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.”

‘A Lot of Uncertainty’ if Ketamine Works for Chronic Pain

By Pat Anson

Hundreds of ketamine clinics have opened across the United States in recent years, offering infusions of the anesthetic for a variety of medical conditions – from anxiety and depression to PTSD and chronic pain. Ketamine is only FDA-approved for depression and anesthesia, so its use in treating pain is considered “off-label.”

That off-label use is not supported by scientific evidence, a new Cochrane review has found. Australian researchers analyzed 67 clinical trials involving over 2,300 adults who used ketamine or four similar drugs that block brain receptors and found little evidence that they work as pain relievers.

“We want to be clear – we're not saying ketamine is ineffective, but there’s a lot of uncertainty,” said lead author Michael Ferraro, a doctoral candidate at the University of New South Wales (UNSW). “The data could point to a benefit or no effect at all. Right now, we just don’t know.”

Ferraro and his colleagues looked at the therapeutic effects of ketamine, memantine, dextromethorphan, amantadine and magnesium on various chronic pain conditions and found no evidence that they benefit any condition at any dose. Side effects such as delusion, delirium and paranoia were a major concern, particularly with intravenous use.

"This group of drugs, and ketamine in particular, are in relatively common use for chronic pain around the world. Yet we have no convincing evidence that they are delivering meaningful benefits for people with pain, even in the short term,” said co-author Neil O'Connell, a Professor of Evidence-Based Healthcare at Brunel University of London.

“That seems a good reason to be cautious in the clinic and clearly indicates an urgent need to undertake high quality trials.”

The reviewers also found no studies that support two supposed benefits of ketamine: that it reduces depression and the use of opioids. Ketamine is often used as a treatment for depression or as an alternative to opioids for pain relief.

“We've seen the harm that can come from taking medicines developed for acute pain and applying them to chronic pain, opioids are a prime example. Now we're seeing a similar pattern with ketamine,” said co-author James McAuley, PhD, a Psychology Professor at UNSW and senior researcher at Neuroscience Research Australia.

“As opioid prescribing is slowly reduced, there’s a growing demand for alternatives, but we need to be careful not to rush into widespread use without strong evidence.”

A ‘Lifeline’ for Pain Patients

But patients who have received ketamine infusions found them useful in relieving pain from Complex Regional Pain Syndrome (CRPS) and other difficult-to-treat conditions.

“I implore the medical community not to dismiss ketamine as a treatment option based solely on this one review, when tens of thousands of us are finding relief,” says Barby Ingle, founder and past president of the International Pain Foundation. “For many of us, ketamine is not just an option — it’s a lifeline.

“Chronic pain is a complex, individualized condition, and ruling out therapies that benefit even a subset of patients perpetuates a one-size-fits-all approach that has long plagued healthcare. Such dismissals increase costs to society by limiting access to effective treatments, leaving patients to suffer unnecessarily. I have lost too many friends to suicide with these painful rare diseases.”

In 2009, Ingle had her CRPS, also known as Reflex Sympathetic Dystrophy (RSD) or algoneurodystrphy, treated for the first time with ketamine by the late Dr. Robert Schwartzman, a neurologist who pioneered the use of ketamine infusions as a chronic pain treatment. She went into the hospital in a wheelchair, but was able to walk out a week later after a series of ketamine infusions by Schwartzman. She continues to get infusions regularly.

“My experience with IV-ketamine has allowed me to manage my pain without the fear of addiction or life-threatening side effects, further emphasizing its value as a treatment option long-term,” Ingle told PNN.  

“Ketamine can offer significant advantages over opioids, as it is non-addictive and does not suppress breathing, making it a safer option for long-term pain management. These benefits are particularly crucial for patients with chronic pain, who often face the risks of opioid dependence and respiratory complications. For other patients due to their genetics, lifestyle, and environment, opioids may be the best option. I am saying don’t take any option off the table.”

Ingle says rigorous, high-quality clinical studies are needed to document the benefits of ketamine therapy. Of the 67 studies that were reviewed by researchers, many were small or short-term, which limited their ability to draw conclusions.

Some U.S. medical organizations support the use of ketamine under certain circumstances. The American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, and the American Academy of Pain Medicine have guidelines that support ketamine infusions for CRPS, chronic neuropathic pain and short-term acute pain.

From Arthritis to Pain Relief: 5 Benefits of Ginger

By Dipa Kamdar

From warming winter teas to zesty stir-fries, ginger (Zingiber officinale) has long been a kitchen staple. But beyond its culinary charm, this spicy root has a rich history in traditional medicine – and modern science is catching up. Studies now show that ginger may offer a wide range of health benefits, from easing nausea and relieving colds to reducing inflammation and supporting heart health.

Here’s what you need to know:

1. Nausea Relief

Multiple clinical trials have shown consistent evidence that ginger can reduce nausea and vomiting, particularly when compared to a placebo. The NHS even recommends ginger-containing foods or teas for easing nausea.

Ginger seems especially effective for nausea during pregnancy. In small doses, it’s considered a safe and effective option for people who don’t respond well to standard anti-nausea treatments.

There’s also promising evidence that ginger can help with chemotherapy-induced nausea, though results are mixed when it comes to motion sickness and post-surgery nausea.

Researchers believe ginger’s anti-nausea effects may work by blocking serotonin receptors and acting on both the gut and brain. It may also help by reducing gas and bloating in the digestive tract.

2. Anti-Inflammatory Benefits

Ginger is rich in bioactive compounds, such as gingerol and shogaol, which have strong antioxidant and anti-inflammatory properties.

Recent research suggests ginger supplements may help regulate inflammation, especially in autoimmune conditions. One study found that ginger reduced the activity of neutrophils — white blood cells that often become overactive in diseases like lupus, rheumatoid arthritis and antiphospholipid syndrome.

Neutrophils produce extracellular traps (NETs), which are web-like structures used to trap and kill pathogens. But when NETs form excessively, they can fuel autoimmune diseases. In the study, taking ginger daily for one week significantly reduced NET formation.

While this study used ginger supplements, it’s unclear whether fresh ginger or tea has the same effect. Still, the findings suggest ginger may be a helpful, natural option for people with certain autoimmune conditions – though more research is needed.

Ginger also has antimicrobial properties, meaning it can help combat bacteria, viruses and other harmful microbes. Combined with its anti-inflammatory effects, this makes ginger a popular remedy for easing cold and flu symptoms like sore throats.

3. Pain Management

When it comes to pain, the research on ginger is encouraging – though not conclusive. Some studies show that ginger extract can reduce knee pain and stiffness in people with osteoarthritis, especially during the early stages of treatment. However, results vary, and not everyone experiences the same level of relief.

For muscle pain, one study found that taking two grams of ginger daily for 11 days reduced soreness after exercise.

Ginger may also ease menstrual pain. In fact, some studies suggest its effectiveness rivals that of non-steroidal anti-inflammatory drugs like ibuprofen.

Researchers believe ginger works by activating pathways in the nervous system that dampen pain signals. It may also inhibit inflammatory chemicals like prostaglandins and leukotrienes.

4. Heart Health and Diabetes Support

High blood pressure, high blood sugar and elevated “bad” cholesterol (low-density lipoprotein or LDL cholesterol) are all risk factors for heart disease. Ginger may help with all three.

A 2022 review of 26 clinical trials found that ginger supplementation can significantly improve cholesterol levels — lowering triglycerides, total cholesterol and LDL cholesterol, while raising HDL (“good”) cholesterol. It may also lower blood pressure.

For people with type 2 diabetes, ginger could offer additional benefits. A review of ten studies found that taking one to three grams of ginger daily for four to 12 weeks helped improve both cholesterol levels and blood sugar control.

These benefits appear to come from multiple mechanisms, including improved insulin sensitivity, enhanced glucose uptake in cells, and reduced oxidative stress. Ginger’s anti-inflammatory actions may also contribute to its heart-protective effects.

Some early research suggests that ginger may also offer benefits for sexual health, though evidence in humans is still limited. Animal studies have found that ginger can boost testosterone levels, improve blood flow, and enhance sexual behaviour. In traditional medicine systems, it has long been used as an aphrodisiac. While there’s not yet strong clinical evidence to confirm a direct impact on libido, ginger’s anti-inflammatory, circulatory and hormonal effects could play a supportive role, particularly for people managing conditions like diabetes or oxidative stress.

5. Brain Health

Emerging evidence suggests ginger may also offer neuroprotective and anti-cancer benefits. Lab-based studies show that ginger compounds can help protect brain cells from oxidative damage – a key factor in neurodegenerative diseases like Alzheimer’s.

Other in-vitro research has found that ginger can slow the growth of some cancer cells. However, these findings are still in early stages and more research is needed to confirm their relevance in humans.

Ginger is generally safe when consumed in food or tea. But like any supplement, it should be used in moderation.

Doses above four grams a day may cause side effects such as heartburn, bloating, diarrhoea or mouth irritation. These are usually mild and temporary.

Certain groups should use caution with high doses. Ginger may increase bleeding risk in people on blood thinners (like warfarin, aspirin or clopidogrel), and it can enhance the effects of diabetes or blood pressure medications, potentially leading to low blood sugar or blood pressure. Pregnant women should also consult a doctor before using high doses.

So ginger isn’t just a fragrant kitchen spice – it’s a natural remedy with growing scientific support. For most people, enjoying ginger in food or tea is a safe and effective way to tap into its therapeutic potential. If you’re considering taking supplements, it’s always best to speak with your doctor or pharmacist first, especially if you’re managing a medical condition or taking medication.

Dipa Kamdar is a Senior Lecturer in Pharmacy Practice at Kingston University in London.  She is registered pharmacist and a member of the Royal Pharmaceutical Society.

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

Can AI Videos Replace In-Person Physical Therapy?

By Crystal Lindell

A UK-based technology company claims their Artificial Intelligence (AI) videos are good enough to replace in-person physical therapy for some back pain patients. 

Like the United States, the waiting time in the UK to see a medical specialist can be daunting. According to the UK’s National Health Service (NHS), the average wait time after a referral for simple back or spine pain is more than 18 weeks. Nearly 350,000 people in England were on waiting lists for treatment for musculoskeletal problems last year. 

But in a pilot study of over 2,500 NHS patients who used a physiotherapy (physical therapy) app operated by Flok Health, the waiting times were cut in half. 98% of referred patients continued watching the AI powered videos, while only 2% required or requested a transfer to traditional to face-to-face care with a therapist.

The app works by showing patients pre-recorded videos of actual human instructors, but then tailors the video clip order based on how AI interprets responses from the patient. 

“Each appointment is like a 30 minute video call, except our side of the call is created by our AI engine in real-time, just for you,” Flok Health explains on its website. “You can answer questions and your digital physio will respond to you live, in a continuously generated personal video stream.”

Patients are also prescribed a set of exercises for the coming week before the next appointment. Flok Health says the exercises are specifically selected based on “a detailed analysis of symptoms and movement patterns.” The app also guides patients through practicing their exercises between appointments, and helps them see their progress and stay on track.

Patients also have access to human physiotherapists and doctors. The company said they monitor patient recovery remotely and can arrange to speak to a patient if they have questions. 

The BBC's Scott Nover tried the app back in March and wrote about his experience with an AI generated physical therapist named “Kirsty.” He found her recommendations lacking, with his main complaint being that Kirsty wasn’t able to correct his form in real time like a live therapist would.

“The big difference here is that Kirsty can't see me. Her pre-recorded videos don't watch my movements and stretches. They rely on me following her instructions correctly and reporting if something is amiss,” Nover wrote.

“My back felt better after my sessions with Flok, but the app likely isn't for me. I'm clumsy and uncoordinated and need someone watching my form at all times – if not, I'm likely to hurt myself further.”

However, I could see a near-future scenario where AI is able to analyze patient form in real-time with technology that’s similar to that used in gaming counsels like XBox Kinect. 

Nover also pointed to a 2024 study for a similar AI-powered back pain treatment called selfBACK that found patients were unlikely to use it. Nearly one-third of patients never accessed the app, and another third rarely used it. 

It’s definitely easier to blow off an app than it is to blow-off an in-person physical therapy appointment with an actual human being, so those results make sense. 

As a patient, I’ve had both in-person physical therapy referrals given to me sometimes, and links to relevant videos with accompanying handouts provided to me at other times. 

To be frank, this Flok Health app sounds a lot like that latter. And I will confess that I was a lot less likely to follow a physical therapy treatment plan when it didn’t involve an actual physical therapist.

At the same time, at least in the United States, physical therapy can be very expensive, especially when there’s a high co-pay for each session. So having less expensive treatment options is a good thing. Although it’s unclear when Flock might be widely available to U.S. patients.

I’m skeptical that AI will be fully replacing physical therapists any time soon, but it sounds like tech companies are hoping they can make a massive dent in their client base and waiting times..

Poor Nutrition Linked to Higher Risk of Chronic Pain

By Crystal Lindell

Vitamin and mineral deficiencies could play a key role in chronic pain, according to new research that found low levels of Vitamin D, B12, folate and magnesium were common in people with severe chronic pain. 

The study, led by researchers at the University of Arizona Health Sciences, analyzed health data on over 220,000 people in the National Institutes of Health’s “All of Us” Research Database. The study is the first to look at micronutrient levels of people with and without chronic pain on a large scale.

“I treat chronic pain patients, and oftentimes we don’t come up with a diagnosis. But just because there isn’t a surgery that will help you doesn’t mean you’re not in pain. It just means that our understanding of pain is limited to date,” said senior author Julie Pilitsis, MD, head of the Department of Neurosurgery at U of A College of Medicine–Tucson.

“This study is a novel way to approach chronic pain treatment, where you are looking at the patient holistically to see what could be going on systemically that is easily modifiable – changes in diet as opposed to medications or other things.”

Pilitsis and her colleagues focused on five micronutrients commonly associated with chronic pain: vitamins D, B12, and C, folate and magnesium. Nutritional data was analyzed for people without pain, those with mild-to-moderate chronic pain, and people with severe chronic pain.

They found that people with severe chronic pain were more likely to have deficiencies in vitamin D, vitamin B12, folate and magnesium. The findings, however, varied depending on gender, race and ethnicity.

“The finding that surprised us the most was that Asian females had higher vitamin B12 levels than expected,” said co-author Deborah Morris, PhD, a research laboratory manager in the Department of Neurosurgery. “Asian females with severe chronic pain had the highest vitamin B12 levels overall. We were expecting it to be lower.”

The results also varied for vitamin C, where males with mild-to-moderate or severe chronic pain were more likely to have low or borderline low levels of vitamin C, compared to males without pain. 

Researchers caution that they didn’t prove a cause-and-effect relationship between nutrition and pain, but they believe their findings could lead to personalized diets and nutritional supplements for people with chronic pain. 

The Western Diet, which is common in the United States, is deficient in fruits and vegetables and contains high amounts of meat, refined grains, and desserts. This could contribute to nutritional imbalances and deficiencies in micronutrients. 

Frustratingly, like so much medical research regarding chronic pain these days, it seems one of the primary goals of the researchers is to reduce opioid use. 

“Our goal is to improve the quality of life for people with chronic pain and reduce opioid usage, and these findings have the potential to do that as part of a holistic approach to pain management,” said Morris. 

Note how she doesn’t say she wants to help patients reduce ibuprofen or gabapentin use, despite the fact that both can cause serious side effects. 

I’m glad to see more progress when it comes to understanding the causes of chronic pain –  especially since I suffer from it – but constantly framing every advancement as a way to “reduce opioid use” is disappointing. Opioid prescriptions have already been greatly reduced to levels not seen in over 20 years.

While chronic pain patients should obviously be making sure their vitamin and mineral levels are within the normal range, my fear is that doctors will over-correct – and start pushing vitamins and supplements as alternatives to pain medication. 

I myself suffered from extremely low vitamin D levels, and I do find that keeping it in the normal range helps reduce my pain levels. Holistic treatments can be a good thing, but only if they are truly holistic – encompassing both non-traditional and traditional approaches. 

Why Ice Cream May Be Bad for Your Gut Health

By David Hilzenrath, KFF Health News

It’s a marvel of food technology: ice cream that resists melting. In a video explaining the science behind it, a seller of food chemicals shows scoops of ice cream holding their shape under hot lights. The super ingredient? Polysorbate 80.

Polysorbate 80 is an emulsifier, a chemical used to control the consistency of thousands of supermarket products. Other widely used emulsifiers or stabilizers include carboxymethyl cellulose, carrageenan, and maltodextrin.

Recently, such ingredients have been showing up in scientific studies for another reason: Researchers say they may cause a variety of health problems.

Studies have found that emulsifiers can alter the mix of bacteria in the gut, known as the microbiome or microbiota; damage the lining of the gastrointestinal tract; and trigger inflammation, potentially contributing to problems elsewhere in the body.

Emulsifiers and stabilizers are among the most common ingredients in ultra-processed foods, a prime target of the “Make America Healthy Again” campaign by Health and Human Services Secretary Robert F. Kennedy Jr.

They are on the department’s radar: Their potentially harmful effects were flagged in a document HHS recently produced to support Kennedy’s drive to eliminate petroleum-based food dyes. But they illustrate the complexity of the war on food additives.

They show how, when it comes to food science, regulators are chronically playing catch-up. In the meantime, for many ingredients, regulators and consumers alike are left in a gray zone between suspicion and proof of harm in humans.

Emulsifiers’ assault on the microbiome could help explain inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, metabolic disorders, and even cancer, the studies suggest.

“There is a lot of data showing that those compounds are really detrimental for the microbiota and that we should stop using them,” said Benoit Chassaing, a research director at the French National Institute of Health and Medical Research and a co-author of several related studies.

Yet much larger and more ambitious clinical trials in humans are needed, Chassaing added.

For Lewis Rands, who has suffered from gastrointestinal illness, the research fits his own experience as a consumer. Changing his diet to avoid emulsifiers has made a shocking difference, easing symptoms that were debilitating, Rands said.

“Clinically, many patients have reported an improvement in symptoms with such changes,” said Ashwin Ananthakrishnan, a gastroenterologist and researcher at Massachusetts General Hospital.

The scientific findings come with caveats. For instance, much of the research has been done in mice, or by mimicking the human gut in a tube. There are many unknowns. Not all emulsifiers have bad effects, or the same effects, and some people are thought to be much more vulnerable than others.

Even some researchers who have co-authored papers say that the substances have not been proven harmful to humans and that it’s too soon to say regulators should ban them.

Still, the research poses a challenge for the FDA. When emulsifiers began spreading through the food supply, the agency wasn’t focusing on the gut microbiome, a relatively recent scientific frontier, researchers said.

Martin Makary, appointed by President Donald Trump to head the FDA, mentioned the microbiome at his Senate confirmation hearing in March. Though he didn’t cite emulsifiers specifically or identify chemicals by name, he said substances that affect the microbiome deserve the FDA’s attention.

“There’s a body of research now that suggests concern with some of these ingredients,” Makary said. “We have to look at those ingredients, and you have my commitment to do so if confirmed as FDA commissioner.

“These chemicals are creating an inflammatory response in the gastrointestinal tract, and with an altered microbiome lining that GI tract, kids feel sick.”

The FDA and the Department of Health and Human Services did not respond to questions about Makary’s testimony.

However, when journalist Emily Kopp asked HHS for the science behind its recent announcement that it is phasing out petroleum-based food dyes, the agency provided a compilation of information on potentially harmful compounds commonly found in ultraprocessed foods. The document, which appeared to be a draft, included a section on emulsifiers, such as xanthan gum and carrageenan. It noted that the section needed more work.

HHS subsequently provided the document to KFF Health News.

As far back as 2020, an international organization for the study of inflammatory bowel diseases advised that, for people with those conditions, it “may be prudent to limit intake” of maltodextrin, carrageenan, carboxymethyl cellulose, and polysorbate 80.

Emulsifiers are developed from a variety of sources, including plants and bacteria. Some ingredients that might affect the microbiome show up in foods because they were deemed “generally recognized as safe,” or GRAS.

“New information may at any time require reconsideration of the GRAS status of a food ingredient,” the Code of Federal Regulations says.

Ben & Jerry’s vs Häagen-Dazs

Rands, a genetic scientist, took matters into his own hands to battle severe inflammatory bowel disease. The illness caused bloating, stomach pain, cramps, frequent bowel movements, and bleeding, he said.

It left him in a constant state of anxiety and stress, he added, wondering where the nearest bathroom was and whether he’d reach it in time. Even taking a walk around the block with his wife and baby near their home in Australia was problematic.

Then, on the advice of a dietitian, Rands began avoiding foods with emulsifiers: chemicals such as carboxymethyl cellulose, carrageenan, guar gum, xanthan gum, and maltodextrin — plus other additives.

For instance, instead of eating Ben & Jerry’s ice cream, he switched to Häagen-Dazs ice cream that is free of the substances at issue. The relief was dramatic.

“It’s a huge difference,” Rands said. “To me, it’s made more of a difference than any drug.”

He has been able to scale back or stop taking several drugs, which is an added relief — not least because some can have harmful side effects, and, he said, one was taking its toll.

Rands said he used a scientific approach, isolating variables in his diet and logging the results. Avoiding artificial sweeteners helps, he said, but most of the benefit relates to avoiding the emulsifiers.

Ben & Jerry’s did not respond to a request for comment.

‘Science That Hasn’t Been Done Yet’

The Consumer Brands Association, which represents makers of processed foods, stands behind use of the chemicals.

“Food safety and protecting the integrity of the food supply is priority number one for the makers of America’s food and beverage products,” Sarah Gallo, the group’s senior vice president of product policy, said in a statement. “Emulsifiers and thickening agents play an important role in improving food texture and consistency, and have been studied by the FDA through a rigorous scientific and risk-based process.”

Asked for specifics on how the FDA had analyzed potential effects on the microbiome, the group did not respond.

Chassaing said the chemicals were “never considered for the potential effect on the microbiota.”

Robert Califf, who led the FDA under Presidents Barack Obama and Joe Biden, said in an interview that scientists are just beginning to understand the microbiome. He compared it to where the field of genomics was 20 years ago, only much more complicated — “multiplied by a thousand dimensions.”

He said the substances “fell within the standards” when they were greenlighted. “But hopefully most people agree that the standards need to be upgraded,” he added.

“This is different than traditional food safety thinking about, ‘Does it cause an immediate problem?’” Califf said. “We’re talking about long-term health outcomes here.”

And has the FDA evaluated those?

“How could it? There was no way to do it,” Califf said. The answers will vary depending on the emulsifier, and “proving whether it’s bad or good is going to require rigorous science that hasn’t been done yet.”

More recent scientific capabilities expand the possibilities, he said.

‘A Lot of Confusion in the Field’

For a consumer, trying to steer clear of emulsifiers can be difficult. Without realizing it, people can consume a variety of emulsifiers from a variety of foods — and the same chemicals from multiple sources.

Polysorbate 80 was listed as an ingredient on the labels of 2,311 products as of May 12, according to an online database posted by the Environmental Working Group using information from NielsenIQ. Carrageenan was listed on 8,100 product labels; maltodextrin, 12,769; and xanthan gum, 17,153.

Some emulsifiers have multiple names, making them harder to recognize. Some names can apply to more than one emulsifier. And some chemical names that appear on product labels don’t appear in the FDA’s “Substances Added to Food” inventory.

Carboxymethyl cellulose — not to be confused with methyl cellulose — is also known as carboxymethylcellulose  and cellulose gum. Maltodextrin can be derived from substances such as cornstarch, rice starch, and wheat starch — but the FDA doesn’t consider it synonymous with the term “modified food starch.”

The naming practices can frustrate efforts to track the chemicals in food, to measure how much of the stuff people are taking in, and even to figure out precisely which chemicals a scientific study evaluated, researchers said.

“There’s a lot of confusion in the field,” said Christine McDonald, a researcher at the Cleveland Clinic who has studied maltodextrin. She called for more consistent naming of additives in the United States.

The very term “emulsifier” is problematic. By strict definition, emulsifiers create an emulsion — a stable blend of liquids that would not otherwise mix, such as oil and water. However, the term is used broadly, encompassing chemicals such as maltodextrin that thicken, stabilize, or alter texture.

Gummed Up

Emulsifiers can be found in foods marketed as natural or healthy as well as ones that look artificial. Some products contain multiple emulsifiers.

Products sold at Whole Foods, for instance, list a variety of emulsifiers on their labels. 365 brand Organic Vegan Ranch Dressing & Dip contained organic tapioca maltodextrin and xanthan gum.

Pacific Seafood Starfish brand Cornmeal Crusted Fishsticks — marked as wild-caught and MSC-certified (sustainably sourced) — contain guar gum. Flour tortillas by 365 included monoglycerides of fatty acids and “stabilizer (guar gum, xanthan gum, carrageenan).”

At a Safeway supermarket, Healthy Choice Grilled Chicken Pesto With Vegetables listed modified potato starch, modified corn starch, carrageenan, xanthan gum, and guar gum.

The label on Newman’s Own Caesar salad dressing said the product contained no artificial preservatives or flavors, no colors from an artificial source, and was gluten-free. The ingredient label listed, “as a thickener,” xanthan gum.

In response to questions for this article, Whole Foods Market said it prohibits more than 300 ingredients commonly found in food.

“Our experts evaluate ingredients for acceptability in all food products we sell based on the best available scientific research,” the company said in a statement provided by spokesperson Rachel Malish.

Safeway’s parent company, Albertsons Companies, did not respond to inquiries. Nor did Pacific Seafood, Newman’s Own, or Conagra Brands, which makes Healthy Choice.

A Growing Body of Research

Research on emulsifiers has been building in recent years.

For example, a study published in January by the Journal of Crohn’s and Colitis concluded that a diet low in emulsifiers is an effective treatment for mild or moderate Crohn’s disease. The eight-week clinical trial, which tracked 154 patients in the United Kingdom, focused on carrageenan, carboxymethyl cellulose, and polysorbate 80.

A study published in February 2024 in the journal PLOS Medicine found that higher intakes of carrageenan and mono- and diglycerides of fatty acids were associated with higher risks of cancer. The study observed 92,000 French adults for an average of 6.7 years.

A study published in September 2023 in The BMJ, formerly known as the British Medical Journal, found that intake of several types of emulsifiers was associated with the risk of cardiovascular disease. The study observed more than 95,000 French adults for a median of 7.4 years.

A series of earlier studies found that emulsifiers “can promote chronic intestinal inflammation in mice”; that two in particular, carboxymethyl cellulose and polysorbate 80, “profoundly impact intestinal microbiota in a manner that promotes gut inflammation and associated disease states”; and that, based on a laboratory study of human samples, “numerous, but not all, commonly used emulsifiers can directly alter gut microbiota in a manner expected to promote intestinal inflammation,” as recounted in a 2021 paper in the journal Microbiome.

Other findings diverge. A study from Australia, published in February in Alimentary Pharmacology and Therapeutics, followed 24 Crohn’s patients over four weeks and concluded that, in the context of a healthy diet, the emulsifier content had “no influence over disease activity.”

The authors declared conflicts of interest, including payments from PepsiCo, drug companies, and Mindset Health Pty, which promotes hypnosis-based therapy. One of the authors, gastroenterology professor Peter Gibson of Monash University in Australia, said the conflicts of interest “have nothing whatsoever to do with the study.”

“It is important not to overinterpret results of studies,” he said, adding that his team’s report “does not mean that emulsifiers are good for you or that there are no health benefits in avoiding emulsifiers.”

Häagen-Dazs ‘Keeps It Real’

Häagen-Dazs touts the absence of such chemicals as a virtue. “Keeping it real, the way it should be,” it said in an online plug for its vanilla ice cream. “No emulsifiers. No stabilizers.”

However, at the company that makes Häagen-Dazs in the United States, Dreyer’s Grand Ice Cream, there are limits to that approach.

Under other brand names — such as Edy’s, Dreyer’s, and Drumstick — it markets products that contain emulsifiers or stabilizers. The company did not respond to questions. In addition, a spokesperson for Nestlé, which markets Drumstick and Häagen-Dazs brands internationally, did not respond.

Drumstick Vanilla Caramel Sundae Cones have no artificial flavors or colors, the package says — but they feature an array of other ingredients, including soy lecithin, guar gum, monogylcerides, and carob bean gum.

The cones, the company’s website says, offer “one incredibly creamy experience.”

But the creamy filling doesn’t melt. Instead, over 24 hours on a KFF Health News reporter’s kitchen counter, it bled a caramel-tinged fluid and shrank into a sticky white foam that could be cut with a knife.

KFF Health News is a national newsroom that produces in-depth journalism about health issues.

Cactus-Like Plant Shows Promise as Treatment for Intractable Cancer Pain

By Pat Anson

Throughout history, humans have often turned to plants and herbs for pain relief. Poppy plants gave us opium, aspirin was derived from willow trees, and peppermint oil is used to relieve everything from migraines to joint pain. Turmeric, ginger, lavender, eucalyptus and capsaicin are staples in many topical analgesics.

Researchers at the National Institutes of Health (NIH) say a cactus-like shrub native to Morocco also shows promise as a treatment for severe cancer pain and other types of intractable pain.

In a small pilot study recently published in the journal NEJM Evidence, they reported that injections of resiniferatoxin (RTX), a molecule derived from resin spurge (Euphorbia resinifera), provided durable pain relief to patients with terminal end-stage cancer.

"The effects are immediate," lead author Andrew Mannes, MD, chief of the NIH Clinical Center Department of Perioperative Medicine, said in a press release. "This is a potential new therapy from a new family of drugs that gives people with severe cancer pain an opportunity to return some normality to their lives."

The study involved 19 patients with terminal end-stage cancer who did not get adequate pain relief from opioids and other pharmaceutical drugs. But after a single injection of RTX, their worst pain intensity fell by 38% and their use of opioids by 57%. Quality of life also improved, allowing the patients to reengage with family and friends in their final days.

NIH scientists believe RTX has the potential to treat other pain conditions, including other types of cancer pain, neuropathy, post-surgical pain, trigeminal neuralgia, and chronic nerve pain caused by chemotherapy.

"Targeting specific nerves brings many pain disorders into the range of RTX and allows physicians to tailor the treatment to the patient's pain problem. This interventional approach is a simple path to personalized pain medicine," said senior author Michael Iadarola, PhD, a research scientist in the NIH Clinical Center Department of Perioperative Medicine.

RTX acts similarly to capsaicin, the active molecule in chili pepper, by numbing nerve fibers in damaged tissue and blocking them from sending pain signals to the brain. RTX enters the TRPV1 ion channel in the peripheral nervous system, allowing an overload of calcium to flood into the nerve fiber. Patients are still able to feel mild sensations like touch, pressure and pin pricks, but more severe pain signals are blocked.

"Basically, RTX cuts the pain-specific wires connecting the body to the spinal cord, but leaves many other sensations intact," Iadarola said. "These TRPV1 neurons are really the most important population of neurons that you want to target for effective pain relief."

"What makes this unique from all the other things that are out there is that it is so highly selective," Mannes said. "The only thing it seems to take out is heat sensation and pain."

People in North Africa knew this thousands of years ago. The first written record of Euphorbia resinifera being used for pain control dates back to the time of the Roman Emperor Augustus, when dried latex from the plant was used as medicine.

The NIH is planning further studies of RTX in clinical trials.

A Non-Alcoholic Drink Can Help You Relax, Socialize and May Even Relieve Pain

By Madora Pennington

I am going for a month without drinking, not because I have a problem with alcohol or because alcohol is interfering with my life. I don't and it isn't.

I just got back from a long vacation, which included an 8-day all-inclusive cruise. We wanted to get our money’s worth. After weeks of drinking every day, it seemed only sensible to take a full break from alcohol. No one would argue that so much drinking is healthy.

I am not alone. You may have heard about the “sober curious” — those who abstain to see what socializing, stress, and life itself is like without alcohol. Young adults, overall, are drinking less alcohol. These trends are fueling the demand for non-alcoholic, yet interesting drinks that seem sophisticated or reminiscent of a cocktail.

But is there a non-alcoholic drink that also helps you relax and socialize? I found a company, Sentia Spirits, that makes beverages that enhance your body’s production of GABA

Don’t confuse GABA (gamma-aminobutyric acid) with the nerve pain medication gabapentin (Neurontin). GABA is a naturally occurring neurotransmitter that sends signals in the brain and spinal cord, while gabapentin is a synthetic variation of GABA. The medication acts similarly as GABA, but tends to cause many unwanted side effects. Benzodiazepines, SSRI antidepressants, muscle relaxers, and other drugs also affect GABA in the body.

Sentia’s beverages contain herbs and botanicals that improve mood, focus, calmness, and energy. Their concoctions taste more like bitters than a mocktail, but certainly provide an interesting experience for the palate.

I found them to be subtly relaxing, without the impairment of an alcohol-induced buzz.

GABA itself is also available in supplements that people take to relax and improve sleep. It may also help relieve pain. When GABA binds to pain receptors, it reduces the transmission of pain signals, potentially providing relief from various types of physical discomfort.

SENTIA SPIRITS

Research has found that low levels of GABA make it harder to keep negative emotions such as fear, anxiety and depression in check, and may also worsen chronic pain. As PNN has reported, Dr. Forest Tennant recommends GABA supplements for patients with intractable pain "to force damaged nerve tissue to correctly function and relieve pain.”  

As far as reasons for abstaining, alcohol worsens depression. And people with alcohol use disorder often have chronic pain, which means they could be self-medicating.

Using supplemental GABA or medications that promote it could be a useful strategy in managing the spiral of chronic pain on the body and brain. Many sources suggest taking GABA on an empty stomach to give it a better chance of reaching the brain.

Limiting alcohol intake might also be a wise choice for anyone. Certainly, finding ways to diminish stress and improve sleep should be part of pain management.

Sentia costs about $40 for a 500ml bottle, which is enough for 20 shot-sized servings. If you don't want it straight or want to make it look like a cocktail, you can mix it with tonic water.

Talk to your healthcare provider about your pain control regimen and how to improve it before taking GABA or any supplement.

I enjoyed my time of sobriety very much. I thought I would miss drinking, but did not. The sleepiness and haziness from a glass of wine is stronger than I realized, and it doesn’t make socializing more fun for me. I ended my sober curious time with a resolve to drink less overall.

Care and Control of Adhesive Arachnoiditis Depends on Water

By Dr. Forest Tennant

Chronic illness tends to decrease one’s desire to drink fluids. If you have Adhesive Arachnoiditis (AA), however, you must drink some fluids about every 2 hours while awake. Why?

AA is an inflammatory disease of the spinal canal in which cauda equina nerve roots become attached by adhesions to the arachnoid-dural membranes covering the spinal canal. 

The arachnoid membrane is unique among tissues in the body as it doesn’t have its own blood supply. No arteries feed into it. Consequently, it depends on a “full tank” of spinal fluid that comes from the fluids you drink. Spinal fluid brings nutrients and medication to the arachnoid. It also bathes the inflamed area and washes away inflammatory waste and toxins.

Spinal fluid must be constantly kept at a high level. The body makes about 500 milliliters (17 ounces) of spinal fluid a day. If you are dehydrated due to lack of regular fluid intake, you may not make enough spinal fluid to control AA, including its pain.

Water Soak Every Day

Soaking in water daily is also important to control pain and inflammation from AA.

Water soaking is an age-old remedy for pain that is still worthwhile. It is believed to relieve pain by relaxing muscles and increasing blood flow to damaged areas of the body.  

Water soaking also extracts excess bioelectricity and inflammatory toxins that have accumulated due to inflammation and damage to the neurologic circuitry in the body. 

Here is a list of water soaking measures that are applicable to a person with AA: 

1. Stand in the shower and let water flow off your back, neck and legs.

2. Immerse your body up to your neck in a bathtub, hot tub, jacuzzi or pool.

3. Drape a warm, water-soaked towel over your back.

4. Soak your feet and ankles in warm water.

The soaks should be done for 5 to 15 minutes. Minerals or herbs can be put in foot baths. The most popular mineral preparation is Epsom Salts.

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.

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

Flexible Implant Could Be Alternative to Spinal Cord Stimulators

By Pat Anson

Spinal cord stimulators have long been fraught with problems. First developed in the 1960’s, the devices are surgically implanted near the spine to deliver mild electric impulses that block pain signals from traveling to the brain.

Although their design and technology have improved over the years, making them smaller, rechargeable and programmable, spinal cord stimulators (SCSs) still have high failure rates and poor safety records. Recent studies have also questioned their effectiveness in treating back pain.

Researchers at the University of Southern California have developed an alternative: a small, flexible, wireless, and battery-free implant that could overcome some of the limitations of SCSs.

NATURE ELECTRONICS

The experimental device, recently introduced in a paper published in Nature Electronics, is powered by a wearable ultrasound transmitter and uses machine learning algorithms to customize treatment for each patient. The implant is designed to bend and twist, unlike traditional stimulators that tend to be bulky and are hard-wired to batteries.

“Implantable percutaneous electrical stimulators… are expensive, can cause damage during surgery and often rely on a battery power supply that must be periodically replaced. Here we report an integrated, flexible ultrasound-induced wireless implantable stimulator combined with a pain detection and management system for personalized chronic pain management," wrote a team of researchers at USC’s Alfred E. Mann Department of Biomedical Engineering.

The researchers tested the wireless stimulator in laboratory rodents experiencing different levels of pain. They found the device accurately predicted the levels of stress experienced by the animals and adapted the electrical stimulation it delivered, easing most of their pain.

“We classify pain stimuli from brain recordings by developing a machine learning model and program the acoustic energy from the ultrasound transmitter and, therefore, the intensity of electrical stimulation," researchers said. "The implant can generate targeted, self-adaptive and quantitative electrical stimulations to the spinal cord according to the classified pain levels for chronic pain management in free-moving animal models."

The research team is planning further tests on other lab animals, with the goal of eventually testing the device in clinical trials on humans.

About 50,000 traditional spinal cord stimulators are implanted every year in the U.S., where they are promoted as alternatives to opioids and other pain treatments. However, a 2022 study found that SCSs do not reduce patient use of opioids, epidurals, steroid injections or radiofrequency ablation. About a fifth of patients experienced complications so severe the devices had to be removed or revised.

‘Zombie’ Nerve Cells Make Chronic Pain Worse

By Pat Anson

The zombies are at it again.

Weeks after researchers announced a new way to treat low back pain by targeting so-called zombie cells – a new study suggests that peripheral nerve pain could also be treated with drugs that target aging cells.

Senescent neurons are cells that stop dividing, but refuse to die and linger in the central nervous system. As people age, more and more of these “zombie cells” build up, secreting inflammatory agents that increase pain sensitivity and raise the risk of age-related diseases like arthritis, Alzheimer’s and Parkinson’s.

“Very little is known about underlying causes of pain experienced during aging. The prevalence of chronic pain in aging populations and the lack of effective and non-addictive treatments motivated this exploration into neuronal senescence as a potential mechanism,” Lauren Donovan, PhD, a research scientist at Stanford University, told PsyPost.

In studies on laboratory animals, Donovan and her colleagues at Stanford found that pain was amplified in older mice by senescent cells, which released inflammatory signals when the mice were injured. The same inflammatory reaction was found in younger mice, but was more pronounced in the older ones.

When the injured mice were treated with a drug called ABT263 – a compound that destroys senescent cells – the older mice showed less pain sensitivity and significant improvement in their weight-bearing behavior.

The younger mice treated with ABT263 showed only modest improvements in their pain-related behavior, which suggests that senescent cells play a significant role in causing chronic pain.

“The key takeaway for the average person is that as we age, some of our sensory neurons undergo a process called senescence, which may contribute to chronic pain,” said Donovan, who reported the findings in the journal Nature Neuroscience.

“In addition, we found that injury can exacerbate senescence in neurons, leading to an additive effect of aging and injury that may enhance pain. This research identifies a new potential target for treating chronic pain, especially in older individuals. It suggests that addressing cellular senescence in the nervous system can lead to new ways of managing pain and sensory dysfunction.”

Researchers at McGill University reported similar findings last month in studies on laboratory mice with damaged discs. When the mice were given drugs that targeted senescent cells in their spines, they experienced less pain and their bone quality improved.

Previous animal studies have shown that senolytic drugs can reverse osteoarthritis by eliminating senescent cells, giving the body a chance to repair and rejuvenate damaged cartilage.

The findings need to be replicated in humans, but they suggest that senolytic drugs that target zombie cells have the potential to prevent or even cure some age-related diseases.

Online Emotional Support Therapy Modestly Reduces Chronic Pain

By Pat Anson

An online support program designed to “retrain the emotional brain” modestly reduces chronic pain and helps patients keep their negative emotions in check, according to a small pilot study in Australia.

Many people with chronic pain also develop anxiety and depression, but are unable to get psychological treatment because they live in rural areas or have mobility issues, and don’t have easy access to a therapist.

“We’ve known now for some time that chronic pain is more than just ‘Ouch, it hurts.’ It’s more than a sensory experience, it’s incredibly emotional,” says lead author Nell Norman-Nott, PhD, a research fellow at the University of New South Wales and clinical trial manager at the NeuroRecovery Research Hub.

Norman-Nott and her colleagues enrolled 89 people with chronic pain in the “Pain and Emotion Therapy” program. Half of the patients participated in 8 weekly group sessions over Zoom, in which a therapist teaches them emotional skills such as distraction, breathing exercises, and relaxation and self-soothing techniques.

The other participants received the treatment they were already getting, such as medication or physical therapy, and served as a control group.

The study findings, published in JAMA Network Open, show that after 9 weeks there were moderate improvements in depression, anxiety and sleep in those that received online therapy. But there was no change in pain intensity compared to those in the control group.

However, after a 6-month follow-up period, participants reported a 10% reduction in their pain levels, as well as continued improvement in their emotions and sense of well-being.

One of them is Janelle Blight, who lives with chronic back pain, arthritis and neuropathic pain. For the first time in 30 years, she was able to reduce her morphine dose after getting online therapy.

“I’ve been on a lot of opioids and things like that, but I’ve had nothing or found no course that’s been able to help take away the pain or help control the pain at home,” said Blight. “By doing the course, I’ve been able to learn how to reduce my emotional side of my pain, which has helped my chronic pain in the end.”

During a briefing with reporters, researchers called the study a “major step forward in pain care.” But in the actual study, they said the 10% reduction in pain intensity after six months was not well understood and “should be treated with caution.” The improvement was dependent on participants continuing to use the emotional skills they developed during online therapy.

Researchers hope to build on what they’ve learned with a larger study involving 300 participants in 2026. Registrations are open (for Australians only) on the NeuroRecovery Research Hub website.

How Workplace Conditions Contribute to Chronic Pain and Mental Health Issues

By Pat Anson

If you are of a certain age – like me – you’ll remember when computers started entering the workplace in the 1980’s. There was a huge learning curve, but eventually work became faster and more efficient.

There was also a tradeoff: employees reported back and neck pain from sitting at keyboards all day, and carpal tunnel syndrome became a thing. Companies learned about the hazards of repetitive motion, and how chair height, limited desk space and poorly shaped computer mouses affected worker health, absenteeism and productivity. A new industry was born: ergonomics.

Flash forward 40 years and companies are now being urged to think about “emotional ergonomics” – how workplace stress contributes to anxiety, depression, burnout, and chronic pain.

“Physical pain is often a symptom of deeper, underlying stressors—from job pressures to mental health challenges. Addressing industrial ergonomics without considering emotional well-being is an incomplete strategy. The most forward-thinking companies recognize that true injury prevention must integrate both,” says Kevin Lombardo, CEO of the DORN Companies.

DORN has partnered with organizations that specialize in ergonomics, business psychology, and suicide prevention on a new white paper called “Emotional Ergonomics: How the Intersection of Industrial Ergonomics, Pain, and Mental Health Shapes Worker Wellbeing.”

The paper’s main findings are that workplace conditions deeply affect the physical and mental health of workers, and that organizations must address them together to have a healthy, high-performing workforce. Workplace stress affects 40% of employees in the United States and contributes to about $190 billion in added healthcare costs.

Unlike the 1980’s, when most jobs entailed a 40-hour work week and were performed outside the home, today’s knowledge-driven economy blurs the lines between professional and personal lives. Employees may get work-related emails or texts at all hours of the day and night, and a growing number work from home. This increases exposure to stress, cognitive demands, poor sleep habits, and the psychosocial risks that come with juggling work, family and personal time.

A recent study found that stress and anxiety have become the most common work-related injuries, accounting for over half (52%) of new cases. That trend is mirrored in Google searches for “burnout,” which have risen dramatically in the last 10 years.

“This research signals a necessary shift in how we approach workplace well-being. Emotional Ergonomics bridges the gap between physical safety and mental resilience, ensuring that employee health is not just a compliance checkbox but a business imperative. Organizations that fail to recognize this connection risk long-term workforce instability and financial strain,” says Dr. Sally Spencer-Thomas, President of United Suicide Survivors International.

Common psychosocial hazards in the workplace include:

• Excessive workload and time pressures

• Toxic relationships between coworkers and supervisors

• Hazing, bullying, harassment and discrimination

• Exposure to workplace accidents and trauma

• Low autonomy and limited decision-making

• Job insecurity

• Work-Life disruption

To address these issues, companies can adjust workloads and allow for more flexible scheduling; adopt health and wellness programs; train supervisors in empathetic communication skills; and allow for “quiet time” and space where workers can decompress from job strain.

The goal is to view workers not as cogs in a machine, but as individuals with different physical, emotional, and psychological needs. An “I’ve got your back” mentality in the workplace builds trust and helps employees feel valued.  

To learn more about the study findings and ways to build emotional ergonomics, you can sign up to watch a live webinar on Wednesday, May 21.

Drugs Targeting ‘Zombie Cells’ May Reduce Low Back Pain

By Pat Anson

Low back pain is one of the most common and difficult pain conditions to treat. Although it’s the leading cause of disability worldwide, a recent study found that only about 10% of pharmaceutical and non-surgical therapies for low back pain provide relief. More invasive treatments, such as spinal injections and nerve blocks, have also been found to be no more effective than a placebo.

In short, there’s not much evidence to support the use of many treatments commonly used for low back pain -- which makes a preclinical study on two potential treatments all the more interesting.

Low back pain is commonly caused by senescent cells, so-called “zombie cells” that build up in spinal discs as people age or when discs are damaged. Instead of dying off like normal cells, these aging cells linger in the spine, causing pain and inflammation.

In experiments on laboratory mice, researchers at McGill University found that two drugs – o-vanillin and RG-7112 -- can clear zombie cells from the spine, reduce pain and improve bone quality. O-vanillin is a natural compound, while RG-7112 is an FDA-approved cancer drug that shrinks tumors.

“Our findings are exciting because it suggests we might be able to treat back pain in a completely new way, by removing the cells driving the problem, not just masking the pain,” said senior author Lisbet Haglund, PhD, a Professor in McGill’s Department of Surgery and Co-director of the Orthopaedic Research Laboratory at Montreal General Hospital.

Haglund and her colleagues found that o-vanillin and RG-7112 had a beneficial effect when taken separately, but their impact was greatest when they were taken together orally.  After just eight weeks of treatment, the drugs slowed or even reversed disc damage in mice.  

“We were surprised that an oral treatment could reach the spinal discs, which are hard to access and present a major hurdle in treating back pain,” said Haglund. “The big question now is whether these drugs can have the same effect in humans.”

O-vanillin belongs to a family of spicy and pungent natural compounds known as vanilloids, which are found in chili peppers and turmeric. Vanilloids are already used to control inflammation and reduce pain in topical patches like Qutenza.

O-vanillin was not originally intended to be part of the McGill study. But while testing other drugs, researchers decided to include o-vanillin to see whether it might be effective when taken orally. The results offer some of the first evidence that o-vanillin can clear out zombie cells. Analogs of RG-7112 were already known to do this in osteoarthritis and cancer research, but had not previously been used to treat back pain.

The McGill findings are published in the journal Science Advances. In future studies, Haglund’s team hopes to modify o-vanillin to help it stay in the body longer and become more effective. In addition to back pain, they believe the two drugs have the potential to treat other age-related diseases driven by senescent cells, such as arthritis and osteoporosis.

Physical Therapy Coverage Often Ends When Patients Still Need It

By Jordan Rau, KFF Health News

Mari Villar was slammed by a car that jumped the curb, breaking her legs and collapsing a lung. Amy Paulo was in pain from a femur surgery that wasn’t healing properly. Katie Kriegshauser suffered organ failure during pregnancy, weakening her so much that she couldn’t lift her baby daughter.

All went to physical therapy, but their health insurers stopped paying before any could walk without assistance. Paulo spent nearly $1,500 out of her own pocket for more sessions.

Millions of Americans rely on physical and occupational therapists to regain strength and motor skills after operations, diseases, and injuries. But recoveries are routinely stymied by a widespread constraint in health insurance policies: rigid caps on therapy sessions.

Insurers frequently limit such sessions to as few as 20 a year, a KFF Health News examination finds, even for people with severe damage such as spinal cord injuries and strokes, who may need months of treatment, multiple times a week. Patients can face a bind: Without therapy, they can’t return to work, but without working, they can’t afford the therapy.

Paulo said she pressed her insurer for more sessions, to no avail. “I said, ‘I’m in pain. I need the services. Is there anything I can do?’” she recalled. “They said, no, they can’t override the hard limit for the plan.”

A typical physical therapy session for a privately insured patient to improve daily functioning costs $192 on average, according to the Health Care Cost Institute. Most run from a half hour to an hour.

Insurers say annual visit limits help keep down costs, and therefore premiums, and are intended to prevent therapists from continuing treatment when patients are no longer improving. They say most injuries can be addressed in a dozen or fewer sessions and that people and employers who bought insurance could have purchased policies with better therapy benefits if it was a priority.

Atul Patel, a physiatrist in Overland Park, Kansas, and the treasurer of the American Academy of Physical Medicine and Rehabilitation, said insurers’ desire to prevent gratuitous therapy is understandable but has “gone too far.”

“Most patients get way less therapy than they would actually benefit from,” he said.

Hard caps on rehab endure in part because of an omission in the Affordable Care Act. While that law required insurers to cover rehab and barred them from setting spending restrictions on a patient’s medical care, it did not prohibit establishing a maximum number of therapy sessions a year.

More than 29,000 ACA health plans — nearly 4 in 5 — limit the annual number of physical therapy sessions, according to a KFF Health News analysis of plans sold last year to individuals and small businesses. Caps generally ranged from 20 to 60 visits; the most common was 20 a year.

Health plans provided by employers often have limits of 20 or 30 sessions as well, said Cori Uccello, senior health fellow at the American Academy of Actuaries.

“It’s the gross reality in America right now,” said Sam Porritt, chairman of the Falling Forward Foundation, a Kansas-based philanthropy that has paid for therapy for about 200 patients who exhausted their insurance over the past decade. “No one knows about this except people in the industry. You find out about it when tragedy hits.”

Even in plans with no caps, patients are not guaranteed unlimited treatment. Therapists say insurers repeatedly require prior authorization, demanding a new request every two or three visits. Insurers frequently deny additional sessions if they believe there hasn’t been improvement.

“We’re seeing a lot of arbitrary denials just to see if you’ll appeal,” said Gwen Simons, a lawyer in Scarborough, Maine, who represents therapy practices. “That’s the point where the therapist throws up their hands.”

‘Couldn’t Pick Her Up’

Katie Kriegshauser, a 37-year-old psychologist from Kansas City, Missouri, developed pregnancy complications that shut down her liver, pancreas, and kidneys in November 2023.

After giving birth to her daughter, she spent more than three months in a hospital, undergoing multiple surgeries and losing more than 40 pounds so quickly that doctors suspected her nerves became damaged from compression. Her neurologist told her he doubted she would ever walk again.

Kriegshauser’s UnitedHealthcare insurance plan allowed 30 visits at Ability KC, a rehabilitation clinic in Kansas City. She burned through them in six weeks in 2024 because she needed both physical therapy, to regain her mobility, and occupational therapy, for daily tasks such as getting dressed.

“At that point I was starting to use the walker from being completely in the wheelchair,” Kriegshauser recalled. She said she wasn’t strong enough to change her daughter’s diaper. “I couldn’t pick her up out of her crib or put her down to sleep,” she said.

The Falling Forward Foundation paid for additional sessions that enabled her to walk independently and hold her daughter in her arms. “A huge amount of progress happened in that period after my insurance ran out,” she said.

In an unsigned statement, UnitedHealthcare said it covered the services that were included in Kriegshauser’s health plan. The company declined to permit an official to discuss its policies on the record because of security concerns.

A Shattered Teenager

Patients who need therapy near the start of a health plan’s year are more likely to run out of visits. Mari Villar was 15 and had been walking with high school friends to get a bite to eat in May 2023 when a car leaped over a curb and smashed into her before the driver sped away.

The accident broke both her legs, lacerated her liver, damaged her colon, severed an artery in her right leg, and collapsed her lung. She has undergone 11 operations, including emergency exploratory surgery to stop internal bleeding, four angioplasties, and the installation of screws and plates to hold her leg bones together.

Villar spent nearly a month in Shirley Ryan AbilityLab’s hospital in Chicago. She was discharged after her mother’s insurer, Blue Cross and Blue Shield of Illinois, denied her physician’s request for five more days, making her more reliant on outpatient therapy, according to records shared by her mother, Megan Bracamontes.

Villar began going to one of Shirley Ryan’s outpatient clinics, but by the end of 2023, she had used up the 30 physical therapy and 30 occupational therapy visits the Blue Cross plan allowed.

Because the plan ran from July to June, she had no sessions left for the first half of 2024.

MARI VILLAR AND HER THERAPIST

“I couldn't do much,” Villar said. “I made lots of progress there, but I was still on crutches.”

Dave Van de Walle, a Blue Cross spokesperson, said in an email that the insurer does not comment on individual cases. Razia Hashmi, vice president for clinical affairs at the Blue Cross Blue Shield Association, said in a written statement that patients who have run out of sessions should “explore alternative treatment plans” including home exercises.

Villar received some extra sessions from the Falling Forward Foundation. While her plan year has reset, Villar is postponing most therapy sessions until after her next surgery so she will be less likely to run out again. Bracamontes said her daughter still can’t feel or move her right foot and needs three more operations: one to relieve nerve pain, and two to try to restore mobility in her foot by lengthening her Achilles tendon and transferring a tendon in her left leg into her right.

“Therapy caps are very unfair because everyone’s situation is different,” Villar said. “I really depend on my sessions to get me to a new normalcy. And not having that and going through all these procedures is scary to think about.”

Rationing Therapy

Most people who use all their sessions either stop going or pay out-of-pocket for extra therapy.

Amy Paulo, a 34-year-old Massachusetts woman recovering from two operations on her left leg, maxed out the 40 visits covered by Blue Cross Blue Shield of Massachusetts in 2024, so she spent $1,445 out-of-pocket for 17 therapy sessions.

Paulo needed physical therapy to recover from several surgeries to shorten her left leg to the length of her right leg — the difference a consequence of juvenile arthritis. Her recovery was prolonged, she said, because her femur didn’t heal properly after one of the operations, in which surgeons cut out the middle of her femur and put a rod in its place.

“I went ballistic on Blue Cross many, many times,” said Paulo, who works with developmentally delayed children.”

Amy McHugh, a Blue Cross spokesperson, declined to discuss Paulo’s case. In an email, she said most employers who hire Blue Cross to administer their health benefits choose plans with “our standard” 60-visit limit, which she said is more generous than most insurers offer, but some employers “choose to allow for more or fewer visits per year.”

Paulo said she expects to restrict her therapy sessions to once a week instead of the recommended twice a week because she’ll need more help after an upcoming operation on her leg.

“We had to plan to save my visits for this surgery, as ridiculous as it sounds,” she said.

Medicare Is More Generous

People with commercial insurance plans face more hurdles than those on Medicare, which sets dollar thresholds on therapy each year but allows therapists to continue providing services if they document medical necessity. This year the limits are $2,410 for physical and speech therapy and $2,410 for occupational therapy.

Private Medicare Advantage plans don’t have visit or dollar caps, but they often require prior authorization every few visits. The U.S. Senate Permanent Subcommittee on Investigations found last year that MA plans deny requests for physical and occupational therapy at hospitals and nursing homes at higher rates than they reject other medical services.

Therapists say many commercial plans require prior authorization and mete out approvals parsimoniously. Insurers often make therapists submit detailed notes, sometimes for each session, documenting patients’ treatment plans, goals, and test results showing how well they perform each exercise.

“It’s a battle of getting visits,” said Jackee Ndwaru, an occupational therapist in Jacksonville, Florida. “If you can’t show progress they’re not going to approve.”

An Insurer Overruled

Marjorie Haney’s insurance plan covered 20 therapy sessions a year, but Anthem Blue Cross Blue Shield approved only a few visits at a time for the rotator cuff she tore in a bike accident in Maine. After 13 visits in 2021, Anthem refused to approve more, writing that her medical records “do not show you made progress with specific daily tasks,” according to the denial letter.

Haney, a physical therapist herself, said the decision made no sense because at that stage of her recovery, the therapy was focused on preventing her shoulder from freezing up and gradually expanding its range of motion.

“I went through those visits like they were water,” Haney, now 57, said. “My range was getting better, but functionally I couldn’t use my arm to lift things.”

Haney appealed to Maine’s insurance bureau for an independent review. In its report overturning Anthem’s decision, the bureau’s physician consultant, William Barreto, concluded that Haney had made “substantial improvement” — she no longer needed a shoulder sling and was able to return to work with restrictions. Barreto also noted that nothing in Anthem’s policy required progress with specific daily tasks, which was the basis for Anthem’s refusal.

“Given the member’s substantial restriction in active range of motion and inability to begin strengthening exercises, there is remaining deficit that requires the skills and training of a qualified physical therapist,” the report said.

Anthem said it requires repeated assessments before authorizing additional visits “to ensure the member is receiving the right care for the right period of time based on his or her care needs.” In the statement provided by Stephanie DuBois, an Anthem spokesperson, the insurer said this process “also helps prevent members from using up all their covered treatment benefits too quickly, especially if they don’t end up needing the maximum number of therapy visits.”

In 2023, Maine passed a law banning prior authorization for the first 12 rehab visits, making it one of the few states to curb insurer limitations on physical therapy. The law doesn’t protect residents with plans based in other states or plans from a Maine employer who self-insures.

Haney said after she won her appeal, she spaced out the sessions her plan permitted by going once weekly. “I got another month,” she said, “and I stretched it out to six weeks.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues.