapentin and NSAIDs.

Compression socks can make a world of difference, by reducing the amount of swelling you’ll experience on the days when you need to be on your feet more or when it’s just especially hot outside.

Plus, keeping your foot and ankle swelling down with compression socks also makes the recovery cycle easier to get ahead of. The less swelling you have, the faster it will go away.

Summertime isn’t always a day at the beach for chronic pain patients, but with a little bit of planning and a few accommodations, it can still offer lots of fun!

What tips do you use to survive the hot summer months? Is your pain better or worse when the weather heats up? We’d love to hear from you in the comments below!

Tiny Injectable Implant Could Revolutionize Neuromodulation

By Pat Anson

Scientists in Abu Dhabi have developed a tiny neuromodulation device that can treat chronic nerve pain without the need for invasive surgery. 

The experimental device is so small – about the size of a small seed – that it can be injected into the body with a standard needle. It is powered wirelessly from outside the body, allowing doctors or patients to adjust its neuromodulation levels in real time.

“This work represents a shift in how we think about treating nerve-related conditions,” said Khalil Ramadi, PhD, an Assistant Professor of Bioengineering at NYU Abu Dhabi and senior author of a research paper published in Science Advances. 

“By creating a device that can be injected rather than surgically implanted, we are making these therapies simpler, safer, and more accessible, while still maintaining precise control over nerve activity.”

Current neuromodulation methods, such as spinal cord stimulation and transcutaneous electrical nerve stimulation (TENS), have their limits. 

TENS units are not invasive and easy to operate, but can cause uncomfortable tingling sensations for patients. They also stimulate a wide area, activating nerves and muscles that don’t need treatment. 

Spinal cord stimulators require invasive surgeries near the spine, and come with implanted wires and batteries that can malfunction, need replacement, and cause infections.

Because the SEED (Stimulating Electrode for Electroceutical Delivery) implant is injected, it can be placed and tracked with standard medical imaging, such as ultrasound and CT scans, allowing it to target a specific nerve. 

Once implanted, it delivers mild electric signals that can be programmed and tailored for each individual patient. Power for the device is delivered wirelessly from an external battery that can be worn on the wrist.

SCIENCE ADVANCES

The SEED device is in the preclinical stage and has only been tested on the peripheral nerves of laboratory rats. Researchers say the device demonstrated precise control over nerve stimulation and performed consistently.

“This technology has the potential to bridge the gap between non-invasive therapies and traditional implants,” said first author Mohamed Elsherif, PhD, Research Associate at NYU Abu Dhabi. “It opens the door to treatments that are both effective and easy to deliver, which could significantly improve patient care.”

The SEED implant will likely need to be tested on larger animals, such as pigs or sheep, before human trials can begin. Clinical use of the device will require FDA approval and is at least 5 to 10 years away. 

Researchers at Rice University are developing a similar device – about the size of a grain of rice – to treat neuropathic pain. Like the SEED implant, the device has not been fully tested on humans.   

You Don’t Really Know What Chronic Pain Is Like Until You Have It

By Crystal Lindell

I was recently talking to two people who asked me about various pain treatments. One was an older woman and the other was a young man. 

When I mentioned kratom – because I could tell that at least one of them was desperate for help – they had two very different reactions. 

One was receptive, while the other was adamantly against it. But it may not be the ones you’d expect.The older woman immediately wanted to know more, while the young man – the much more stereotypical kratom user – was immediately against the idea.

And from their reactions, I could immediately discern which of the two was actually suffering from chronic pain – the older woman.

Because when you have pain that never goes away, you will try anything to find relief. It’s one of the many truths I have come to learn first-hand as a long-time chronic pain sufferer myself.

In fact, there is a lot about living with chronic pain that’s difficult to understand unless you have been through it.

The way it wears you down and damages every aspect of your life. How expensive it is. How much it impacts your relationships.

The special type of despair that comes from the fear that you might never get better.

I have learned just how hard it is for someone with chronic pain just to get out of bed everyday. How much of an accomplishment that is.  

I know that my fellow chronic pain sufferers have likely struggled with doctors and pharmacists and health insurance companies. That they have tried every medication and treatment they could access. And that they have probably contemplated even the most extreme “solution.”

I know that they probably never feel truly rested, because of the way chronic pain even infects your sacred sleep.

And I know what it’s like when loved ones become much less helpful, as they have to keep helping you into eternity. How quickly they lose patience with the situation. 

Or, as French author and chronic pain sufferer Alphonse Daudet once wrote, "Pain is always new to the sufferer, but loses its originality for those around him.”

There’s a bond that comes from the unique experience of shared suffering. A special level of empathy. Which is why I have such a special place in my heart for anyone else enduring chronic pain. 

But it’s nearly impossible to fully grasp life with chronic pain from the outside. 

My theory is that our brains are not set up to process even the concept of chronic pain in the abstract, because recognizing that it could happen to us would be too devastating to accept.

People who have had acute pain, from an injury, accident or surgery, might assume they know what it would be like. But they can only understand so much.

A lot of people like to pretend that if they had chronic pain, they would somehow manage it better than you can. 

They’d yoga their way out of it, or simply go to a chiropractor. They’d be more stoic, and less tired. They would never get frustrated, and they would still do all the activities they did before the chronic pain started.

They’d be wrong though.

You never know how you’ll actually handle chronic pain until you’re enduring it. It has a way of humbling you faster than you expect. Opening you up to trying treatments you thought you’d never consider, like kratom. 

In the end, none of us are as strong as we like to pretend we are. But when we are forced to confront our own weaknesses, we do have the opportunity to see just how strong others have been the whole time.

How Neurosteroids Made Their Debut in Chronic Pain Care

By Dr. Forest Tennant and Ingrid Hollis

In 1981, some neuroscience researchers discovered a group of hormones being made in the brain and spinal cord.  Some are also made in the gonads, the primary reproductive glands. 

Initially, the scientists didn’t know why the central nervous system (CNS) produces these hormones, but they soon learned that they protect, energize, and heal CNS tissues, such as nerves and glial cells that may be injured or damaged. They also found that these hormones control pain. 

The hormones were named neurosteroids because their chemical structure resembled that of the corticosteroids, such as prednisone and hydrocortisone.

A main function of neurosteroids is to heal injured nerve tissue and relieve pain. This includes the glial cells that cause neuroinflammation, central sensitivity, and constant pain. Neurosteroids are potent anti-neuroinflammatory hormones. 

The main neurosteroids are:

• Pregnenolone

• Allopregnanolone

• Estradiol (estrogen)

• Testosterone

• Progesterone

• Nandrolone

• Dehydroepiandrosterone (DHEA)

You will note that some neurosteroids such as estrogen have biologic effects outside the spine, controlling mood, cognition and neurological health.

Neurosteroid Research

Animal research into neurosteroids is large, well done, and compelling, in that the studies clearly show that these hormones will benefit pain care. For example, rats that had their spinal cords damaged totally recovered when given neurosteroids. 

Glial cell inflammation -- which causes central pain -- was also controlled by neurosteroids, which are potent suppressors of neuroinflammation. Researchers found that if there was a tissue tear, injury or inflammation in the cells, neurosteroids immediately restored them to their normal state. 

Once the functions of neurosteroids were better understood, it was widely believed among neuroscientists that they could be a powerful therapeutic tool to treat severe chronic and intractable pain. 

Like many great scientific discoveries, the main clinical constituency didn’t know and didn’t care about these findings.  Fortunately, two clinical innovators figured out that neurosteroids can be utilized for treating two severe painful conditions: burning mouth syndrome and adhesive arachnoiditis (AA).  Treatment of the latter utilizes pregnenolone, DHEA, and palmitoylethanolamide (PEA).

The Transition from Animals to Humans 

The transition from giving a drug to laboratory animals to using them safely and effectively in humans takes a lot of time and experimentation.   Factors that have to be considered include dosage, formulation, and various combinations of neurosteroids. 

The first physician to make the transition is Dr. Susan Sklar, who has developed a neurosteroid protocol for the previously untreatable intractable pain condition known as burning mouth syndrome. 

Learning to great extent from Dr. Sklar’s success, I and my associates developed a neurosteroid protocol for adhesive arachnoiditis.  Results to date are gratifying and correlate with the therapeutic improvements seen in animal research.

In summary, neurosteroids are a group of hormones produced in the CNS that protect and heal nerve tissues.  Animal studies show they heal injured spinal cord nerves and glial cells, and suppress inflammation, regenerate tissues, and reduce pain.

Neurosteroids are not a substitute for pain treatment with opioids and neuropathic agents, but an additional resource that greatly enhances pain relief.  Experience to date should be a motivator to expand the use of neurosteroids for all intractable and chronic pain conditions.

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

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

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