Does Mindfulness Really Help with Chronic Pain?

By Neen Monty

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

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

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

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

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

Clear? As mud…

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

1. Paying attention to the present moment.

2. Doing so without judgment.

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

The Difference Between Pain and Suffering

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

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

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

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

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

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

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

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

The Limits of Mindfulness

Does mindfulness cure pain? No. It does not.

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

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

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

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

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

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

And often oversold as something it’s not.

Why Mindfulness Is Still Worth Trying

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

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

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

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

And sometimes, that’s enough.

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

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

5 Tips for Surviving the Holiday Season with Chronic Pain

By Crystal Lindell

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

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

1. Check Your Pharmacy Schedule

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

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

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

2. Embrace Pre-Made Food

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

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

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

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

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

3. Include Rest Days in Your Holiday Plans

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

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

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

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

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

4. Wear Compression Socks on Long Trips

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

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

5. Use Gift Bags

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

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

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

Low-Glutamate Diet Linked to Fewer Migraines

By Pat Anson

A diet low in glutamate significantly reduced migraines in U.S. veterans with Gulf War Illness, according to a new study that documents for the first time that a reduction in migraine symptoms is linked to changes in the brain.  

Glutamate is an amino acid used in food additives like monosodium glutamate (MSG), which is widely used in processed food and soups as a flavor enhancer. Previous studies have shown that a low glutamate diet reduces pain and other symptoms from fibromyalgia.   

Researchers at Georgetown University Medical Center observed a “big, big decrease” in migraines in 40 veterans with Gulf War Illness a month after they were put on a low-glutamate diet. Like fibromyalgia, Gulf War illness causes an array of musculoskeletal, gastrointestinal, and neurologic symptoms, including migraines. It is thought to be caused by exposure to toxic chemicals during the war.

“More than half of the Gulf War veterans had migraines before the diet, and that dropped to under 20% after following the diet for one month,” said senior author Ashley VanMeter, PhD, Professor of Neurology at Georgetown University School of Medicine. “So it was a very significant drop.”

In addition to fewer migraines, veterans on the low-glutamate diet also had significant reductions in widespread body pain, fatigue, mood issues, and cognitive dysfunction. 

Findings from the study were recently presented at the annual meeting of the Society for Neuroscience in San Diego. The research, funded by the U.S. Department of Defense, grew out of a collaboration with Kathleen Holton, PhD, a nutritional neuroscientist at American University, who has been researching the low-glutamate diet as a way to manage neurological conditions. 

In addition to food additives, glutamate occurs naturally in foods like tomatoes, cheese, mushrooms and nuts. Glutamate acts as a neurotransmitter in the brain and is believed to stimulate nerve cells that process pain signals. 

In the Georgetown University study, researchers used brain scans to compare differences in the visual cortex – the part of the brain that processes visual information – in patients with Gulf War Illness and a group of healthy patients. Those with Gulf War Illness had a thicker right visual cortex and were more likely to report migraines than the healthy control group. 

But after being put on a low glutamate diet, the brain scans of Gulf War Illness vets showed a significant reduction in cortical thickness.

Holton says the findings support the theory that glutamate may damage nerve cells, causing a repetitive cycle of neuroinflammation and oxidative stress in the brain. 

“We think this is one of the reasons people who are susceptible to dietary glutamate tend to have prolonged symptoms over time,” said Holton.  

Thickening of the visual cortex is common among migraine sufferers, especially those whose migraines occur with aura, or visual disturbances. That raises the question of whether a low-glutamate diet could be an inexpensive treatment option for patients with migraine or fibromyalgia..  

“This is a very doable diet,” VanMeter said. “It’s a healthy diet, it’s not that hard to follow, and it’s a very low-cost way of treating what for some individuals is a chronic and debilitating condition.” 

Holton noted that the study also adds to a growing body of evidence about how processed foods impact health.

“This speaks to the fact that diet can not only make us sick, but can also acutely treat our symptoms,” she said.

The FDA considers MSG to be “generally recognized as safe,” although some people are sensitive to it and experience short-term, mild symptoms, such as headache, numbness, flushing, tingling, palpitations, and drowsiness.

“Over the years, FDA has received reports of symptoms such as headache and nausea after eating foods containing MSG. However, we were never able to confirm that the MSG caused the reported effects,” the agency says.

Medicare May Stop Paying for Peripheral Nerve Blocks

By Pat Anson

A public comment period will end soon on a proposal that could dramatically limit coverage of peripheral nerve blocks (PNB) and nerve ablation procedures for Medicare patients suffering from chronic nerve pain.

A PNB generally involves the injection of an anesthetic or corticosteroid into an injured area to block the transmission of pain signals. Under the proposal, all PNBs and nerve ablation procedures would no longer be covered for any pain condition, and the number of steroid injections and radiofrequency ablation procedures for nerve pain and trigeminal neuralgia would be limited.    

Five Medicare administrative contractors (MACs) representing 24 states made the proposal in September and public comments will be accepted until November 22. MACs are private insurers that process Medicare claims and determine what coverage is “reasonable and necessary.” 

In this case, they’ve determined that PNB’s and other nerve procedures have little or no benefit, and “therefore are not considered medically reasonable and necessary.” If approved, the proposal could be adopted by MACs in other states and become de facto Medicare policy nationwide.

Not surprisingly, there is opposition to the MAC proposal from healthcare providers who perform the procedures, who claim denial of coverage would force millions of chronic pain patients “to turn to opioids or less effective treatments.”       

“For decades, chronic pain patients have received treatment from PNBs and ablation techniques that provide rapid and durable pain relief, enhance function and quality of life, and decrease reliance on systemic pain medications, including opioids,” said Patrick Giam, MD, President of the American Society of Anesthesiologists. 

“We urge Medicare to consider the compelling clinical and functional evidence that supports coverage of PNBs and related procedures.” 

“Unless the MACs want more Americans to be unable to work, reliant on opioids, and suffering in pain, it’s hard to understand their motivation here,” Tricia Pendergrast, MD, an anesthesiology resident at the University of Michigan, wrote in a recent STAT News op/ed 

“Eliminating peripheral nerve block coverage will not result in meaningful cost savings from these patients, and may lead to more frequent emergency department and clinic visits, increased use of opioids and other pharmacologic interventions.” 

As an alternative to injections and nerve blocks, the MAC proposal suggest the use of anti-depressants, gabapentin, topical lidocaine and transcutaneous electrical nerve stimulation (TENS) as first-line treatments for neuropathic pain.

Pregabalin, tramadol, capsaicin patches, Botox injections, and psychotherapy would be considered second-line treatments. 

Opioids should only be considered as a third-line treatment, according to the MAC proposal, “as a last resort.”

Another effort to limit coverage of chronic pain treatments for Medicare patients begins in January. That is when Medicare is launching a 6-year pilot program in six states that will use artificial intelligence (AI) to review prior authorization claims for epidural steroid injections, cervical fusions, spinal cord stimulators, arthroscopic knee surgery, and other pain treatments. 

Medicare considers the treatments to be “low value,” potentially unsafe, and ripe for fraud and wasteful spending. 

The Wasteful and Inappropriate Service Reduction Model will cover 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. 

Can Self-Hypnosis Relieve Hot Flashes?

By Crystal Lindell

A new study suggests that self-administered hypnosis significantly reduces hot flash symptoms for women going through menopause.

While previous research has shown that hypnosis can relieve hot flashes, depression, PTSD and even some types of chronic pain, those studies mainly focused on hypnosis given by a professional in a clinical setting.

The results from this study are noteworthy because they show that hypnosis can be effective even if it’s self-administered.

Hot flashes can cause sweating, discomfort, anxiety, fatigue, and sleep interference. Up to 80% of older women report hot flash symptoms from menopause, which can persist for 4 to 7 years.

The study, which was published in JAMA Network Open, included 250 postmenopausal women. One group received self-administered hypnosis, while the other group received a placebo “sham” hypnosis. 

Participants in the hypnosis intervention were given educational material on the use of hypnosis for the treatment of hot flashes and were asked to listen to 20-minute audio-recorded hypnosis sessions daily for 6 weeks. The audio recordings included hypnotic relaxation methods and mental imagery for “coolness” to counteract the “hot” sensations.

Those receiving the placebo hypnosis were asked to listen to white noise audio recordings labeled as “hypnosis” for 20 minutes each day. They were also given the same educational material.

Participants in both groups completed a daily diary on the frequency and severity of their hot flashes.

The results were striking. After six weeks, the hypnosis group experienced a significantly greater reduction in hot flash scores vs. the sham group (53.4% vs 40.9%).

The hypnosis group also reported a greater reduction in daily interference from hot flashes (49.3% vs 37.4%), and greater perceived benefits (90.3% vs 64.3%) compared with the sham hypnosis group.

“Self-administered clinical hypnosis was shown to be an effective, clinically significant intervention for the treatment of hot flashes due to its efficacy in reducing hot flash scores (ie, frequency and severity) by more than half and yielding improvements in participants’ perception of their quality of life,” wrote lead author Gary Elkins, PhD, a Professor of Psychology and Neuroscience at Baylor University.

While hormonal changes are the root cause of menopausal hot flashes, environmental factors can also play a role. According to the Mayo Clinic, hot flash triggers include hot weather or warm environments; wearing heavy clothing; drinking caffeinated or alcoholic beverages; eating spicy foods; feeling stressed; drinking hot beverages; taking hot showers or baths; and smoking cigarettes.

The wide range of triggers, including “feeling stressed” may help explain why hypnosis would be effective at treating hot flashes. And since stress is also a trigger for chronic pain flares, there are definitely implications here for the chronic pain community. 

Of course, there is always the fear that doctors will take too much from studies like this, and will use the results as a reason to deny patients treatments like medication. 

Ideally though, this type of research will instead be used to broaden the treatment options for various health conditions, offering the possibility to pair non-traditional treatments like hypnosis with more traditional options like pain medication. 

If a treatment works and it’s accessible, then it’s worth trying — even if that treatment is hypnosis. 

Why Exercise Should Be Your First Treatment for Osteoarthritis

By Clodagh Toomey

Stiff knees, aching hips and the slow grind of chronic joint pain are often accepted as an unavoidable part of getting older. But while osteoarthritis is the world’s most common joint disease, experts say the way we treat and prevent it is badly out of step with the evidence.

The best medicine isn’t found in a pill bottle or an operating theatre – it’s movement. Yet across countries and health systems, too few patients are being guided toward the one therapy proven to protect their joints and ease their pain: exercise.

Exercise is one of the most effective treatments for chronic, disabling joint conditions such as osteoarthritis. Yet very few patients actually receive it.

Research across health systems in Ireland, the UK, Norway and the United States shows the same pattern: fewer than half of people with osteoarthritis are referred to exercise or physiotherapy by their primary care provider. More than 60% are given treatments that guidelines do not recommend, and around 40% are sent to a surgeon before non-surgical options have even been tried.

To understand why those figures are so troubling, it helps to understand what exercise does for joints. Osteoarthritis is by far the most common form of arthritis, already affecting more than 595 million people worldwide.

According to a global study in The Lancet, that number could approach one billion by 2050. Longer life expectancy, increasingly sedentary lifestyles and rising numbers of overweight or obese people are driving the trend.

Yet people who exercise regularly are physically and biologically protecting themselves from developing the disease and from suffering its worst effects.

The cartilage that covers the ends of our bones is a tough, protective layer with no blood supply of its own. It relies on movement.

Like a sponge, cartilage is compressed when we walk or load a joint, squeezing fluid out and then drawing fresh nutrients back in. Each step allows nutrients and natural lubricants to circulate and maintain joint health.

That is why the old idea of osteoarthritis as simple “wear and tear” is misleading. Joints are not car tires that inevitably grind down.

Osteoarthritis is better understood as a long process of wear and repair in which regular movement and exercise are critical to healing and to the health of the entire joint.

A Disease of the Whole Joint

We now know osteoarthritis is a whole-joint disease. It affects the joint fluid, the underlying bone, the ligaments, the surrounding muscles and even the nerves that support movement.

Therapeutic exercise targets all these elements. Muscle weakness, for instance, is one of the earliest signs of osteoarthritis and can be improved with resistance training. There is strong evidence that muscle weakness increases the risk of both developing the disease and seeing it progress.

Nerve and muscle control can also be trained through neuromuscular exercise programmes such as GLA:D® (Good Life with osteoArthritis: Denmark) for hip and knee osteoarthritis. Usually delivered in supervised group sessions by physiotherapists, these programmes focus on movement quality, balance and strength to improve joint stability and rebuild confidence.

Significant improvements in pain, joint function and quality of life have been recorded for up to 12 months after completing the programme.

Exercise is good medicine for the whole body: it has documented benefits across more than 26 chronic diseases. In osteoarthritis, it helps not only by strengthening cartilage and muscle but also by tackling the inflammation, metabolic changes and hormonal shifts that drive the disease.

Obesity is a major risk factor for osteoarthritis, and not merely because of the extra mechanical load on joints. High levels of inflammatory molecules in the blood and in joint tissues can degrade cartilage and accelerate disease.

For osteoarthritis, regular activity can counter this at a molecular level, lowering inflammatory markers, limiting cell damage and even altering gene expression.

Exercise First, Surgery Later

Currently there are no drugs that modify the course of osteoarthritis. Joint replacement surgery can be life-changing for some people, but it is major surgery and does not succeed for everyone.

Exercise should be tried first and continued throughout every stage of the disease. It carries far fewer side effects and brings many additional health benefits.

Osteoarthritis is not simply a matter of “worn out” joints. It is shaped by muscle strength, inflammation, metabolism and lifestyle.

Regular, targeted exercise addresses many of these factors at once – helping to protect cartilage, strengthen the whole joint and improve overall health. Before considering surgery, movement itself remains one of the most powerful treatments we have.

Clodagh Toomey, PhD, is a Physiotherapist and Associate Professor in the School of Allied Health at the University of Limerick in Ireland.

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

Placebos Don’t Work If You Know It’s a Placebo

By Crystal Lindell

Migraine patients who knew they were getting a placebo did not get any pain relief from it.

That’s a short summary of an actual study that was published in JAMA Network Open.

And to be honest, as a pain patient and a former migraine sufferer myself, I’m annoyed that they even wasted their time and resources on this research.

So how did they reach this very obvious conclusion? They recruited 120 chronic or episodic migraine patients for a three-month trial at two headache centers in Germany. About half the participants were given an “open-label placebo” twice a day — fake pills that the patients knew were fake — along with their usual treatments. The other patients just received treatment as usual and served as a control group..

Not surprisingly, they found that the open label placebos did not reduce monthly headache days, pain intensity, or days needing rescue medication compared to the control group.

In other words, the fake pills did not work. A conclusion I could have told them before a single participant was even registered for the study.

The frustration doesn’t stop there though. The researchers then tried to salvage these results by claiming that some of the patients did have slight improvements in what they call "secondary outcomes." That includes things like quality of life, pain-related disability, and “Global Impression of Change.” The latter is a fancy way of saying they felt better.

Even though they literally got no pain relief from the placebo pills and no reduction in migraine days, the authors insist that open-label placebos (OLPs) "might have a supportive role in migraine care.”

“Although more research is needed, OLPs… could potentially be a safe and suitable complementary option for patients with migraine, especially those who prefer nonpharmacologic approaches,” said lead author Julian Kleine-Borgmann, MD, a resident in the Department of Neurology at the University Medical Center Essen.

In other words, they want to explore this ineffective line of treatment even further!

This whole study was a waste of time, and the only saving grace would have been if they saw the results and concluded that further research into fake treatments should end – so that real treatment options can be further developed.

But no, the researchers looked at these very clear results and concluded that since some patients felt slightly better, further studies are needed. 

No. Stop it.

We get it, the medical community has had little success treating migraines or developing new pain treatments. But resorting to fake pills that patients know are fake won’t help anyone – except maybe the researchers who build their careers studying it. 

In fact, it only serves to reinforce the stigma that many pain patients are just looking for attention from doctors. 

It’s not difficult to imagine doctors thinking that if fake pills work on patients who know they are fake, then clearly their pain is probably fake too.

The results of this study should prove that is not the case, but I fear that the researchers don’t seem to have fully absorbed that lesson, given the fact that they want to explore placebo treatment further.

Migraines are a very real and debilitating medical condition that can greatly impact people’s lives. Patients who suffer from them deserve very real treatments in response.

Magic Mushrooms May Relieve Chronic Pain and Depression

By Crystal Lindell

A new study shows that psilocybin, the active ingredient in what’s colloquially called magic mushrooms, could help relieve chronic pain and depression by targeting specific parts of the brain — at least in mice.

Psilocybin is a naturally occurring alkaloid with psychoactive properties that’s been used for pain relief for thousands of years. In the United States, however, it is classified as an illegal Schedule One controlled substance. 

Researchers at the Perelman School of Medicine at the University of Pennsylvania tested psilocybin on laboratory mice with chronic nerve injury and inflammatory pain.

They found that a single dose reduced both pain, anxiety and depression in the mice, judging by their behavior. The benefits lasted almost two weeks.

Unlike many pharmaceuticals, researchers say psilocybin gently activates specific nerves in the brain, called serotonin receptors.

“Unlike other drugs that fully turn these signals on or off, psilocybin acts more like a dimmer switch, turning it to just the right level,” lead author Joseph Cichon, MD, an assistant professor of Anesthesiology and Critical Care at Penn, said in a press release.

”This new study offers hope. These findings open the door to developing new, non-opioid, non-addictive therapies as psilocybin and related psychedelics are not considered addictive.”

To pinpoint where the effects originated, researchers injected psilocin — the active metabolite that the body rapidly converts from psilocybin — into different parts of the mice’s central nervous system. The team then used advanced fluorescent microscopy, a technique that uses glowing dyes to detect nerve activity, to see which neurons are activated and firing.

When psilocin was injected directly into the prefrontal cortex of the brains of the mice, it provided the same pain relief and mood improvements as when psilocybin was given to the whole body. But when researchers injected psilocin into the spinal cords of the mice, they found that it didn’t have the same calming effect.

“Psilocybin may offer meaningful relief for patients by bypassing the site of injury altogether and instead modulating brain circuits that process pain, while lifting the ones that help you feel better, giving you relief from both pain and low mood at the same time,” said Cichon.

Researchers hope their findings, published in the journal Nature Neuroscience, could help spur advancements in treatments for other conditions, such as addiction or post-traumatic stress disorder.

Cichon says more research is needed to determine the effectiveness of psilocybin.

“In my anesthesiology practice, I often see that both pain and mood symptoms can worsen following surgery due to the physiological and psychological stress imposed by the procedure,” he said. “While psilocybin shows promise as a treatment for both pain and depression, it remains uncertain whether such therapies would be safe, effective, or feasible in the context of surgery and anesthesia.”

The Penn team plans further studies to investigate dosing strategies, long-term effects, and the ability of the brain to re-wire itself through the use of psilocybin.

“While these findings are encouraging, we don’t know how long-lived psilocybin’s effects are or how multiple doses might be needed to adjust brain pathways involved in chronic pain for a longer lasting solution,” said co-author Stephen Wisser, a PhD student in Cichon’s lab.

While the DEA considers psilocybin an illegal substance with no accepted medical use, Oregon and Colorado have legalized it for supervised therapeutic use. Several cities in California, Michigan, Minnesota, Washington and Maine have also decriminalized it. And efforts are underway to change psilocybin’s federal status. 

The Food and Drug Administration has granted a breakthrough therapy designation to psilocybin to expedite research and drug development. Over 60 scientific studies have shown the ability of psilocybin and other psychedelics to reduce pain from fibromyalgia, cluster headache, complex regional pain syndrome (CRPS) and other conditions.

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.”

Experimental Implant Could Dispense Drugs Inside Joints During Arthritis Flares

By Crystal Lindell

Researchers in the UK are developing an artificial cartilage that could dispense anti-inflammatory and pain relieving medications from within joints during an arthritis flare-up.

The gel-like material, developed by a team at the University of Cambridge, has been designed to respond to changes in pH, a measure of acidity. During flare-ups, arthritic joints become inflamed and slightly more acidic than the surrounding tissue.

As acidity increases, the polymer implant becomes softer and more jelly-like, triggering the release of drug molecules within the joint. In theory, researchers say the drugs would be released precisely where and when they are needed, providing more effective and continuous relief.

“These materials can ‘sense’ when something is wrong in the body and respond by delivering treatment right where it’s needed,” said Stephen O’Neill, PhD, a postdoctoral researcher at Cambridge. “This could reduce the need for repeated doses of drugs, while improving patient quality of life.”

The research was reported in the Journal of the American Chemical Society. 

The polymer material was developed by a research group in the Department of Chemistry at Cambridge that specializes in designing and building unique materials for a range of potential applications.

“For a while now, we’ve been interested in using these materials in joints, since their properties can mimic those of cartilage,” said lead author Oren Scherman, PhD, Director of the Melville Laboratory for Polymer Synthesis. “But to combine that with highly targeted drug delivery is a really exciting prospect.”

Clinical trials are needed before the material can be used in patients. Researchers say their next steps will be to test the materials in living organisms to evaluate their performance and safety. 

If successful, that could lead to a new generation of responsive biomaterials capable of treating a variety of chronic diseases. The gel could be adapted for placement in different parts of the body.

“It’s a highly flexible approach, so we could in theory incorporate both fast-acting and slow-acting drugs, and have a single treatment that lasts for days, weeks or even months,” said O’Neill.

While it is incredible to see these new advances in pain treatment, it’s also imperative that researchers make sure that they are actually better than the current treatments available. They also need to make sure that the implants are relatively easy to remove in the case of complications.

In the research paper, the authors suggest the implants could be used for rheumatoid and osteoarthritis pain. However, both of those diseases can cause widespread joint pain, so it remains unclear if material needs to be implanted in multiple joints to be effective.

And if the implants can be effective “for days, weeks or even months,” how would they be re-loaded with medication or even fully replaced? Such a process could be very taxing for patients, especially if it requires a trip to the hospital or a doctor’s office each time.

In the original Jurassic Park movie, the character Dr. Ian Malcolm says, “Your scientists were so preoccupied with whether they could, they didn't stop to think if they should.”

I hope these researchers heed that advice. 

Balancing the Risks and Benefits of Kratom

By David Kroll

David Bregger had never heard of kratom before his son, Daniel, 33, died in Denver in 2021 from using what he thought was a natural and safe remedy for anxiety.

By his father’s account, Daniel didn’t know that the herbal product could kill him. The product listed no ingredients or safe-dosing information on the label. And it had no warning that it should not be combined with other sedating drugs, such as the over-the-counter antihistamine diphenhydramine, which is the active ingredient in Benadryl and other sleep aids.

As the fourth anniversary of Daniel’s death approaches, a recently enacted Colorado law aims to prevent other families from experiencing the heartbreak shared by the Bregger family. Colorado Senate Bill 25-072, known as the Daniel Bregger Act, addresses what the state legislature calls the deceptive trade practices around the sale of concentrated kratom products artificially enriched with a chemical called 7-OH.

7-OH, known as 7-hydroxymitragynine, has also garnered national attention. On July 29, 2025, the U.S. Food and Drug Administration issued a warning that products containing 7-OH are potent opioids that can pose significant health risks and even death.

As kratom and its constituents are studied in greater detail, the Centers for Disease Control and Prevention and university researchers have documented hundreds of deaths where kratom-derived chemicals were present in postmortem blood tests. But rarely is kratom deadly by itself. In a study of 551 kratom-related deaths in Florida, 93.5% involved other substances such as opioids like fentanyl.

I study pharmaceutical sciences, have taught for over 30 years about herbal supplements like kratom, and I’ve written about kratom’s effects and controversy.

One Name, Many Products

Kratom is a broad term used to describe products made from the leaves of a Southeast Asian tree known scientifically as Mitragyna speciosa. The Latin name derives from the shape of its leaves, which resemble a bishop’s miter, the ceremonial, pointed headdress worn by bishops and other church leaders.

Kratom is made from dried and powdered leaves that can be chewed or made into a tea. Used by rice field workers and farmers in Thailand to increase stamina and productivity, kratom initially alleviates fatigue with an effect like that of caffeine. In larger amounts, it imparts a sense of well-being similar to opioids.

In fact, mitragynine, which is found in small amounts in kratom, partially stimulates opioid receptors in the central nervous system. These are the same type of opioid receptors that trigger the effects of drugs such as morphine and oxycodone. They are also the same receptors that can slow or stop breathing when overstimulated.

In the body, the small amount of mitragynine in kratom powder is converted to 7-OH by liver enzymes, hence the opioid-like effects in the body. 7-OH can also be made in a lab and is used to increase the potency of certain kratom products, including the ones found in gas stations or liquor stores.

And therein lies the controversy over the risks and benefits of kratom.

‘No Currently Accepted Medical Use’

Because kratom is a plant-derived product, it has fallen into a murky enforcement area. It is sold as an herbal supplement, normally by the kilogram from online retailers overseas.

In 2016, I wrote a series of articles for Forbes as the Drug Enforcement Administration proposed to list kratom constituents on the most restrictive Schedule 1 of the Controlled Substances Act. This classification is reserved for drugs the DEA determines to possess “no currently accepted medical use and a high potential for abuse,” such as heroin and LSD.

But readers countered the DEA’s stance and sent me more than 200 messages that primarily documented their use of kratom as an alternative to opioids for pain.

Others described how kratom assisted them in recovery from addiction to alcohol or opioids themselves. Similar stories also flooded the official comments requested by the DEA, and the public pressure presumably led the agency to drop its plan to regulate kratom as a controlled substance.

But not all of the stories pointed to kratom’s benefits. Instead, some people pointed out a major risk: becoming addicted to kratom itself. I learned it is a double-edged sword – remedy to some, recreational risk to others. A national survey of kratom users was consistent with my nonscientific sampling, showing more than half were using the supplement to relieve pain, stress, anxiety or a combination of these.

Natural Leaf Powder vs Concentrated Extracts

After the DEA dropped its 2016 plan to ban the leaf powder, marketers in the U.S. began isolating mitragynine and concentrating it into small bottles that could be taken like those energy shots of caffeine often sold in gas stations and convenience stores.

This formula made it easier to ingest more kratom. Slowly, sellers learned they could make the more potent 7-OH from mitragynine and give their products an extra punch. And an extra dose of risk.

People who use kratom in the powder form describe taking 3 to 5 grams, the size of a generous tablespoon. They put the powder in capsules or made it into a tea several times a day to ward off pain, the craving for alcohol or the withdrawal symptoms from long-term prescription opioid use.

Since this form of kratom does not contain very much mitragynine – it is only about 1% of the powdered leaf – overdosing on the powder alone does not typically happen.

That, along with pushback from consumers, is why the Food and Drug Administration is proposing to restrict only the availability of 7-OH and not mitragynine or kratom powder. The new Colorado law limits the concentration of kratom ingredients in products and restricts their sales and marketing to consumers over 21.

Even David Bregger supports this distinction. “I’m not anti-kratom, I’m pro-regulation. What I’m after is getting nothing but leaf product,” he told WPRI in Rhode Island last year while demonstrating at a conference of the education and advocacy trade group the American Kratom Association.

Such lobbying with the trade group last year led the American Kratom Association to concur that 7-OH should be regulated as a Schedule 1 controlled substance. The association acknowledges that such regulation is reasonable and based in science.

Potential Use as Medicine

Despite the local and national debate over 7-OH, scientists are continuing to explore kratom compounds for their legitimate medical use.

A $3.5 million NIH grant is one of several that is increasing understanding of kratom as a source for new drugs.

Researchers have identified numerous other chemicals called alkaloids from kratom leaf specimens and commercial products. These researchers show that some types of kratom trees make unique chemicals, possibly opening the door to other painkillers.

Researchers have also found that compounds from kratom, such as 7-OH, bind to opioid receptors in unique ways. The compounds seem to have an effect more toward pain management and away from potentially deadly suppression of breathing. Of course, this is when the compounds are used alone and not together with other sedating drugs.

Rather than contributing to the opioid crisis, researchers suspect that isolated and safely purified drugs made from kratom could be potential treatments for opioid addiction. In fact, some kratom chemicals such as mitragynine have multiple actions and could potentially replace both medication-assisted therapy, like buprenorphine, in treating opioid addiction and drugs like clonidine for opioid withdrawal symptoms.

Rigorous scientific study has led to this more reasonable juncture in the understanding of kratom and its sensible regulation. Sadly, we cannot bring back Daniel Bregger. But researchers can advance the potential for new and beneficial drugs while legislators help prevent such tragedies from befalling other families.

David Kroll, PhD, is a Professor of Natural Products Pharmacology & Toxicology in the Department of Pharmaceutical Sciences at the University of Colorado Anschutz Medical Campus.

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

How To Get More Pain Relief From Rx Opioids

By Drs. Forest Tennant, Martin Porcelli and Scott Guess

Due to a multitude of legal restrictions and biases, many persons living with pain who take opioid medication can’t get enough relief to function, be comfortable, and have quality of life.

Summarized below are some of the ways we have found to boost or enhance the pain-relieving effect of prescription opioids.

Take a Booster (Potentiator)

Opioids trigger the endorphin receptor to relieve pain. If you simultaneously take a medicine or supplement that triggers a different receptor or suppresses inflammation, pain relief is enhanced. This boosting effect is the reason opioids are combined with acetaminophen or aspirin in pain medications such as Vicodin or Percocet.

Here is a list of potential non-prescription boosters. You may have to experiment to find one or two that boost the potency of your opioid. You can swallow the booster with your oral opioid or take the booster within 15 minutes after taking the opioid.

• Taurine 1000 mg

• Glutamine 1000 mg

• Lion’s Mane mushrooms

• Quercetin

• Benadryl

• St. John’s wort

• White willow bark

• Cannabidiol (CBD)

• Kava

• Palmitoylethanolamide (PEA) 300 to 600 mg

Under the Tongue vs Swallowing

A medication dissolved under the tongue (sublingually) is always more potent than if you swallow it whole. That’s because digestion in the stomach and intestines may wipe out as much as 50% of an oral opioid’s pain relief capability.

Try dissolving an opioid tablet under your tongue. You may find it much more effective, as it will enter the bloodstream faster. We recommend starting with half your usual dose and increase it as needed, being careful not to exceed your usual dose. Discuss this practice with your medical practitioner.

Don’t Forget Aspirin

Aspirin has been disparaged to the point that people are afraid to take it. It is still one of the very best opioid boosters. Dissolve it under your tongue to avoid stomach upset or bleeding.

Receptor Health

The central nervous system has many receptors (“action points”) that relieve pain. They need to stay healthy and active to provide maximal pain relief. A good nutrition program that consists of daily protein, vitamin D, and magnesium helps keep nerve receptors healthy and maximizes opioid pain relief.

Bedtime Preparation

Some medicinals taken at bedtime have the effect of making the next day’s opioids more effective. Here are some suggestions:

• Metformin 500 mg + L-Theanine 200 mg

• Tryptophan 500 to 1000 mg

• Amitriptyline

• Pentoxifylline

Cannabis

Some persons find that cannabis provides significant pain relief, while others experience little or no relief.

Do not take cannabis products within four hours before or after an opioid dosage to avoid over-sedation, loss of coordination, and mental deficiency.

Kratom

Kratom is the only non-prescription herbal supplement that has opioid-like effects. It comes in a variety of forms, usually natural leaf powder that is sold in capsules, edibles or drinks.

Kratom can be simultaneously taken with opioids, but be wary of synthetic or concentrated kratom as its potency may be unknown or too high.

All persons who take opioids for pain relief should find a kratom form and dosage that relieves pain. Given today’s adverse attitudes and restrictions on opioids, a person relying on prescription opioids alone must face the fact that their medical practitioners may end or reduce their opioid therapy at any time. When this happens, you may have to rely on kratom.

Prescription Boosters

Many physicians prescribe non-opioid medications for pain relief, such as gabapentin (Neurontin), clonidine, tizanidine, baclofen, and pregabalin (Lyrica). These can also be used to boost the potency of opioids. Take these medications within four hours before or after your opioid dose.

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.

Martin J. Porcelli, DO, is a family medicine doctor in Pomona, CA and is affiliated with Casa Colina Hospital.

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. 

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.

FDA Approves First Implant That Zaps Rheumatoid Arthritis

By Madora Pennington

A nerve stimulation implant recently approved by the FDA reduces symptoms of rheumatoid arthritis by stimulating the vagus nerve with mild electronic pulses. It’s the first FDA-approved neuromodulation device for adults with moderate-to-severe rheumatoid arthritis (RA).

The vagus nerve stimulator (VNS), created by SetPoint Medical of Valencia, California, is the size of a coffee bean. It is implanted in the left side of the neck under anesthesia during an outpatient procedure.

The device delivers electronic pulses into the vagus nerve for just one minute each day to calm the immune system and have an anti-inflammatory effect. RA causes the immune system to attack the lining of joints, damaging cartilage and eroding bone.

“The approval of the SetPoint System, the first-in-class neuroimmune modulation platform, represents a transformative milestone in the management of autoimmune diseases,” Murthy Simhambhatla, PhD, CEO of SetPoint Medical, said in a press release. “We plan to introduce the SetPoint System in targeted U.S. cities this year, followed by expansion across the country starting in early 2026.”

In auto-immune diseases like RA, the function of the vagus nerve becomes impaired. The nerve starts in the brainstem and runs through the neck, chest and abdomen, where it branches out into many organs.

The vagus nerve helps regulate the nervous system, including heart rate, blood pressure, respiration and digestion. When the nerve malfunctions, it causes inflammation and disrupts the immune system.

In a clinical trial of 242 patients, just over half (51.5%) had at least a 20% improvement in RA symptoms after 24 weeks with the SetPoint implant. Most patients tolerated the device well, but two experienced side effects of vocal cord weakness and hoarseness.

SETPOINT MEDICAL IMAGE

The SetPoint System is intended for RA patients who have not benefited from medications designed to calm the immune system, known as Disease-Modifying Antirheumatic Drugs (DMARDS) or the much stronger biologics that target specific immune cells. Doctors can monitor the device with an iPad application and patients can recharge it themselves with a wireless charger.

Vagus nerve stimulation is not new. In 1997, the FDA approved VNS for epilepsy. The implanted device is installed in the chest like a pacemaker to reduce seizures or even stop ones in progress.  

VNS can also treat chronic pain, by helping the brain "turn down" pain signals and reduce pain indirectly through its anti-inflammatory effects.  

Other types of pain for which VNS has demonstrated effectiveness are chronic migraine, chronic primary headache, cluster headache, fibromyalgia, chronic pancreatitis, esophageal pain, irritable bowel syndrome, neuropathic pain, musculoskeletal pain, osteoarthritis, and chronic low back pain.

SetPoint is investigating whether its technology can also treat multiple sclerosis, Crohn's disease and other autoimmune conditions.

When Headlines Lie: Misleading News About Opioids and Chronic Pain

By Neen Monty

The headline in Physician’s Weekly screams alarm:

“Rising Use of Potent Opioids in Chronic Pain Management”

And then the sub heading:

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

Terrifying, right? We must do something!

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

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

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

And what did they find?

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

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

Yes, that’s right: 1%.

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

Hardly a crisis. Hardly anything to scream about.

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

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

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

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

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

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

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

Finally! An Honest Headline

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

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

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

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

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

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

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

Let’s be clear:

• PRT is not for severe back pain

• PRT is not for pain caused by pathology

• PRT is not a cure-all

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

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

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

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

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

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

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

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

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

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

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

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

That’s the real headline.

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

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