People Who Live in Rural Areas Have More Pain and Less Access to Treatment

By Crystal Lindell 

A new study by researchers at the University of Texas at Arlington found that people living in rural areas have significantly higher rates of chronic pain than those who live in big cities. They’re also at a big disadvantage when it comes to getting their pain treated.

As a rural resident myself for the last 11 years, I have some thoughts as to why this might be. I think one of the causes may be a little different than what researchers often assume. 

The study used data from a national health survey of over 10,000 people in 2019, and then followed up with them a year later in 2020. 

Respondents were split into four pain categories; those with no pain, nonchronic acute pain, chronic pain, and high-impact chronic pain (HICP), which is pain that significantly impacts daily life.

Participants were then assigned to one of four urban-rural metro areas based on where they live: Large Central Metro (big cities with at least one million people), Large Fringe Metro, Medium and Small Metro, and Non-Metropolitan (Rural).

The chart below shows that the highest rates of chronic pain (27.8%) and HICP (10.4%) were found in rural non-metropolitan areas. Pain rates were progressively lower in metro areas with more people. 

Notably, 43.1% of the people living in big cities had “no pain,” while only 34% of those in rural areas were pain free. That’s a statistically big difference.

The Journal of rural health

“We already know about the rural-urban gap in mortality and life expectancy,” said Feinuo Sun, PhD, an assistant professor of kinesiology at UT Arlington and lead author of the study in The Journal of Rural Health.

“But when you look at pain, especially chronic pain, it becomes clear that rural residents face additional burdens.”

Sun and her colleagues say their findings highlight the rural disadvantage that exists in pain development and treatment. Due to health care shortages in rural areas, people have limited access to pain treatment and lower quality services.

They also found that the percentages of people transitioning from milder pain conditions in 2019 to more severe ones in 2020 were highest in rural areas. Even when starting from the same baseline pain status, people in rural areas fared worse after one year compared to those in urban areas.

“Without early intervention, (chronic pain) can have serious long-term consequences, including premature mortality. That's why targeted outreach and early pain management strategies are so important," said Sun.

Rural residents are also more likely to work physically demanding jobs and experience higher poverty rates, both of which contribute to chronic pain.

Those are definitely contributing factors. People who live near me in northern Illinois tend have more physically demanding work, such as farming and construction, and they have a much harder time accessing good healthcare. 

Personally, I have to drive almost two hours each way just to see my primary care physician, because I have to get more complex pain care. That’s where the closest university hospital is to my house. 

Lower Cost of Living

But there’s another reason that is easy to overlook if you don’t live out here: Rural areas are much cheaper than urban ones. 

That’s literally the reason I choose to live in a rural area. The rent in my area is astronomically cheaper than nearby metro areas, and much less compared than a big city like Chicago. 

If you're managing a life with chronic pain, you’re going to be less likely to be able to work and you’re also going to be more likely to spend more of your income on medical expenses. You’ll need a cheaper place to live.

Additionally, many people move out to rural areas like mine because it’s easier to live on Social Security, disability or pensions. None of those benefits increase based on your local cost of living, so it makes sense to live in a rural area where the same amount of money can go much further. 

So it’s not always physically demanding labor that causes more pain in rural areas. It’s being in chronic pain that makes it more likely you’ll move to or stay in a rural community.

Of course, the researchers also found an association with opioid medication, because what would a pain study be in 2025 if the authors didn’t link it in some way to opioids?

The UT researchers think that  “elevated pain levels, along with fewer treatment options, may help explain the heavier reliance on opioids” in rural communities. They’re already working on a follow-up study to examine disparities in pain care. I can already tell them some of the answers they seek. 

People in rural areas are more likely to take opioids for pain care because they are incredibly cheap and accessible. Even if a rural area doesn’t have a local pharmacy, you still have access to mail-order pharmacies. 

And if a rural area doesn’t have a physical therapist, acupuncturist or a massage therapist, there are few alternatives besides opioids. Opioids also require fewer appointments with providers, which are at a premium when doctors are 2 hours away or more.

In the end, geography shapes both our pain and standard of living. Rural areas need better access to healthcare and more populated areas need lower costs of living. We can help people, we just have to work in both directions.  

Former CDC Commissioner: Kratom Has ‘Low Abuse Potential’

By Pat Anson

The U.S. Food and Drug Administration has a conflicted and contentious history with kratom, the herbal supplement used by millions of Americans to self-treat their pain, anxiety, and depression.  

Kratom has been used for centuries in southeast Asia as a natural stimulant and pain reliever, but only in the past decade has it become widely available in the United States -- over the strong objections of the FDA.

In 2016, the FDA joined with the DEA in proposing that kratom be classified as an illegal Schedule I controlled substance due to its abuse potential, a request that was later withdrawn due to a public outcry.

That setback didn’t stop then-FDA Commissioner Scott Gottlieb, MD, from launching a public relations campaign demonizing and mischaracterizing kratom as an addictive “opioid.” Gottlieb cited FDA research that an Assistant Secretary for Health later called “embarrassingly poor evidence & data.”

To improved its data, last year the FDA said it would conduct a new study on the risks and safety of kratom, and then abruptly cancelled it without explanation, claiming kratom has a “chemical affinity” with opioids and should not be used to treat medical conditions. “The use of this substance, that has yet to be tested and determined safe for use in human population by the Agency, is a significant concern,” the FDA said.

The claim that kratom “has yet to be tested and determined safe” is misleading, because the FDA had just completed a pilot study showing that kratom is relatively safe, even at doses as high as 12 grams -- the equivalent of taking 24 capsules of kratom leaf powder within five minutes.   

“In 2024, the FDA completed a single ascending-dose clinical trial examining ground kratom leaf in experienced users. The results were illuminating: participants experienced no serious adverse events at doses up to 12 grams, with side effects limited to mild nausea and pupil constriction. Crucially, subjective ‘drug liking’ scores never reached statistical significance compared to placebo, indicating low abuse potential for natural leaf,” former CDC Commissioner Robert Redfield, MD, said in an op/ed published today in The Hill.

Redfield’s comment is notable, because the FDA itself has never had much to say about its 2024 study and still hasn’t posted the final results. According to the American Kratom Association, FDA researchers were "profoundly disappointed” at the lack of adverse events associated with kratom, as that doesn’t square with the agency’s long-held public position on kratom.

Redfield may be reassured of the safety of natural kratom, but he thinks the federal government should take emergency action to ban the import and sale of synthetic kratom extracts, which have elevated levels of 7-hydroxymitragynine, an alkaloiid that is present in only minute amounts in the natural leaf. Kratom extracts have been associated with serious adverse events and overdoses.  

Redfield says synthetic kratom has “pharmaceutical-grade opioid chemistry” and should be taken off the market immediately. But he thinks natural kratom is relatively safe, and cites the 2024 study as evidence.

“This clinical evidence establishes a critical scientific baseline: natural kratom leaf, when used as it has been for centuries, presents a markedly different risk profile than the synthetic products flooding American markets,” Redfield wrote. “This is not about banning kratom. Full spectrum kratom, used responsibly, appears to have acceptable safety margins based on FDA’s own clinical data. This is about preventing synthetic opioids from hiding behind botanical names.”

The FDA still has “serious safety concerns” about natural kratom, but has little evidence to back them up and is apparently slow-walking research. Only two federally-funded kratom studies are currently recruiting participants. One would study the effects of natural kratom and the potential for withdrawal, while the second trial would study the effects of kratom extracts.

Both studies are small and won’t be completed until 2028 —- over a decade after the agency tried to get kratom banned nationwide.

Seniors Should Be Cautious Using Gummies and Other Cannabis Products

By Paula Span, KFF Health News

Benjamin Han, a geriatrician and addiction medicine specialist at the University of California-San Diego, tells his students a cautionary tale about a 76-year-old patient who, like many older people, struggled with insomnia.

“She had problems falling asleep, and she’d wake up in the middle of the night,” he said. “So her daughter brought her some sleep gummies” — edible cannabis candies.

“She tried a gummy after dinner and waited half an hour,” Han said.

Feeling no effects, she took another gummy, then one more — a total of four over several hours.

Han advises patients who are trying cannabis to “start low; go slow,” beginning with products that contain just 1 or 2.5 milligrams of tetrahydrocannabinol, or THC, the psychoactive ingredient that many cannabis products contain. Each of the four gummies this patient took, however, contained 10 milligrams.

The woman started experiencing intense anxiety and heart palpitations. A young person might have shrugged off such symptoms, but this patient had high blood pressure and atrial fibrillation, a heart arrhythmia. Frightened, she went to an emergency room.

Lab tests and a cardiac work-up determined the woman wasn’t having a heart attack, and the staff sent her home. Her only lingering symptom was embarrassment, Han said. But what if she’d grown dizzy or lightheaded and was hurt in a fall? He said he has had patients injured in falls or while driving after using cannabis. What if the cannabis had interacted with the prescription drugs she took?

“As a geriatrician, it gives me pause,” Han said. “Our brains are more sensitive to psychoactive substances as we age.”

Unclear Benefits

Thirty-nine states and the District of Columbia now allow cannabis use for medical reasons, and in 24 of those states, as well as the district, recreational use is also legal. As older adults’ use climbs, “the benefits are still unclear,” Han said. “But we’re seeing more evidence of potential harms.”

A wave of recent research points to reasons for concern for older users, with cannabis-related emergency room visits and hospitalizations rising, and a Canadian study finding an association between such acute care and subsequent dementia.

Older people are more apt than younger ones to try cannabis for therapeutic reasons: to relieve chronic pain, insomnia, or mental health issues, though evidence of its effectiveness in addressing those conditions remains thin, experts said.

In an analysis of national survey data published June 2 in the medical journal JAMA, Han and his colleagues reported that “current” cannabis use (defined as use within the previous month) had jumped among adults age 65 or older to 7% of respondents in 2023, from 4.8% in 2021. In 2005, he pointed out, fewer than 1% of older adults reported using cannabis in the previous year.

What’s driving the increase? Experts cite the steady march of state legalization — use by older people is highest in those states — while surveys show that the perceived risk of cannabis use has declined.

One national survey found that a growing proportion of American adults — 44% in 2021 — erroneously thought it safer to smoke cannabis daily than cigarettes. The authors of the study, in JAMA Network Open, noted that “these views do not reflect the existing science on cannabis and tobacco smoke.”

The cannabis industry also markets its products to older adults. The Trulieve chain gives a 10% discount, both in stores and online, to those it calls “wisdom” customers, 55 or older. Rise Dispensaries ran a yearlong cannabis education and empowerment program for two senior centers in Paterson, New Jersey, including field trips to its dispensary.

The industry has many satisfied older customers. Liz Logan, 67, a freelance writer in Bronxville, New York, had grappled with sleep problems and anxiety for years, but the conditions grew particularly debilitating two years ago, as her husband was dying of Parkinson’s disease. “I’d frequently be awake until 5 or 6 in the morning,” she said. “It makes you crazy.”

Looking online for edible cannabis products, Logan found that gummies containing cannabidiol, known as CBD, alone didn’t help, but those with 10 milligrams of THC did the trick without noticeable side effects. “I don’t worry about sleep anymore,” she said. “I’ve solved a lifelong problem.”

But studies in the United States and Canada, which legalized nonmedical cannabis use for adults nationally in 2018, show climbing rates of cannabis-related health care use among older people, both in outpatient settings and in hospitals.

In California, for instance, cannabis-related emergency room visits by those 65 or older rose, to 395 per 100,000 visits in 2019 from about 21 in 2005. In Ontario, acute care (meaning emergency visits or hospital admissions) resulting from cannabis use increased fivefold in middle-aged adults from 2008 to 2021, and more than 26 times among those 65 and up.

“It’s not reflective of everyone who’s using cannabis,” cautioned Daniel Myran, an investigator at the Bruyère Health Research Institute in Ottawa and lead author of the Ontario study. “It’s capturing people with more severe patterns.”

But since other studies have shown increased cardiac risk among some cannabis users with heart disease or diabetes, “there’s a number of warning signals,” he said.

For example, a disturbing proportion of older veterans who currently use cannabis screen positive for cannabis use disorder, a recent JAMA Network Open study found.

As with other substance use disorders, such patients “can tolerate high amounts,” said the lead author, Vira Pravosud, a cannabis researcher at the Northern California Institute for Research and Education. “They continue using even if it interferes with their social or work or family obligations” and may experience withdrawal if they stop.

Among 4,500 older veterans (with an average age of 73) seeking care at Department of Veterans Affairs health facilities, researchers found that more than 10% had reported cannabis use within the previous 30 days. Of those, 36% fit the criteria for mild, moderate, or severe cannabis use disorder, as established in the Diagnostic and Statistical Manual of Mental Disorders.

VA patients differ from the general population, Pravosud noted. They are much more likely to report substance misuse and have “higher rates of chronic diseases and disabilities, and mental health conditions like PTSD” that could lead to self-medication, she said.

Current VA policies don’t require clinicians to ask patients about cannabis use. Pravosud thinks that they should.

Moreover, “there’s increasing evidence of a potential effect on memory and cognition,” said Myran, citing his team’s study of Ontario patients with cannabis-related conditions going to emergency departments or being admitted to hospitals.

Compared with others of the same age and sex who were seeking care for other reasons, research shows these patients (ages 45 to 105) had 1.5 times the risk of a dementia diagnosis within five years, and 3.9 times the risk of that for the general population.

Even after adjusting for chronic health conditions and sociodemographic factors, those seeking acute care resulting from cannabis use had a 23% higher dementia risk than patients with noncannabis-related ailments, and a 72% higher risk than the general population.

None of these studies were randomized clinical trials, the researchers pointed out; they were observational and could not ascertain causality. Some cannabis research doesn’t specify whether users are smoking, vaping, ingesting or rubbing topical cannabis on aching joints; other studies lack relevant demographic information.

“It’s very frustrating that we’re not able to provide more individual guidance on safer modes of consumption, and on amounts of use that seem lower-risk,” Myran said. “It just highlights that the rapid expansion of regular cannabis use in North America is outpacing our knowledge.”

Still, given the health vulnerabilities of older people, and the far greater potency of current cannabis products compared with the weed of their youth, he and other researchers urge caution.

“If you view cannabis as a medicine, you should be open to the idea that there are groups who probably shouldn’t use it and that there are potential adverse effects from it,” he said. “Because that is true of all medicines.”

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

Kennedy’s HHS Sent Congress ‘Junk Science’ To Defend Vaccine Changes

By Jackie Fortiér, KFF Health News

A document the Department of Health and Human Services sent to lawmakers to support Secretary Robert F. Kennedy Jr.’s decision to change U.S. policy on covid vaccines cites scientific studies that are unpublished or under dispute and mischaracterizes others.

One health expert called the document “willful medical disinformation” about the safety of covid vaccines for children and pregnant women.

“It is so far out of left field that I find it insulting to our members of Congress that they would actually give them something like this. Congress members are relying on these agencies to provide them with valid information, and it’s just not there,” said Mark Turrentine, a professor of obstetrics and gynecology at Baylor College of Medicine.

Kennedy, who was an anti-vaccine activist before taking a role in the Trump administration, announced May 27 that the Centers for Disease Control and Prevention would no longer recommend covid vaccines for pregnant women or healthy children, bypassing the agency’s formal process for adjusting its vaccine schedules for adults and kids.

The announcement, made on the social platform X, has been met with outrage by many pediatricians and scientists.

The HHS document meant to support Kennedy’s decision, obtained by KFF Health News, was sent to members of Congress who questioned the science and process behind his move, according to one federal official who asked not to be identified because he wasn’t authorized to discuss the matter publicly.

The document has not been posted on the HHS website, though it is the first detailed explanation of Kennedy’s announcement from the agency.

Titled “Covid Recommendation FAQ,” the document distorts some legitimate studies and cites others that are disputed and unpublished, medical experts say.

HHS director of communications Andrew Nixon told KFF Health News, “There is no distortion of the studies in this document. The underlying data speaks for itself, and it raises legitimate safety concerns. HHS will not ignore that evidence or downplay it. We will follow the data and the science.”

HHS did not respond to a request to name the author of the document.

‘RFK Jr.’s Playbook’

One of the studies the HHS document cites is under investigation by its publisher regarding “potential issues with the research methodology and conclusions and author conflicts of interest,” according to a link on the study’s webpage.

“This is RFK Jr.’s playbook,” said Sean O’Leary, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics and an assistant professor of pediatrics at the University of Colorado School of Medicine. “Either cherry-pick from good science or take junk science to support his premise — this has been his playbook for 20 years.”

Another study cited in the document is a preprint that has not been peer-reviewed. Under the study’s title is an alert that “it reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.” Though the preprint was made available a year ago, it has not been published in a peer-reviewed journal.

The FAQ supporting Kennedy’s decision claims that “post-marketing studies” of covid vaccines have identified “serious adverse effects, such as an increased risk of myocarditis and pericarditis” — conditions in which the heart’s muscle or its covering, the pericardium, suffer inflammation.

False claims that the 2024 preprint showed myocarditis and pericarditis only in people who received a covid vaccine, and not in people infected with covid, circulated on social media. One of the study’s co-authors publicly rejected that idea, because the study did not compare outcomes between people who were vaccinated and those infected with the covid virus. The study also focused only on children and adolescents.

The HHS document omitted numerous other peer-reviewed studies that have shown that the risk of myocarditis and pericarditis is greater after contracting covid for both vaccinated and non-vaccinated people than the risk of the same complications after vaccination alone.

O’Leary said that while some cases of myocarditis were reported in vaccinated adolescent boys and young men early in the covid pandemic, the rates declined after the two initial doses of covid vaccines were spaced further apart.

Now, adolescents and adults who have not been previously vaccinated receive only one shot, and myocarditis no longer shows up in the data, O’Leary said, referring to the CDC’s Vaccine Safety Datalink. “There is no increased risk at this point that we can identify,” he said.

In two instances, the HHS memo makes claims that are actively refuted by the papers it cites to back them up. Both papers support the safety and effectiveness of covid vaccines for pregnant women.

The HHS document says that another paper it cites found “an increase in placental blood clotting in pregnant mothers who took the vaccine.” But the paper doesn’t contain any reference to placental blood clots or to pregnant women.

“I’ve now read it three times. And I cannot find that anywhere,” said Turrentine, the OB-GYN professor.

If he were grading the HHS document, “I would give this an ‘F,’” Turrentine said. “This is not supported by anything and it’s not using medical evidence.”

While members of Congress who are physicians should know to check references in the paper, they may not take the time to do so, said Neil Silverman, a professor of clinical obstetrics and gynecology who directs the Infectious Diseases in Pregnancy Program at the David Geffen School of Medicine at UCLA.

“They’re going to assume this is coming from a scientific agency. So they are being hoodwinked along with everyone else who has had access to this document,” Silverman said.

The offices of three Republicans in Congress who are medical doctors serving on House and Senate committees focused on health, including Sen. Bill Cassidy (R-La.), did not respond to requests for comment about whether they received the memo. Emily Druckman, communications director for Rep. Kim Schrier (D-Wash.), a physician serving on the House Energy and Commerce Committee, confirmed that Schrier’s office did receive a copy of the document.

“The problem is a lot of legislators and even their staffers, they don’t have the expertise to be able to pick those references apart,” O’Leary said. “But this one — I’ve seen much better anti-vaccine propaganda than this, frankly.”

C.J. Young, deputy communications director for the House Energy and Commerce Committee, confirmed that Democratic staff members of the committee received the document from HHS. In the past, he said, similar documents would help clarify the justification and scope of an administration’s policy change and could be assumed to be scientifically accurate, Young said.

“This feels like it’s breaking new ground. I don’t think that we saw this level of sloppiness or inattention to detail or lack of consideration for scientific merit under the first Trump administration,” Young said.

On June 4, Rep. Frank Pallone (D-N.J.) and Schrier introduced a bill that would require Kennedy to adopt official vaccine decisions from the Advisory Committee on Immunization Practices, or ACIP.

Young said the motivation behind the bill was Kennedy’s decision to change the covid vaccine schedule without the input of ACIP’s vaccine experts, who play a key role in setting CDC policies around vaccine schedules and access.

Kennedy announced June 9 on X that he would remove all 17 members of ACIP, citing alleged conflicts of interest he did not detail, and replace them. He announced eight replacements June 11, including people who had criticized vaccine mandates during the covid pandemic.

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

KFF would like to speak with current and former personnel from the Department of Health and Human Services or its component agencies who believe the public should understand the impact of what’s happening within the federal health bureaucracy. Please message KFF Health News on Signal at (415) 519-8778 or get in touch here.

5 Cool Things to Help You Endure Summer Heat With Chronic Pain

By Crystal Lindell

As temperatures heat up this summer, it can be difficult to get through hot sunny days when you’re also dealing with chronic pain and chronic illness. 

Weather is such a huge factor in the severity of day-to-day chronic pain levels, and if you’re on certain medications heat can also impact your body in other ways, like skin irritation and ankle swelling. 

Here are 5 things I use to get through the summer months while also dealing with chronic pain and chronic illness. 

Gold Bond Friction Defense Stick

My number one summer survival item is the Gold Bond Friction Defense Stick. I use it on my arms and thighs to prevent the heat and humidity from chaffing my skin if I’m wearing shorts, a tank top, a bathing suit or any light summer clothing. 

And this stuff seriously works! Putting it on after my morning shower makes such a huge difference in my quality of life throughout the summer. 

If you have a long day of walking, or swimming you may need to re-apply a few times, but for most day-to-day activities, I have found that once in the morning is more than adequate. 

Find it on Amazon here.

Compression Socks

Every summer my excessive ibuprofen use combines forces with my Ehler-Danlos Syndrome to make my ankles swell up – especially if the humidity is high.

So I swear by these compression socks, which virtually eliminate that symptom, even after long car rides. I have multiple packs of these in multiple colors, and throughout the summer months, I wear them almost daily. 

No, they aren’t super stylish with shorts, but if you wear them underneath pants, nobody can even tell. 

Find them on Amazon here. 

Light, Airy Pants

Speaking of pants, I tend to prefer them to shorts most of the time, even in the summer months. And these light, airy pants are great for enduring the heat. 

They offer all the comfort of pants, with all the breathability of shorts. I use them as pajamas, as well as pants to wear over my bathing suit at the pool, and even for lounging around during the day.

According to my Amazon order history, I have literally ordered these pants eight times! I have them in every color and even in multiple sizes. They’re also great at enduring weight fluctuations that are common when you’re on a lot of medications and dealing with chronic pain because of how stretchy the waist is. 

But the best things about these pants might be that they have pockets! If you’re familiar with the world of women’s pants, you know just how valuable and rare that feature is! 

Find them on Amazon here. 

Adjustable Fan

Sometimes chronic pain and related medications make us especially sensitive to heat and humidity, but a personal, adjustable fan can be a great way to cope. 

We have this fan in multiple colors, and we use them throughout the summer to direct air flow exactly where we want it. 

It’s relatively quiet for a fan, but it still packs a punch when it comes to cooling you off during the summer months. 

Find it on Amazon here. 

Summer Reading Club

If you’re looking for a comforting summer read, I can’t recommend “Garden Spells” by Sarah Addison Allen enough. It’s a very light, easy read that follows the stories of two sisters who have to navigate common sibling friction with the added stress of coming from a magical family that the whole town thinks is “weird.”

I read it for a book club recently and flew through it in two days. It’s a great light read, even if you’re have a chronic pain flare and can’t get off the couch. It also takes place in the south, and the heat is a common theme, making it perfect for getting into the summer state of mind.

Find it on Amazon here. 

What products do you use to get through the hot and humid summer months while dealing with chronic pain? We’d love to hear your recommendations in the comments below! 

The Pain News Network may make a small commission on items purchased through the links above. 

Should Pharmacists Tell Your Doctor How to Treat Pain?

By Pat Anson

Would you like a pharmacist to consult with your doctor about how to treat your chronic pain before you even see the doctor?

Given all the problems that pain patients already have getting pharmacies to fill their opioid prescriptions, that sounds counter-intuitive. But embedding a pharmacist in doctors’ offices and giving them advice is the premise behind a new article published in the Drug Topics Journal, written by Sarah Schang and Madison Irwin, who both have medical degrees in pharmacy (PharmD).   

They think giving pharmacists a prominent and early voice in your pain care will lead to better treatment and reduce the risk of controlled substances being misused. In their eyes, pharmacists “play key roles in educating other health care professionals and patients about safe and effective chronic pain management.”

Under federal law, pharmacists have a “corresponding responsibility” when filling prescriptions for opioids and other controlled substances – a legal right to refuse to fill prescriptions they consider unusual or improper. Usually that “responsibility” begins at the pharmacy level, but Drs. Schang and Irwin think it should start before prescriptions are even written for chronic pain conditions.

“Despite the high prevalence of chronic pain and its far-reaching consequences, it often has suboptimal management, typically involving a combination of pharmacotherapy that can quickly become complex and require expertise. Pharmacists are uniquely well positioned to provide this expertise and optimize medication management for chronic pain,” they wrote.

“There is an immense need for safe and effective medication management in chronic pain, and pharmacists have a unique role to play in meeting this need.”

Schang and Irwin cite several old pilot studies to support their claims. One study, published in 2018, involved 45 pain patients on high-dose opioids being treated at a large family medicine practice. A few days before their appointments, two pharmacists embedded in the practice reviewed patient charts and pain management plans, and recommended changes to their treating physicians.

Almost always, the recommendations were to taper the patients off opioids, switch to non-opioid analgesics, refer the patients to a pain specialist, and offer them a naloxone prescription to reverse overdoses. Those recommendations were often implemented.        

How did that work out for the patients? According to Schang and Irwin, there was a 14% average decrease in their daily dose of opioids in morphine milligram equivalents (MME), a tapering that was achieved “without impacting pain scores.”  

Is that what happened? Not really. A close look at the study itself shows that the average pain score went up after doses were lowered, from 5.3 before the pharmacists’ intervention to 5.5 afterward, based on a zero to 10 pain scale.

It’s also worth noting that these “high-risk” patients were on relatively high opioid doses before the intervention (135 MMEs daily). Even with the 14% reduction in dose, they were still getting an average of 116 MMEs daily – a dose that’s unattainable for most patients today due to fears about “overprescribing” opioids. Most patients in 2025 get less than 90 MME, in many cases substantially less.

Another pilot study cited by Schang and Irwin dates back to 2016. It involved a community pharmacy in an academic medical center in southern California. Pharmacists there reviewed the treatment plans of 23 patients on high dose opioids and recommended changes in their treatment, such as tapering, regular drug tests, and naloxone.

How the changes impacted the patients’ pain levels was apparently not evaluated, but particular attention was paid to their mental health. The most common problems identified by the pharmacists were “untreated” depression, anxiety, insomnia, and substance misuse.

“Notably, substance misuse was identified in nearly a third of patients, which allowed for subsequent referral to substance use disorder treatment when appropriate. Similar interventions in the community pharmacy setting also demonstrated significant value, with pharmacists identifying unaddressed issues with mood in nearly two-thirds of patients and increasing the uptake of naloxone,” Schang and Irwin wrote.

Being referred to addiction treatment or a psychiatrist probably isn’t the goal of most pain patients, who simply want their pain managed. That would go a long way toward resolving their “unaddressed” mental health issues.

Many pain patients today are already frustrated with pharmacists. They can’t get their opioid prescriptions filled due to opioid rationing, and are tired of the stigma and hostility they often face at pharmacies. The pharmacy industry itself is also going through a major contraction, with big chain pharmacies closing thousands of stores, leaving behind a dwindling supply of overworked pharmacists who are just as frustrated as the patients.

This is probably not a good time to embed pharmacists in clinical practices, and make a bad situation even worse.

Meloxicam Almost Killed My Mom, Now FDA Has Approved an IV Version

By Crystal Lindell

Buried in the fine print for the newest non-opioid pain medication to be approved by the FDA is a stark warning that hits close to home. 

The FDA just approved Xifyrm, which is the branded IV version of the non-steroidal anti-inflammatory drug meloxicam for adults with moderate-to-severe pain.

It offers once daily dosing, and of course, manufacturer Azurity Pharmaceuticals highlights the fact that "Xifyrm provides a non-opioid analgesic" in its press release about the drug. 

There’s just one problem: it’s the same drug that almost killed my mom in 2022. 

If you look at the fine print in the prescribing information, you’ll see the disclaimer that points to one of the major risks that come with this medication. 

"NSAIDs, including meloxicam, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, small intestine, or large intestine, which can be fatal,” Azurity warns.

They go on to say that these serious adverse events “can occur at any time, with or without warning symptoms.”

And 4 out 5 patients who develop these complications have no warning signs at all. 

Azurity then shares how common these complications are, writing that they occur in “1% of patients treated for 3-6 months, and in about 2-4% of patients treated for one year.”

They also add that “even short-term NSAID therapy is not without risk.”

Unfortunately, my mom was in the group of 2-4% of patients who were treated with mexlicam for one year and then had serious complications. 

Her doctor gave her the oral version for chronic hip pain because he didn’t want to give her opioids. She took it exactly as prescribed, and about one year later, meloxicam almost killed her. 

She had a very sudden and very serious perforated ulcer. 

My mom had no warning symptoms, just as the fine print for Xifyrm warns can happen. She collapsed at work and then was taken to the emergency room via ambulance. There, her sudden intense stomach pain was dismissed by staff for 9 hours before she finally got a CT scan. She was then immediately rushed into emergency surgery for a perforated ulcer. 

My mom spent the next week in critical care, unable to eat or drink anything at all for a full week while her stomach healed. 

It was a harrowing experience made worse by the fact that all of this happened during the height of the COVID lockdown, meaning none of us were able to visit her at all while she was in the hospital. 

And the thing is, she is one of the lucky ones, because she survived. 

We often hear harrowing tales of opioids causing overdose deaths, but that doesn’t mean that alternatives like NSAIDs are safe. The fact that 2-4% of patients could have a potentially fatal complication from this drug should scare both doctors and patients. 

Many doctors hesitate to prescribe opioid pain medications these days, even for post-surgical and cancer pain, and my fear is that this new IV version of meloxicam will quickly become one of their favorite alternatives, just as the oral version already is. 

Interestingly, the FDA recently released a boxed warning for veterinarians on the use of meloxicam in cats before surgery, saying repeated off-label use can cause sudden kidney failure and even death. 

When it comes to humans, it’s also noteworthy that Azuirty also makes it clear that this new IV medication shouldn’t be used alone when rapid pain relief is needed. That allows for the potential use of opioids, but I’m skeptical that doctors will heed that advice. 

A lot of doctors have an “avoid opioids at all costs” approach to pain care these days, but many of them have not reckoned with what that can actually mean for patients. They also rarely go over the true risks of NSAIDs with their patients, despite the fact that lectures about the dangers of opioids are common in medical care. 

These days, my mom is in good health, and in fact we just celebrated her 64th birthday. It’s a milestone that’s now all the more precious after we almost lost her.

I would urge doctors to exercise extreme caution when turning to opioid alternatives like Xifyrm, and other NSAIDs. They are not without risk. And in fact, they can be more dangerous than opioids. 

Brandeis Must Confront the Human Cost of Opioid Restrictions

By Arianne Grand-Gassaway

As a mother who lost my 35-year-old daughter, Desiree, to a counterfeit Xanax pill in the wake of restrictive prescribing policies, I am calling on Brandeis University to reckon with its role in a public health crisis.

The 2016 CDC Guideline on Opioid Prescribing, heavily influenced by Physicians for Responsible Opioid Prescribing (PROP) and its founder, Dr. Andrew Kolodny— Co-Director of Opioid Policy Research at Brandeis -- has helped fuel a humanitarian disaster.

Tens of millions of Americans with chronic pain and mental health conditions face untreated suffering, forced tapers, and abandonment by providers terrified of prosecution for prescribing opioids and other controlled substances like Xanax.

I am one of those Americans. I suffer from intractable pain and was denied opioid medication for a decade, before I found a provider who is treating my pain now. That decade of no pain care did irreparable damage to my body though.

Jewish wisdom, a cornerstone of Brandeis’s identity, teaches that saving one life is akin to saving the world (Mishnah Sanhedrin 4:5). Yet, these policies have done the opposite. My daughter, unable to access medically necessary medication for her panic disorder, turned to someone she thought she could trust—a desperate act that cost her life.

So many now are dehumanized by a system that prioritizes fear and suspicion over compassion. My family’s story is not unique. Despite a recent decline in overdoses, drug poisonings remain near record levels, with over 80,000 fatal overdoses in 2024.

Most of these deaths involve illicit fentanyl, while legitimate prescriptions remain out of reach for those who need them most: the sick, injured, and elderly.

On May 7, 2025, I wrote a letter to Brandeis Interim President Arthur Levine, urging dialogue that includes patient voices. Weeks later, after a follow-up call, I have received no response. This silence mirrors the broader dismissal of patients crying out for relief.

Brandeis, a self-proclaimed beacon of social justice, has a moral obligation to examine how Dr. Kolodny’s influence and advocacy have contributed to this crisis. Limiting prescriptions has not reduced addiction or overdoses — it has punished the vulnerable while illicit drugs continue to flood our streets.

By his own testimony, Dr. Kolodny only works part-time at Brandeis, which enables him to continue his work as an expert witness and consultant for plaintiff law firms involved in opioid litigation, for which he charges $780 per hour.

In 2022, Dr. Kolodny testified in West Virginia that “it’s been lucrative” work for him personally, although he declined to state the total amount of money he’s been paid by law firms over the years. Under questioning, he didn’t dispute estimates that it was a million dollars or more.   

I call on Brandeis to host a public forum with patients, providers, and policymakers to confront the harms caused by the CDC guideline and restore the doctor-patient relationship. Providers must be free to prescribe based on good faith and informed consent, without fear. We can prevent addiction and treat it compassionately without sacrificing those whose lives depend on these medications.

This is not just my story — it’s the story of many millions. If Brandeis and other organizations in positions of power to change the trajectory of this tragedy continue to remain silent, I will continue to speak, for Desiree and for all those suffering and dying. The time for action is now. 

People in Pain Need Healthy People to Fight for Them

By Neen Monty,

I haven’t written much lately, because I am sick.

I am not lazy, I do not lack commitment. Or motivation. Or determination.

That is an unfair characterization, an unfair criticism. One that is not uncommon for people who live with chronic pain or a chronic illness.

We are judged to be lazy, exaggerating, malingering, drug seeking. None of it is true.

I am sick. And I am disabled. But I am not just a “chronic pain patient,” as many like to reduce me to. “Chronic pain” is not my identity. It’s not who I am.

However, pain does dictate what I can and cannot do. Every decision I make is influenced and decided by my pain levels. Or rather, how much pain medication I am allowed to utilize.

If I did not have pain, I would still be disabled and sick every day. I never feel “good” in the way that healthy people feel good. I am always fatigued, weak and in pain. And I sure as heck do not choose that. No one would.

We, people like me, need allies. We need people to help us. Because we are too unwell to put 40 hours a week into advocacy and awareness raising. We don’t have that kind of time and energy.

We need people who are healthy to fight for us.

Because helping people who live with painful, progressive, incurable disease should be a given. Helping people who have experienced severe physical trauma and injuries should be a given. People should feel empathy for the ill and infirm. For the injured and traumatized.

Societies are judged on how they treat their weakest members. By this standard, our society is not doing well.

To help, you first have to understand, listen, and believe. You must trust that what we are saying is true.

You cannot be that doctor who “knows better.” The one who makes snap judgements about the woman who walks into the exam room limping, dressed in old clothes, and unkempt. Clearly a hysterical woman with psychological issues.

It’s doctors like that who misjudged me, leaving my serious and rare neurological disease undiagnosed. Because of those four neurologists who judged me, I now must live with constant and severe neuropathic pain every second for the rest of my life.

The insult to injury is that no doctor wants to prescribe opioid pain medication to allow me to manage that pain. To make the pain bearable. To make my life functional.

Had the first neurologist, or even the second one, done their job and diagnosed my disease over ten years ago, I would have had a chance at remission or even reversing the damage. Now? Not much hope of that. I’ll be lucky if the disease is slowed down a tad.

Judgement vs. Empathy

People who have no pain cannot understand what it is like to live with constant, severe pain.

But everyone can show empathy and compassion and kindness -- if they choose to.

I don’t receive a lot of empathy, compassion or kindness. I receive a lot of judgement. I receive a lot of trolling.  I have even been stalked.

Recently, when I had a crisis due to pain and forced opioid tapers, several very kind, empathetic and compassionate people reached out to me. Most were physiotherapists, also known as physical therapists. I cannot tell you how much their support and kindness meant to me. I will never forget.

These are some of the best people I have ever had the privilege to meet or chat with. Some don’t agree with my opioid use, and my opioid advocacy. But they still reached out to help me. I am so very grateful for that.

Many people still don’t believe my various illnesses are real. As I said, I went undiagnosed for over a decade because four neurologists decided I was just a hysterical woman.

Turned out I have a very serious disease. It took neurologist number five, and ten years, to get that diagnoses.

That should never happen, but it’s very common. Women are very often ignored, dismissed, accused of exaggerating or being hysterical.

I used to be a gym junkie, nutrition nazi, a super fit person. I did not bring any of this on myself though poor choices. Though people do love to tell me I did.

All I’m asking for is a better quality of life. And less pain.

I advocate strongly for people like me to have access to whatever pain treatments work. I am not pro-opioid. I am pro pain relief.

When I was in crisis, I also received messages from two doctors. One told me opioids do not work for pain, and that I should be ashamed of myself for promoting them. The other told me if doctors are not prescribing, I must be an addict.

Very unkind. They saw a person in crisis and thought that was a good time to attack. I cannot imagine that they treat their patients with respect, kindness and compassion, if that’s the way they treat me.

I am not able to do much work at the moment. I am far too unwell. My colleagues who live with constant, severe pain also have periods like this.

We support each other as much as we can, but we need support from healthier people.

We need allies.

We need people who live with less severe pain to help.

We need healthy people to help.

We need doctors, therapists, nurses and pharmacists to unlearn the crock science they’ve been taught and learn about real chronic pain. All the many types of chronic pain, not just one.

We need them to learn about chronic pain from the people who live with it. Not the people who profit from it.

We need allies.

Neen Monty is a writer and 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.”

Sen. Joni Ernst Said the Quiet Part Out Loud

By Crystal Lindell

Last week Sen. Joni Ernst (R) of Iowa said the quiet part out loud at a town hall meeting. 

While responding to a comment about President Trump’s planned Medicaid cuts possibly killing people, Ernst shrugged and said, “Well, we all are going to die.”

Her remark drew a chorus of boos, as you’ll see in the video:

Ernst may have been talking about Medicaid, but the implication was that everyone was going to die eventually. Of course, the key word here is “eventually.”

There’s a big difference between dying at 21 and dying at 97. Just because someone is going to die eventually, that doesn’t mean that it’s OK for them to die today. In fact, that’s why when someone cuts another person’s life short via murder, we usually punish them for doing so. 

I’m sure Ernst can understand this concept when it comes to herself. After all, I doubt she’d be OK with being denied urgent medical care herself, and then being met with a shrug and a dismissive, “Well she was going to die anyway.” 

The thing is, Ernst wasn’t thinking of herself when she made the comment. Rather, she was thinking of the general public, the masses if you will.  

She was thinking of you and me. 

And to Ernst, our lives are disposable. We are just the peasants who are going to die eventually, so we might as well die today as far as she’s concerned.

Just in case you thought that perhaps Ernst misspoke or was taken out of context, she doubled down a day later with a weird selfie video filmed in a cemetery, of all places. 

“I made an incorrect assumption that everyone in the auditorium understood that yes, we are all going to perish from this Earth. So I apologize,” she said in the video, before glibly adding, “And I'm really, really glad that I did not have to bring up the subject of the tooth fairy as well."

You can see her full “apology” here:

Our lives are truly just a joke to Sen. Ernst.

The thing is, as a chronically ill patient with a bachelor’s degree in political science, I can report that Ernst’s blase attitude about our deaths is all too common. Both our political leaders and many of our healthcare professionals view the (lack of) value of our lives the same way she does. 

You saw it in the government’s poor response to the COVID pandemic, when they did things like prioritizing the economy over people’s lives. 

You also see it Trump’s “One Big Beautiful Bill,” which would take healthcare benefits away from 10 million people and cut $700 billion from Medicaid

And you see it in the way that chronic pain patients are treated by doctors and government policies. 

Many doctors will do anything to avoid the personal stress and intense scrutiny from law enforcement and state medical boards for prescribing opioids. And some don’t care if it means that patients suffer or even die as a result. Doctors know that untreated pain can be dangerous, especially if it pushes patients to the black market looking for relief. 

They share the same attitude that Ernst expressed: “We all are going to die.”

Most doctors would do anything possible to extend their own lives. They would also do anything possible to extend the quality of their lives, even if that means taking the same opioids they might deny pain patients. 

The root of these issues is that a lot of people with power – whether its political power or power in the exam room – see themselves as belonging to a superior class of humans. And anytime a human feels like they are superior to another human, they can start to justify some really awful things. 

Ernst saying, “We all are going to die” is the natural end point of that thought process. 

But she wasn’t talking about herself.

What Ernst really meant was much darker: “You are all going to die – and I don’t care.”

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.   

5 Tips for Showering with Chronic Pain

By Crystal Lindell

One of the first things I had to come to terms with when I developed chronic pain in 2013 was that showers were no longer something I could do on a whim. 

My pain, which was eventually diagnosed as intercostal neuralgia in my right ribs, flares up when I put the energy and work into taking a shower. 

I’m not sure why showering seems to aggravate it, but I assume it’s related to the fact that I’m standing in one place for a long time, moving my arms in a certain way to clean my hair, and then the movements I do to get dressed afterward. 

All this means that I have to plan my showering schedule the way other people plan their gym workouts – with the expectation that I’ll need rest afterwards. 

I do still shower almost every day, because it’s important to me and I like feeling clean. But that doesn’t mean it’s not a struggle. And I will confess that there are some days when the pain is just too intense to get through a full shower. 

However, there are things you can do to make it both easier to shower with chronic pain, and to go longer periods of time between showers. 

Below are suggestions and advice that I’ve learned from living with chronic pain and caring for disabled relatives who live near me. 

Tip 1: Change your showering schedule to nights 

The first thing I did when I realized that showering was going to be an ordeal was to shift to showering at night. This sounds like a small thing, but for me it was a major change in my daily routine. 

Back when I started having chronic pain, I was still driving into an office everyday for a day job. Getting up to take a full shower, wash my long hair, and then get dressed in office clothes sometimes meant that I didn’t have the ability to drive into the office at all. I would literally have to call my boss to ask if I could work from home or take a sick day. 

When I realized that I no longer had the luxury of showering in the morning, I shifted to doing it the night before. That way, I could save my morning energy for throwing on clothes and light make-up before heading to work.

I no longer drive into an office job everyday, but I do still shower at night if I have anything I have to do outside of the house in the morning. 

It’s honestly one of the foundations of living with chronic pain: you have to plan out things that you didn’t have to think about before. You have to make sure you’re rationing your energy to get the most out of your limited supply. 

For showering, that means scheduling it for times when it doesn’t conflict with other high-energy activities. 

Tip 2: Use dry shampoo when you can’t shower

A lot of people already know about the wonders of dry shampoo, and how it can help you go longer between washing your hair. But most people don’t realize that it works best when it’s used as a preventative measure to keep your hair relatively clean. 

The trick to getting it to work best is to use it on freshly washed and dried hair, so that it can absorb the hair’s natural oil as it comes in. 

There are a ton of dry shampoo options on the market, but in my experience, the more expensive ones aren’t necessarily better. So feel free to reach for whatever you see at your local drug store. 

Personally, I’ve had a lot of success with the Batiste Brand. I like that their shampoos come in a lot of different scents and that they even offer versions for brunettes, who want to avoid the white residue that’s common with dry shampoos. 

Tip 3: Sponge roller curls can help you go longer between hair washings

After watching Agent Carter – a 1940s Marvel super hero TV show – I went through a phase where I was obsessed with all things 1940s style, including hair. 

That’s how I accidentally stumbled onto my next tip: setting your wet hair in foam sponge rollers will help you go a lot longer between washes. The women of the 1940s did this because shampoo was rationed or hard to come by during World War 2. It turns out they knew what they were doing. 

That’s because curly hair, even if it’s been brushed out, does not get oily as fast as straight hair. So if you add curls to straight hair, you won’t have to wash it as often. 

Here’s a quick Youtube tutorial that goes over the basics of using sponge rollers. There are tons more in-depth tutorials if you’re interested. Just make sure your hair is completely dry before you take the curlers out, otherwise they won’t set.

There are sponge rollers on Amazon currently listed for less than $10, but you can also find them at almost every drug store and discount retailer. 

Of course, there is one massive downside to using sponge rollers or any type of curling method at home – they take a lot of time and energy to do your hair. 

However, most salons will offer a service called a “wet set” for a reasonable price. It’s a tried and true service for older women, who tend to be in the demographic of people who aren’t able to wash their hair every day. 

As part of a wet set, the stylist will usually use rollers to give you tight curls, and then style it afterwards so that you can go longer between hair washes. 

Tip 4: Invest in a shower chair 

There are also accommodations that you can use to get through a shower easier. For example, I think a lot of people don’t realize just how helpful a shower chair can be. 

While I don’t use one myself, I have relatives who use a shower chair, which often is the difference between them being able to shower vs. not being able to shower at all. 

These days, you don’t have to order shower chairs from special medical supply services. You can get them for a very reasonable price online. This shower chair on Amazon is currently listed for less than $40, and it features a removable back. 

Tip 5: Use cleansing wipes between showers

Of course, there may be days when you just can’t get through a full shower, but you don’t want to feel dirty. In that case, I suggest investing in some bath wipes for adults. 

Again, I have not personally used a product like this, but I have multiple disabled relatives who found them to be extremely helpful. 

These bath wipes on Amazon are currently listed for less than $20, and they claim to both cleanse and soften your skin. 

You don’t need bath wipes to achieve this effect though. A wet washcloth with some soap used in a few key places can also achieve a similar effect. 

Hopefully you found some good tips on this list, and if you have any other tips or advice for getting through a life where showering is sometimes a luxury, please share them in the comments below!

Pain News Network may receive a small commission from the Amazon links listed in this article.

Knee Arthritis Made Worse by Steroid Injections

By Pat Anson

Corticosteroid injections are often given to patients with osteoarthritis to reduce pain and inflammation in the knee joint, with the relief sometimes lasting for days, weeks or even months. A new study, however, found that steroid injections in the knee may only make arthritis worse in the long run.

The study by researchers at the University of California, San Francisco (UCSF) compared the long-term effects of corticosteroid injections to patients who received injections of hyaluronic acid, a polymer gel that acts as a lubricant and shock absorber.

The research, recently published in the journal Radiology, found that a single hyaluronic acid injection was associated with decreased progression of knee osteoarthritis up to two years later. Just one corticosteroid injection led to more knee joint damage.

“Our study directly challenges a common clinical practice: the use of corticosteroid injections for knee osteoarthritis symptom relief,” said lead author Upasana Bharadwaj, MD, who was a research fellow in the Department of Radiology at UCSF at the time of the research. “It presents robust evidence that corticosteroids accelerate structural knee degeneration, even after a single injection.”

Osteoarthritis (OA) is the most common form of arthritis, with the knee being the most frequently affected joint. Over 32 million U.S. adults have knee OA, and about 10% of them receive corticosteroid or hyaluronic injections.

UCSF researchers followed 70 patients with knee OA who had one injection -- 44 were injected with corticosteroids and 26 were given hyaluronic acid. MRI images were taken before, at the time of, and two years after the injection to assess how much damage and OA progression occurred in the knee joint over time. The scores were then compared to a control group of 140 patients who did not receive any injection.

The researcher team found that both types of injections helped reduce knee pain, but the corticosteroid injections were associated with more joint damage than both the control group and those who received hyaluronic acid injections. In contrast, the hyaluronic acid injections appeared to slow the progression of joint damage.

“The most striking finding is that a single corticosteroid injection led to significantly greater structural damage in the knee joint over two years, especially in cartilage, while hyaluronic acid injections not only avoided this damage but actually showed reduced joint deterioration post-injection,” Bharadwaj said. “Corticosteroids are known to reduce inflammation but also impair the repair mechanisms of cartilage.

“This study could lead to more judicious use of corticosteroid injections, especially for patients with mild to moderate osteoarthritis who are not yet surgical candidates.”

Current guidelines for knee OA often recommend corticosteroid injections for short-term pain relief, but limit the injections to one every three months or no more than three injections per year. Bharadwaj hopes the new research will persuade clinicians to opt for hyaluronic acid injections more frequently and stop the routine use of corticosteroids for knee OA.

“Given their widespread use, these findings could influence clinical guidelines and patient care decisions, encouraging more cautious use and stronger consideration of alternatives like hyaluronic acid,” she said. “The public impact is significant, as osteoarthritis is a major global cause of disability, and millions receive such injections annually.”

A 2022 study by researchers at the Chicago Medical School also compared corticosteroid injections for knee OA to hyaluronic acid injections. That study used X-ray images to evaluate patients after two years and came to the same conclusion that corticosteroids worsened osteoarthritis progression.

Pain Research and Treatment Missing From 2026 HHS Budget

By Pat Anson

An estimated 60 million Americans suffer from chronic pain, costing the U.S. healthcare system about $77 billion a year.  According to the National Institutes of Health (NIH), chronic pain affects more Americans than diabetes, heart disease, and cancer combined.

You’d never know it though by reading the proposed $94.7 billion budget for the Department of Health and Human Services (HHS) released on Friday by the Trump administration.

There are nearly 21,000 words in the 55-page budget for 2026, and not a single word or dollar is devoted to pain research, treatment, or how to help those 60 million Americans.   

The only reference to pain is a quote attributed to HHS Secretary Robert F. Kennedy, Jr.

“A healthy person has a thousand dreams. A sick person only has one, and right now, there’s 60% of the people in this country who have only one dream – that they can make it through the day without pain, with energy, without having to take medications, and we are going to change that for this country,” Kennedy is quoted as saying.

One can quibble about whether RFK Jr. actually said those exact words or if they were invented for the budget document. In either case, many Americans living with chronic pain already get through the day without taking an effective pain medication, although its not by choice.

Kennedy has previously used the line about “a healthy person has a thousand dreams,” which is paraphrased from Confucius. Kennedy used it without attribution in his Senate confirmation hearing in January and again when he was sworn in as HHS Secretary a month later, but didn’t mention pain in either instance.   

Perhaps it’s only fitting, given how the topic of pain is notably absent from the HHS budget. What we get instead are platitudes about “making Americans the healthiest in the world,” while at the same time reducing the HHS budget by 26 percent, and downsizing or eliminating dozens of federal health programs.

The NIH faces some of the steepest cuts, with its $27.5 billion budget cutback to $18 billion. The Trump administration has already gutted the NIH’s Office of Pain Policy and Planning (OPPP), which focused on pain research. The OPPP’s entire staff was fired in April.

“Even though chronic pain is one of the leading health issues in America, it has never had a true home at NIH with a dedicated institute. Many pain researchers have described the NIH as a place where ‘pain lives everywhere and nowhere,’ and now, with the dismantling of the OPPP, I fear that pain may literally have no home at all,” Dr. Juan Hincapie-Castillo, an assistant professor at UNC Chapel Hill, wrote in The Charlotte Observer. Hincapie-Castillo received funding from OPPP for his studies of trigeminal neuralgia.

‘Embrace Radical Change’

In all, HHS plans to consolidate 28 operating divisions into 15, close five of its regional offices, and end funding for 5,000 contracts – all in the name of saving money.

“This planned realignment will allow the Department to do more at a lower cost to taxpayers by increasing operational efficiency and cutting bureaucratic sprawl,” the budget document states.

“America spends nearly one-third of the federal budget on healthcare, only to rank last in terms of health among developed nations. Americans are seeing declines in life expectancy and facing the highest rates of chronic disease in the world. HHS is committed to making Americans healthy again, making the American health system the best in the world, and putting patients first. To accomplish this, we need to embrace radical change.”

HHS is planning to move several agencies — including the Substance Abuse and Mental Health Services Administration (SAMHSA) and some programs in the Centers for Disease Control and Prevention (CDC) -- into a new agency called the Administration for a Healthy America (AHA), which would be under Kennedy’s direct control. AHA will administer $14 billion in discretionary funding to combat the “chronic disease epidemic.”

“(AHA) will prioritize prevention — a missing piece in the American health system — primary care, maternal and child health, mental health, substance use prevention and treatment, environmental health, HIV/AIDS, workforce development, and policy, research, and oversight,” the HHS says.

Note the absence of pain prevention and treatment in that sentence.

Opioids are mentioned nearly half a dozen times in the budget, but only in the context of addiction treatment, not pain management. Many of the CDC programs that deal with opioid abuse and treatment are being moved to AHA, and $4 billion in block grants for mental health and substance abuse treatment is earmarked for states and rural communities.

“States and local communities best know the way to serve their populations – not the federal government,” HHS said.

When he was running for president, Kennedy had ambitious plans to create a series of “wellness farms” in rural areas, where people addicted to illicit or prescription drugs could get treatment, job training and grow their own organic food.

“I’m going to create these wellness farms where they can go to get off of illegal drugs, off of opiates, but also legal drugs, psychiatric drugs, if they want to, to get off of SSRIs, to get off of benzos, to get off of Adderall, and to spend time, as much time as they need — three or four years if they need it — to learn to get re-parented, to reconnect with communities, to understand how to talk to people,” Kennedy said in 2024.

There is no mention of wellness farms or anything like it in the HHS budget, or in the “Make America Healthy Again (MAHA) Report,” which was also released by the Trump Administration last month.

Like the budget document, pain research and treatment are not discussed in the MAHA report, which has been widely criticized for its sloppy science and fake citations, including some that were apparently generated by artificial intelligence (AI).        

American Doctors Are Moving to Canada to Escape Trump Administration

By Brett Kelman, KFF Health News

Earlier this year, as President Donald Trump was beginning to reshape the American government, Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and got out.

Michael now works in a small-town hospital in Canada. KFF Health News and NPR granted him anonymity because of fears he might face reprisal from the Trump administration if he returns to the U.S. He said he feels some guilt that he did not stay to resist the Trump agenda but is assured in his decision to leave. Too much of America has simply grown too comfortable with violence and cruelty, he said.

“Part of being a physician is being kind to people who are in their weakest place,” Michael said. “And I feel like our country is devolving to really step on people who are weak and vulnerable.”

Michael is among a new wave of doctors who are leaving the United States to escape the Trump administration. In the months since Trump was reelected and returned to the White House, American doctors have shown skyrocketing interest in becoming licensed in Canada, where dozens more than normal have already been cleared to practice, according to Canadian licensing officials and recruiting businesses.

The Medical Council of Canada said in an email statement that the number of American doctors creating accounts on physiciansapply.ca, which is “typically the first step” to being licensed in Canada, has increased more than 750% over the past seven months compared with the same time period last year — from 71 applicants to 615. Separately, medical licensing organizations in Canada’s most populous provinces reported a rise in Americans either applying for or receiving Canadian licenses, with at least some doctors disclosing they were moving specifically because of Trump.

“The doctors that we are talking to are embarrassed to say they’re Americans,” said John Philpott, CEO of CanAm Physician Recruiting, which recruits doctors into Canada. “They state that right out of the gate: ‘I have to leave this country. It is not what it used to be.’”

Canada, which has universal publicly funded health care, has long been an option for U.S.-trained doctors seeking an alternative to the American health care system. While it was once more difficult for American doctors to practice in Canada due to discrepancies in medical education standards, Canadian provinces have relaxed some licensing regulations in recent years, and some are expediting licensing for U.S.-trained physicians.

In mere months, the Trump administration has jeopardized the economy with tariffs, ignored court orders and due process, and threatened the sovereignty of U.S. allies, including Canada. The administration has also taken steps that may unnerve doctors specifically, including appointing Robert F. Kennedy Jr. to lead federal health agencies, shifting money away from pandemic preparedness, discouraging gender-affirming care, demonizing fluoride, and supporting deep cuts to Medicaid.

The Trump administration did not provide any comment for this article. When asked to respond to doctors’ leaving the U.S. for Canada, White House spokesperson Kush Desai asked whether KFF Health News knew the precise number of doctors and their “citizenship status,” then provided no further comment. KFF Health News did not have or provide this information.

Philpott, who founded CanAm Physician Recruiting in the 1990s, said the cross-border movement of American and Canadian doctors has for decades ebbed and flowed in reaction to political and economic fluctuations, but that the pull toward Canada has never been as strong as now.

Philpott said CanAm had seen a 65% increase in American doctors looking for Canadian jobs from January to April, and that the company has been contacted by as many as 15 American doctors a day.

Rohini Patel, a CanAm recruiter and doctor, said some consider pay cuts to move quickly.

“They’re ready to move to Canada tomorrow,” she said. “They are not concerned about what their income is.”

The College of Physicians and Surgeons of Ontario, which handles licensing in Canada’s most populous province, said in a statement that it registered 116 U.S.-trained doctors in the first quarter of 2025 — an increase of at least 50% over the prior two quarters. Ontario also received license applications from about 260 U.S.-trained doctors in the first quarter of this year, the organization said.

British Columbia, another populous province, saw a surge of licensure applications from U.S.-trained doctors after Election Day, according to an email statement from the College of Physicians and Surgeons of British Columbia. The statement also said the organization licensed 28 such doctors in the fiscal year that ended in February — triple the total of the prior year.

Quebec’s College of Physicians said applications from U.S.-trained doctors have increased, along with the number of Canadian doctors returning from America to practice within the province, but it did not provide specifics. In a statement, the organization said some applicants were trying to get permitted to practice in Canada “specifically because of the actual presidential administration.”

Michael, the physician who moved to Canada this year, said he had long been wary of what he described as escalating right-ring political rhetoric and unchecked gun violence in the United States, the latter of which he witnessed firsthand during a decade working in American emergency rooms.

Michael said he began considering the move as Trump was running for reelection in 2020. His breaking point came on Jan. 6, 2021, when a violent mob of Trump supporters besieged the U.S. Capitol in an attempt to stop the certification of the election of Joe Biden as president.

“Civil discourse was falling apart,” he said. “I had a conversation with my family about how Biden was going to be a one-term president and we were still headed in a direction of being increasingly radicalized toward the right and an acceptance of vigilantism.”

It then took about a year for Michael to become licensed in Canada, then longer for him to finalize his job and move, he said. While the licensing process was “not difficult,” he said, it did require him to obtain certified documents from his medical school and residency program.

“The process wasn’t any harder than getting your first license in the United States, which is also very bureaucratic,” Michael said. “The difference is, I think most people practicing in the U.S. have got so much administrative fatigue that they don’t want to go through that process again.”

Michael said he now receives near-daily emails or texts from American doctors who are seeking advice about moving to Canada.

‘You Left Just in Time’

This desire to leave has also been striking to Hippocratic Adventures, a small business that helps American doctors practice medicine in other countries.

The company was co-founded by Ashwini Bapat, a Yale-educated doctor who moved to Portugal in 2020 in part because she was “terrified that Trump would win again.” For years, Hippocratic Adventures catered to physicians with wanderlust, guiding them through the bureaucracy of getting licensed in foreign nations or conducting telemedicine from afar, Bapat said.

But after Trump was reelected, customers were no longer seeking grand travels across the globe, Bapat said. Now they were searching for the nearest emergency exit, she said.

“Previously it had been about adventure,” Bapat said. “But the biggest spike that we saw, for sure, hands down, was when Trump won reelection in November. And then Inauguration Day. And basically every single day since then.”

At least one Canadian province is actively marketing itself to American doctors.

Doctors Manitoba, which represents physicians in the rural province that struggles with one of Canada’s worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S.

The campaign focuses on Florida and North and South Dakota and advertises “zero political interference in physician patient relationship” as a selling point.

Alison Carleton, a family medicine doctor who moved from Iowa to Manitoba in 2017, said she left to escape the daily grind of America’s for-profit health care system and because she was appalled that Trump was elected the first time.

Carleton said she now runs a small-town clinic with low stress, less paperwork, and no fear of burying her patients in medical debt.

She dropped her American citizenship last year.

“People I know have said, ‘You left just in time,’” Carleton said. “I tell people, ‘I know. When are you going to move?’”

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