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.

FDA Approves First New Fibromyalgia Drug in 15 Years

By Pat Anson

Fibromyalgia sufferers who have yearned for new treatments finally have one. Tonix Pharmaceuticals says the Food and Drug Administration has approved Tonmya for the treatment of fibromyalgia in adults -- the first new FDA-approved therapy for fibromyalgia in over 15 years.

Fibromyalgia is a poorly understand chronic pain condition that affects about 10 million Americans, most of them women. It causes an array of symptoms, such as widespread body aches, fatigue, insomnia, mood disorders and brain fog.

Until now, the FDA has approved only three medications for fibromyalgia: duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella). Many patients consider the drugs ineffective or have too many side effects.

“The FDA approval of Tonmya as a first-line treatment for fibromyalgia represents a landmark advancement for the millions of people in the U.S. suffering from the debilitating pain this condition causes,” Seth Lederman, MD, CEO of Tonix, said in a press release. “At Tonix, we recognized the transformative potential of pursuing a new approach with Tonmya for fibromyalgia, a chronic overlapping pain condition, that has gone without innovation for many years.”

Tonmya is more of a sleep aid than an analgesic. The tablet is a new, faster-acting formulation of an old drug: cyclobenzaprine hydrochloride (Flexeril), a muscle relaxant that was originally developed as an antidepressant. Tonmya is meant to be taken before bedtime sublingually, to be dissolved under the tongue for rapid absorption into the bloodstream.

Tonix believes that improving sleep quality, specifically restorative sleep, is the key to reducing fibromyalgia symptoms. Poor sleep not only worsens pain, but causes anxiety and depression, which are common features of fibromyalgia. Pain, insomnia, and mood disorders become a vicious cycle when fibromyalgia is poorly treated.

In a Phase 3 clinical study, fibromyalgia patients taking Tonmya reported better sleep and less fatigue after three months, which coincided with at least a 30% reduction in pain in about half of patients. Tonmya was generally well tolerated, with fewer side effects than the other three fibromyalgia medications.

It’s notable that all of the FDA-approved drugs for fibromyalgia are neither new or novel. They were originally developed for other purposes — to relieve depression or seizures — and are simply being repurposed as fibromyalgia treatments.

“The chronic pain of fibromyalgia is debilitating to every aspect of a person’s life, including causing sleep disturbance and fatigue, all of which can negatively impact someone’s ability to carry out their daily activities,” said Sharon Waldrop, founder of the Fibromyalgia Association. “For over 15 years, this community has been underserved and waiting for new treatment options. This approval is a promising step forward and brings renewed hope to millions.”

Tonmya is expected to become available in the fourth quarter of 2025.

Moral Panic Over Herbal Drink Stirs Anti-Kratom Hysteria

By Crystal Lindell 

Last month, a TikTok influencer who goes by the name “YourBestieMisha” posted a video claiming that he was harassed at a Texas gas station by a teenager craving for a drink called “Feel Free.” 

The drink, which is sold in little blue bottles, is made by Oklahoma-based Botanic Tonics. It’s infused with kava root, natural leaf kratom, and other herbs. 

In the video, Michael “Misha” Brown alleges that as he was going into the gas station, he was approached by a "child" who seemed to be about 14 years old.

In Texas, you have to be at least 18 to buy kratom, so when the teen asked Brown to help him get Feel Free, Brown said no. That’s when the teen lunged for his wallet, which Brown says he was able to pull away from the boy. 

Brown then went into the gas station and shared what happened with the clerk, who told him Feel Free is so addictive that people are coming in five or six times a day to purchase a bottle.

“So I get home and look into this and people are literally going to rehab over this drink that is legal in most states in the U.S. and is sold in gas stations,” Brown says in the video. “I don't think we talk enough about things that are legal but are sold next to gum and energy drinks.”

The video has amassed more than 23 million views. However, there does not appear to be any follow-up videos posted by Brown elaborating on his story, or providing any evidence that any of it actually happened. 

MICHAEL “MISHA” BROWN (TIKTOK VIDEO)

In fact, the video has all the classic hallmarks of a “moral panic” story, which is an exaggerated fear or anxiety about something that is fueled by media attention or a video going “viral” online. In this case, there’s the implied harm to a child, no way to verify any of it, and an incentive for the creator to embellish and exaggerate his claims. 

Brown, who is an aspiring actor and singer, has posted thousands of videos online and has over three million followers on TikTok. He also has a podcast and is working on a book. Like other social media influencers, Brown’s income comes from advertising revenue, which is based on the number of views his videos get.

Even if his gas station story actually happened, there’s still a lot to unpack. 

Aside from the fact that children can already purchase excessive amounts of caffeine all on their own, both cigarettes and alcohol are also “things that are legal,” and are sold right next to gum and energy drinks in gas stations across the country. 

The makers of Feel Free have already self-imposed an age restriction for customers to be 21 and older. So if the teen in Brown’s story was hooked on Feel Free, then an adult was helping him get it long before the run-in at the gas station. 

And yes, that is a problem, just like it would be a problem if an adult was buying vodka for a 14-year-old. However, most will agree that doesn’t mean vodka should be illegal for adults.

Videos like Brown’s are concerning because they have the potential to spark real policy debates and hysteria from people who know nothing about kratom, a dietary supplement used by millions for pain relief or as an energy booster. 

The safety of kratom became a hot topic again when the FDA recently announced plans to make the kratom alkaloid 7-hydroxymitragynine (7-OH) an illegal Schedule One controlled substance. 7-OH occurs naturally in kratom in trace amounts, but some kratom vendors sell a concentrated, synthetic version of 7-OH to boost its potency.

Although Feel Free contains very little 7-OH, many media stories have conflated the two, implying the drink has “opioid-like effects” and is “hooking young people.”

In 2023, a class action lawsuit was filed against Botanic Tonics, alleging that Feel Free was misleadingly advertised as a healthy alternative to alcohol. The company settled the case for $8.75 million and agreed to put stronger safety warnings on its products.

Botanic Tonics responded to this latest uproar by trying to differentiate Feel Free from 7-OH, and “applauding” the FDA for its move. 

"Our products contain trace amounts of 7-OH that occur naturally during the traditional drying process — levels that are dramatically different from the concentrated synthetic products now under FDA scrutiny," said Cameron Korehbandi, CEO of Botanic Tonics. "The difference between natural leaf kratom and synthetic 7-OH concentrates represents a night and day distinction in terms of safety and consumer protection."

In my opinion, this was a huge mistake for Botanic Tonics. While it’s tempting to think it can keep Feel Free legal by appeasing the FDA, it’s already become clear that the moral panic around 7-OH is spreading to all kratom products. 

As such, Botanic Tonics should unite with kratom users to ensure that 7-OH continues to be sold the same way nicotine, alcohol, caffeine, and kratom leaf already are: over the counter and with age restrictions. 

If the FDA succeeds in making 7-OH a Schedule One controlled substance, it won’t be long until they come after kratom leaf as well.

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.

Does Having a Diagnosis Change How You Are Treated?

By Crystal Lindell

A few months after I got my first official diagnosis of Ehlers-Danlos syndrome in 2018, I had an appointment with a new orthopedic doctor. 

I was having really bad pain in my left shoulder that I injured while on crutches, which I was using as a result of a foot injury. It felt like I couldn’t catch a break. 

There was a new EDS diagnosis on my patient intake form, which I assumed would be relevant in one way or another. I turned in the form and was led back to a patient room to go over all my symptoms with the nurse, before being left to anxiously wait in an overly air conditioned exam room to meet the doctor. 

When he finally walked in, he didn’t bother to say hello. In fact, before he even introduced himself, he looked up from my patient intake form, scanned me up and down, and said in an accusatory tone, “So. What makes you think you have Ehlers-Danlos syndrome?”

The question caught me off guard. I didn’t “think” I had EDS. I had literally been diagnosed by another doctor in the same hospital system a few months prior.

“Um, well, I was diagnosed by a doctor who works here, and my mom has it, my brother has it, my uncle has it, and my cousin has it.”

“Oh,” he replied, before hastily trying to move on. But the tone had already been set. Instead of it being a meeting between patient and caregiver, it had shifted to a meeting between patient and accuser.

For many years, I had assumed that having an official medical diagnosis would change how doctors treated me. I spent five years blindly struggling with a chronic pain that had no name, desperately searching for a diagnosis or cause. 

If only I had the validation of some sort of official medical diagnosis, then finally they would have to take me seriously. Or so I thought. 

But here I was, getting a crash course in why that wasn’t going to be the case. 

It turns out that doctors who try to dismiss you pre-diagnosis will also try to dismiss you post-diagnosis. 

I also assumed that if I had a “real” diagnosis, my family, friends and professional contacts would be more willing to accept the pain that had been plaguing me for years. 

But alas, that was not the case either. Explaining to them that I had Ehlers-Danlos syndrome resulted in zero changes in their behavior either. 

What I did find is that people who empathized with my chronic pain pre-diagnosis also empathized with my pain post-diagnosis. 

It turns out, it was never about the diagnosis.The people who sneered, judged and dismissed me before I knew I had EDS, continued to sneer, judge and dismiss me after I knew I had EDS too. 

Where before they would try to blame their behavior on my lack of a diagnosis, they just found new reasons after I did have one. Their justifications turned to things like blaming my weight, calling me lazy, and lamenting that if I really wanted to get better, I would try more treatments and take fewer opioids. 

I understand the personal toll it can take to deal with health issues without a diagnosis. And knowing that I have EDS helped me find online support groups and helped me better navigate my medical care. So I do fully support continuing the search for answers if you’re undiagnosed. 

But as a patient who spent years in pain, both with and without a diagnosis, I’m unfortunately here to report that finally getting one probably won’t change how most doctors and loved ones treat you. 

Because how they treat you has never been based on you – it was always just a reflection of themselves.

FDA’s 7-OH Warning Sparks Sensational Claims About Kratom

By Pat Anson

The FDA’s latest campaign against kratom has reignited a wave of sensational claims in the media about the herbal supplement and its potential for addiction.

“A new emergency is quietly growing in the United States,” warns La Voce di New York, with an ominous but corny headline that calls kratom a new “Hippie Drug” disguised as an alternative to coffee.

“However, the preparation hides a high potential for addiction, with symptoms and withdrawal crises very similar to those caused by the most dangerous opioids.”

USA Today said it spoke with over 20 people who became “severely addicted” to kratom. One of them was Kim Maloney, a 49-year-old Ohio mother, who lost her car, home and marriage when her kratom use spun out of control. She believes it would have killed her, had she not gone into rehab.

"My eyes were rolling in the back of my head. I couldn't walk straight. I didn't leave my couch for months. I had pancreatitis. I had shingles. I was sick. I mean, I was really sick,” Maloney said.

Other news outlets are calling kratom “gas station heroin” and “legal morphine,” taking their cue from FDA Commissioner Marty Makary, MD, who recently announced plans to have a kratom alkaloid called 7-hydroxymitragynine (7-OH) classified as a Schedule One controlled substance --- the same category as heroin and LSD.

“7-OH is an opioid that can be more potent than morphine. We need regulation and public education to prevent another wave of the opioid epidemic,” said Makary.

‘Replacing One Addiction with Another’

The FDA’s renewed interest in kratom — and 7-OH in particular — apparently stems from a growing number of social media posts about it being addictive. A Reddit page created last year for people trying to quit 7-OH has over 4,000 members.

“You will have a passionate love affair with 7OH before it shows its true colors,” warns one former user. “Like many, I was a recovered kratom user before trying 7OH. And for the better part of a year, it felt like 7OH was a miracle drug that fixed all the negative side-effects of plain leaf kratom. IT'S NOT.”

Nicholas Campana, a recovering addict and YouTube influencer who goes by the name "Goblin," posted a video a few months ago calling 7-OH the “most dangerous drug in the smoke shop.”

“While kratom is a legitimate step down from opiates, in my opinion this is replacing one addiction with another,” Campana said in the video, which has been viewed over 700,000 times. "7-OH is the latest smoke shop craze. It’s not like the other ones, because this a very, very addictive opioid.”

For the record, neither kratom or 7-OH are opioids. They do not come from poppies. Kratom leaves come from Mitragyna speciosa, a tropical tree native to southeast Asia that belongs to the same botanical family as coffee.

Kratom does have opioid-like effects, however, and 7-OH is one of its active ingredients. In its natural state, only trace amounts of 7-OH are present in kratom. But some kratom vendors are selling gummies, drinks and tablets with concentrated synthetic versions of 7-OH to boost their potency.

‘Works as Well as Oxycodone’

According to one study, as many as two million Americans use kratom. Most take it for pain relief or as an energy booster, and have only been exposed to unadulterated kratom leaf products. Some chronic pain sufferers have tried 7-OH and found it just as effective as prescription opioids.

One of them is Emil, who suffers from chronic pancreatitis. Like many other pain patients, Emil has faced frustrating delays getting his opioid prescriptions filled. He asked that we not use his last name.

“I have had good experiences with 7-OH, using it primarily when I am waiting for a new prescription from my doctor since that can take over a week from the time I request it to getting it filled by the pharmacy, sometimes even longer,” Emil told PNN. ““It does not seem to cause the tiredness and aloofness, for lack of a better word, that prescription painkillers can cause and I feel like I am able to focus better, with less of the unpleasant side effects of painkillers such as nausea, dry mouth, etc. 

“I am prescribed oxycodone for pain and while it is somewhat effective in combination with ibuprofen in treating my pain, it is a constant struggle to keep my pain under control.  I would say that 7-OH works just about as well as oxycodone in controlling the pain, but definitely with less unpleasant side effects and really no so-called withdrawal symptoms or cravings, at least for me, as some people report with prescription painkillers. I truly do not understand why they are trying to ban it outright as a Schedule I substance with no medical use.”

The FDA has offered surprisingly little evidence about the harmful effects of 7-OH or why it is again trying to classify it as a Schedule One controlled substance. The FDA’s Adverse Event Reporting System has recorded only 15 cases involving 7-OH, two of them deaths, but because of “ambiguity about the contributory role of 7-OH” — which suggests other drugs were involved — the agency is downplaying the significance of those cases.

“This raises serious questions about the evidentiary basis for such a significant regulatory action,” Jeff Smith, PhD, national policy director for the Holistic Alternative Recovery Trust, wrote in an op/ed published in Medical Economics. “More research is needed to fully assess 7-OH’s risks, including its potential for misuse, dependence or drug-drug interactions. But they do not support the claim that 7-OH is an imminent threat to public health.

“To be clear, 7-OH is a potent compound. But potency alone does not justify prohibition. Alcohol, benzodiazepines and prescription opioids are far more dangerous and remain legally available under strict regulation. The proper response to uncertainty is research and oversight: not bans.”

‘Embarassing FDA Mistakes’

Kratom supporters and those who want access to 7-OH can take comfort in the FDA’s failure to get kratom banned in previous attempts.

In 2016, the Drug Enforcement Administration – acting at the request of the FDA – tried to classify 7-OH and the kratom alkaloid mitragynine as Schedule One drugs, only to drop those efforts after a public outcry. A top federal health official later said the FDA withdrew its scheduling request because of “embarrassingly poor evidence & data.”

In 2024, the FDA made another preliminary attempt at regulating kratom, publishing a notice in the Federal Register seeking public comment on a proposed survey of kratom users to evaluate 7-OH and mitragynine for potential harms. Ten days later, the FDA abruptly withdrew its study plans, citing unexplained “circumstances necessitating changes.”

Kratom advocates at the time said the FDA’s withdrawal of the study notice was the “latest embarrassing mistake” the agency made about kratom.

“The FDA’s few anti-kratom staff are repeatedly undermining the Agency’s credibility on harm reduction strategies,” said Mac Haddow, Senior Fellow on Public Policy at the American Kratom Association (AKA), an association of kratom vendors. “The FDA remains trapped in the web of their own making that unfairly demonizes products like kratom.”

The AKA has since changed its tune, and is now applauding the FDA for its “decisive and science-driven recommendation to classify 7-hydroxymitragynine (7-OH) as a Schedule I substance.”

“These 7-OH products are not kratom. They are chemically altered substances that carry potent opioid-like effects and pose an imminent threat to consumers,” Haddow said in a new statement.

It’s up to the DEA to decide if 7-OH should be classified as a controlled substance. If it does, the DEA must then publish a notice in the Federal Register, take public comments and reevaluate the evidence, a rulemaking process that could take months or even years. Until then, 7-OH can legally remain on the market under federal law as an unregulated dietary supplement, as long as no medical claims are made about it.

(Update 8/13/25: Florida isn’t waiting for the DEA or FDA to act. Florida Attorney General James Uthmeier has filed an emergency rule classifying concentrated forms of 7-OH as a Schedule One controlled substance in Florida. The rule makes it illegal to sell, possess or distribute concentrated forms of 7-OH in the state, calling them “an immediate and imminent hazard to the public health, safety, and welfare.”)

Hydromorphone Injections Can Quickly Relieve Intractable Pain

By Dr. Forest Tennant

I recall the time over a decade ago when Anazao Laboratory in Tampa, Florida informed me they had developed ultra-high potency (50 mg/ml) hydromorphone for palliative pain care. Anazao Labs was well aware of my patients’ needs, since they formulated my endocrine medicinals. 

In contrast to the other injectable opioids, Anazao’s hydromorphone formulation could be injected subcutaneously under the skin rather than intramuscularly.  The injection required a very small amount of fluid (.1 to .2 ml) that was administered with an allergy or insulin syringe.

My patients’ pain was called “intractable” to meet California’s Medical Board guideline and legal definitions.  The criteria for patients to enter my clinic was a determination that there was a high risk of death within one year unless opioid treatment could be administered. The top causes of intractable pain were adhesive arachnoiditis, traumatic brain injury, severe neuropathies (CRPS), autoimmune disease, and post-cancer care.

I recall the first patient to whom I prescribed ultra-high potency hydromorphone.  She was not receiving adequate pain relief with long-acting and breakthrough opioids, so she was referred for an intrathecal implanted device (pain pump) for opioid administration.  Due primarily to its cost and insurance reasons, she could not obtain this expensive treatment, so I chose to experiment with the new ultra-high potency hydromorphone. 

It worked remarkably well.  In fact, she soon found she didn’t require a long-acting or breakthrough opioid. Using the new hydromorphone formulation, she dropped her daily morphine milligram equivalent (MME) dosage from over 500 to less than 100 MME per day.

After success with this patient, I prescribed the hydromorphone formulation to other patients on high dose oral opioids, who could not obtain intrathecal opioids or an implanted electrical stimulator.  All the patients tolerated and adjusted well to it.  Ultra-high dose hydromorphone became an alternative to intrathecal opioids at my pain clinic.

When I later prescribed the hydromorphone formulation to other patients with intractable pain, I found that I could eliminate or reduce their use of high dose opioids through oral, patch or sublingual administration, and obtain equal or superior pain relief.

I have since retired from clinical practice, but still believe this is a major reason for using ultra-high potency hydromorphone for patients in severe pain.  My initial experience told me that the hydromorphone formulation could be an alternative to standard intractable pain care, which is the combined use of a long-acting opioid with a short-acting opioid for breakthrough pain. That therapy has shortcomings, because long-acting opioids suppress endocrine levels, which can lead to a wide range of health problems.

My procedure in prescribing hydromorphone was to instruct both the patient and a live-in family member on proper injection technique, secure storage, and maintaining sterility.  At the time I closed my clinic, I probably had about 2 dozen patients who successfully used this innovative formulation.

I have come to some conclusions that go against common beliefs about opioid therapy.  First and foremost, high potency hydromorphone can usually substitute in most cases for long-acting opioids such as OxyContin, transdermal fentanyl, and methadone.  Effective pain relief occurs within minutes after the injection, so the patient doesn’t have a proclivity to follow the opioid dose with a sedative or neuropathic drug such as a benzodiazepine. 

Seldom did my patients use over 3 to 4 injections a day.  To date, I know of no overdoses occurring.  I attribute this to hydromorphone’s rapid, potent, short-acting activity, which doesn’t invite the use of other drugs (including alcohol), to help the patient achieve pain relief.  Blood levels of the hydromorphone don’t stay elevated longer than about two hours, which protects against overdose. Pain relief remains much longer, however, likely because it is hydrophilic in neurologic tissues.

In summary, I have found ultra-high potency hydromorphone to be a significant advance in palliative pain care for intractable pain patients.  It has proven to be a bonafide alternative to intrathecal opioid delivery and to high opioid dosages necessary when combining the use of long and short acting opioids.  Its unique properties seem to reduce the risk of overdose. 

Families and patients can be trained to safely and effectively use this medicinal to relieve suffering from the most severe forms of intractable pain.  Unfortunately, it is an under-recognized and underused treatment for the palliative care of intractable pain patients.

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. 

Cannabis Use by Older Adults Linked to ‘Younger Brains’ and Improved Cognition

By Crystal Lindell

A new study suggests that cannabis use by older adults slows the aging of their brains and may even improve cognitive function.  

An international research team analyzed extensive health data on over 25,000 adults in the UK, looking at the relationship between cannabis use, aging, and cognitive function. They found that cannabis users had brain characteristics “typically associated with younger brains “ and “enhanced cognitive abilities.” 

“Cannabis users exhibited superior performance across multiple cognitive domains, and interestingly, the effects of cannabis and cognition are presented concurrently across a range of brain systems,” the authors said.

“These findings suggest that cannabis use may be associated with a deceleration of neural aging processes and the preservation of cognitive function in older adults.”

It’s important to note that the study is a preprint, published in Research Square, which means the findings have not yet been peer-reviewed by a medical journal and may undergo changes. 

While it’s common knowledge that cannabis can alter mood, cognition and perception, researchers wanted to look at other potential impacts, particularly in older adults. Most previous studies investigating the effects of cannabis on brain function focused on adolescents and young adults.

Due to legalization, cannabis is increasingly being used by older adults and there’s a growing recognition that cannabis can be used therapeutically to treat pain, insomnia, depression and other conditions associated with old age.  

Normal aging typically involves a gradual decline in cognitive abilities, but when researchers compared the cognitive performance of cannabis users and non-users, they found that  cannabis use had positive effects on most cognitive functions compared to normal aging.

Cannabis users performed better in various cognitive tasks, including problem solving, planning skills, numeric memory, intelligence, and vocabulary. The effects — where cannabis users outperform non-users — were evident across different age groups, starting in middle age (45–55 years) and continuing into old age (66 + years)

Researchers think cannabis enhanaces cognitive performance by improving how different parts of the brain communicate with each other, a process known as functional network connectivity (FNC).

“Our findings reveal that cannabis usage and healthy aging are associated with overlapping brain network configurations, particularly within the FNC between subcortical and sensorimotor regions, as well as between subcortical and cerebellar areas, albeit with significantly reversed effects,” they said.

The enhanced performance of these brain regions may be due to higher concentrations of cannabinoid receptors in brain tissue, which makes them more responsive to cannabinoids such as tetrahydrocannabinol (THC) and cannabidiol (CBD).

Researchers say their findings could lead to further research into whether cannabinoids and endocannabinoids could be used to treat multiple sclerosis, Parkinson's disease, Alzheimer's disease, and other neurodegeneration diseases.

Limits on Rx Opioids Led to Unintended Consequences in Australia

By Pat Anson

An Australian study highlights some of the benefits and unintended consequences of efforts to limit the prescribing of opioid pain medication.

Like the United States, there’s been a fair amount of controversy in Australia about opioid medication and the role it played in the so-called opioid crisis. In response, Australian regulator took two steps in 2020 to limit prescribing: creating prescription drug monitoring programs (PDMPs), and limiting the amount of opioids and repeat prescriptions subsidized by the government.

To see how well the changes worked, researchers analyzed emergency department (ED) visits by patients prescribed opioids by primary care doctors in Victoria, the second most-populated state in Australia with over seven million people. Victoria was the first state to adopt a mandatory PDMP, which doesn’t stop a doctor from prescribing opioids but alerts them to possible misuse by a patient.

The research findings, published in the Medical Journal of Australia, show that ED visits by patients on prescription opioids fell by 11.8 visits per 100,000 people after opioids restrictions were implemented. At the same time, however, researchers identified a short-term but statistically significant increase of 7.3 ED visits per 100,000 people that were linked to non‐opioid substances.

The study didn’t identify what those non-opioid substances were, but researchers suspect that some were uncontrolled medications, such as pregabalin and antidepressants, which are often prescribed as alternatives to opioids for pain relief.

“As we expected, the new policies were associated with reduced opioid‐related harm; the reduced availability of prescription opioids presumably explains this change. We also expected that the changes would have unintended effects, and found an immediate increase in the non‐opioid substance‐related ED presentation rate that was greater among people prescribed opioids than in the control group,” researchers reported.

“One possible mechanism underlying the increase in non‐opioid substance‐related harms could be related to increased prescribing of unmonitored pain medicines, such as pregabalin and tricyclic antidepressants, following the introduction of the prescription drug monitoring program.”

PDMPs have also had unintended consequences in the United States. In a 2021 study, the Reason Foundation found that opioid prescribing declined in states that adopted PDMPs, but that overdoses involving heroin, illicit fentanyl and cocaine significantly increased – suggesting that some patients were substituting illicit drugs for prescription opioids.

The focus on prescription opioids may have been misplaced in Victoria. According to a 2023 report by the state’s coroner, the anti-anxiety medication diazepam was the lead drug involved in fatal overdoses (213 deaths) in Victoria, followed by heroin (204 deaths), methamphetamine (164 deaths), alcohol (153 deaths) and pregabalin (78 deaths). In contrast, oxycodone was involved in 41 deaths and codeine in 24 deaths.

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..

Bad News Continues for Non-Opioid Analgesics

By Pat Anson

The bad news keeps piling up for non-opioid analgesics, which are often touted as safer and more effective alternatives to opioid pain medication.

A large new study found that pregabalin (Lyrica) raises the risk of heart failure in older patients, while Vertex Pharmaceuticals said it was stopping development of an experimental drug for post-operative pain because it was less effective than a low dose of hydrocodone.   

The pregabalin study, recently published in JAMA Network Open, compared the drug to gabapentin (Neurontin) among Medicare patients with chronic non-cancer pain. Both pregabalin and gabapentin are gabapentinoids, a class of nerve medication that was originally developed to prevent seizures in epileptic patients.

Because they are not opioids and perceived as safer, both drugs are now widely being prescribed for a variety of pain conditions, usually off-label.  

In a subset of patients with cardiovascular disease, researchers found that hospitalizations and emergency department visits for heart failure were more common in pregabalin users compared to patients on gabapentin. The difference wasn’t significant (18.2 visits vs 12.5 per 1,000 person-years), but it was enough for researchers to recommend caution when prescribing pregabalin.

“Practicing clinicians should undertake a careful assessment of ongoing cardiovascular risk factors and perform adequate risk-benefit counseling for older patients before prescribing pregabalin for chronic pain,” wrote lead author Elizabeth Park, MD, Columbia University Irving Medical Center.

Pregabalin is believe to be riskier because it binds to calcium channels associated with heart failure and arrhythmias. Both the American Heart Association and European Medicines Agency already list pregabalin as a drug that increases the risk of heart failure.

"The study serves as an important reminder that not all gabapentinoids are created equal and that in the pursuit of safer pain control, vigilance for unintended harms remains paramount," said Robert Zhang, MD, and Edo Birati, MD, in an accompanying editorial.

"For older adults with chronic pain, particularly those with cardiovascular disease, clinicians should weigh the potential cardiovascular risks associated with pregabalin against its analgesic benefits. This is particularly relevant given the growing use of gabapentinoids in older populations and ongoing polypharmacy issues in this age group."

The research doesn’t give gabapentin a clean bill of health, since it also raises the risk of heart failure in older patients – just not as much as pregabalin. Last month another study found that gabapentin increases the risk of dementia and cognitive impairment.

Researchers have long been concerned about the effects of gabapentinoids on the brain, while many patients have complained the drugs cause brain fog, dizziness, weight gain and mood changes. Despite warnings that they are overprescribed for conditions they were never intended to treat, the use of gabapentinoids continues to grow in the United States. 

New Analgesic No Better Than Vicodin

The new analgesic being developed by Vertex Pharmaceuticals – called VX-993 -- will apparently never reach patients, after the company announced disappointing results from a Phase Two clinical trial.  VX-993 is a non-opioid that blocks pain signals in peripheral nerves before they reach the brain, which means it doesn’t have the same “liking” effects of opioids, which can lead to addiction.  

When given to patients recovering from bunionectomy surgery, VX-993 was slightly more effective than a placebo in reducing post-operative pain, but provided less pain relief than a low dose of a hydrocodone/acetaminophen combination (Vicodin).  

“Based on these results, as well as the totality of preclinical data and results from our previous bunionectomy clinical studies, VX-993 is not expected to be superior to our existing NaV1.8 inhibitors and therefore we will not be advancing it as monotherapy in acute pain,” Carmen Bozic, MD, Executive Vice President and Chief Medical Officer at Vertex, said in a statement.

VX-993 acts similarly to Journavx (suzetrigine), a non-opioid developed by Vertex that acts on peripheral nerves. Journavx was recently approved by the FDA to treat moderate to severe acute pain, despite lackluster results in clinical trials that also showed it was no more effective than Vicodin.

The FDA’s approval of Journavx coincides with implementation of the NOPAIN Act, which makes non-opioid analgesics in outpatient surgical settings eligible for higher Medicare reimbursement rates. Journavx costs about three times as much as Vicodin.

What Is Legitimate Pain?

By Dr. Forest Tennant

The question posed by the headline of this article may at first seem ridiculous or unneeded. But a definition of “legitimate pain” is really needed.

Federal government regulations require physicians to get a DEA license to prescribe opioids and other controlled substances. The prescribing must be for a “legitimate medical purpose” -- which is obviously intended to mean legitimate pain. 

It may be surprising, but the federal government doesn’t have a definition for legitimate pain.  State medical boards throughout the United States also do not define legitimate pain, although they monitor physicians for the “legitimacy” of their treatments. 

Recent history has shown that many physicians have been investigated and prosecuted for prescribing opioids without a “legitimate medical purpose,” despite the fact that there is no written definition of legitimate pain to be found in medical regulations and guidelines.

The lack of a written definition of legitimate pain has allowed wide discretion and abuse by prosecutors and their hired medical consultants, making it difficult for doctors to defend themselves against a system that is seemingly rigged against them.

Government agencies, medical boards, professional groups, and insurance plans also call pain “illegitimate” if they don’t like the treatment, dosage, brand, doctor, or cost. 

As unbelievable as it may sound, I’ve read and heard some terribly biased and ignorant definitions of what is and isn’t legitimate pain. 

For example, I’ve heard that a simple need for opioids makes pain illegitimate. The new definition of pain, according to some physicians, is really “opioid use disorder,” which requires treatment for addiction. I’ve also read that pain is a character deficiency and a natural part of life that needs no treatment.

There are some well-meaning persons who claim that pain is whatever the patient says it is. Sorry patients, there are simply too many addicts prowling doctor’s offices with detailed, fraudulent claims of pain fabricated to obtain opioids. Common sense and science tell us to “find the cause of pain before you prescribe.”   

It’s hard to believe, but the International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience.”  I can’t wait to ask United Healthcare and Medicare to pay for an expensive drug with this definition.

It is important to point out that the term “legitimate pain” is not only lacking in regulatory guidelines, but it is also not found in medical dictionaries.  Pain may be an experience, emotion or sensation, but it has historically been regarded as a symptom of an underlying disease or injury. 

For example, the Dunglison’s Medical Dictionary of 1874 says “pain is generally symptomatic.”  Medical practitioners today, however, need a new definition of pain because the term “legitimate” is now used to justify treatment with opioids and other controlled drugs. 

Here is my definition of pain, which I believe will generally satisfy all parties, including patients, practitioners, governmental bodies, insurance companies, and the media:

“A stressful symptom caused by a disease or injury that can be objectively identified by diagnostic tests or physical examination.”  

In the past, an argument was made that some causes of pain, such as fibromyalgia and headaches, can’t be objectively verified.  This may have been true in the past, but today’s technological advances in medical imaging and laboratory tests, along with a detailed physical examination, can objectively determine the cause of nearly every source of pain. 

An examination of my submitted definition not only implies that a medical practitioner has the right to treat the patient, it also implies that the practitioner has an obligation to treat both the pain and the cause. 

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.

Living With Chronic Pain Teaches You to Ignore the Haters

By Crystal Lindell

When I first started having chronic pain in 2013, one of the major hurdles I faced was that I suddenly had a lot of trouble handling my full-time job. Doing a 90 minute commute each way, managing stress, traveling for conferences – all of it became infinitely more difficult. 

A lot of bosses probably would have immediately started to look for ways to let me go at that point, but I was lucky enough to have one who didn’t. He was an incredible mentor, friend and advocate for me – both within the company and with third parties. 

In fact, I would often rave about him to others, bragging about how empathetic and compassionate he was about the whole situation. 

A few years later, my boss started to have really bad knee pain, to the point that he eventually needed a knee replacement. 

Before he could have the surgery though, we had to cover a week-long industry conference at an exhibition hall together, and the whole experience left him very drained. He was suddenly experiencing chronic pain. 

Near the end of the week our team was having dinner, and he leaned over to tell me something. 

“I’m sorry I was not more compassionate to you about your health problems. It’s so awful. I go to bed tired, I wake up tired. The pain is always there. It’s horrible. I should have been nicer,” he told me.

I was stunned. 

This was someone who I had always categorized as being among the most compassionate about my chronic pain. And here he was – now faced with it himself – feeling as though he should have been even nicer. 

I always point to that story when I talk about why I don’t take it personally when others judge how I manage my life with chronic pain. Until you’ve been through it, it’s really hard to truly understand what it’s like to live with it – and what you’d do to make it stop. 

Even the most compassionate people often find that they were not compassionate enough. That it’s worse than they previously understood. 

And most people are not compassionate. On the contrary,  over the years a lot of people have been really judgemental about my health choices. People love to offer unsolicited advice, talk behind my back, and make rude comments like these: 

“She just wants to get high all day.”

“If you really wanted to get better you’d take up running/yoga/pilates and lose weight.”

“How bad could it be? She’s just lazy.”

But one thing I’ve noticed repeatedly is that when life hands them a health problem of their own, they are quickly humbled. 

People who thought I wasn’t doing enough to get better suddenly feel overwhelmed by something as routine as an MRI.

People who thought I took too many pain pills suddenly ask me for tips on how to get their doctor to prescribe pain medication. 

People who sneered at my kratom use suddenly want a tutorial on how to use it. 

People who called me childish for advocating for universal health care suddenly realize that the health insurance industry doesn’t care if they live or die. 

And people who thought I wasn’t doing enough to further my career quit their jobs and stopped working altogether. 

To be honest, I get it. It’s really hard to conceptualize a life with chronic pain or any chronic health issue until it happens to you. And it’s easy to judge how someone else is handling it. 

So when they are humbled, I never say “I told you so.” Instead, I offer sympathy, and whatever advice they ask for. 

And I tell them the most important thing you can tell someone with chronic pain: You are not crazy, you are not alone, and you can still live a very fulfilling life regardless of your health issues. 

Before that happens though, before they are humbled, when they are still healthy and offering judgements, I do something else – I ignore them. Because I know that no matter what they say, they wouldn’t handle my chronic pain any better than I do. 

To quote one of the most famous song writers of our generation: 

“Haters gonna hate, hate, hate, hate, hate. Baby, I'm just gonna shake, shake, shake, shake, shake. I shake it off, I shake it off.”

Endometriosis Linked with Hundreds of Comorbidities

By Pat Anson

Endometriosis is one of the most frustrating and debilitating conditions a woman can have, causing physical, sexual and emotional pain that’s difficult to diagnose and treat.

Patients who have endometriosis are often told it’s “all in your head” or that “you’ll grow out of it.” Few of them do. Nearly 200 million people worldwide suffer from endometriosis, including about one in 10 American women.

A new study at the University California-San Francisco (UCSF) is providing new insights into endometriosis, linking it with hundreds of comorbidities such as cancer, Crohn's disease, and migraine. The research could improve how endometriosis is diagnosed and treated – ending some of the silence and misconceptions about the disease.

Researchers analyzed the electronic health records of over 43,000 people with endometriosis, comparing them to a large control group without the disease. Their findings are published in the journal Cell Reports Medicine 

“We now have both the tools and the data to make a difference for the huge population that suffers from endometriosis,” says senior author Marina Sirota, PhD, a professor of pediatrics and interim director of the UCSF Bakar Computational Health Sciences Institute. “We hope this can spur a sea change in how we approach this disorder.”

Endometriosis or “endo” occurs when blood-rich tissue that grows in the uterus is expelled each month during menstruation, spreading to the ovaries, fallopian tubes, abdomen and other nearby organs. The misplaced endometrial cells implant themselves in the new host tissue and grow, causing internal bleeding, inflammation and pain.

The wayward cells can be removed by surgery, but endometriosis is usually treated with hormones to suppress the menstrual cycle. Not everyone responds to surgery or hormonal therapy, which can have side effects. Removal of the uterus is a last-ditch treatment usually reserved for older women, but some women continue to have pain even after a hysterectomy.

“Endo is extremely debilitating,” said co-author Linda Giudice, MD, a physician-scientist in UCSF’s obstetrics, gynecology and reproductive sciences department. “The impact on patients’ lives is huge, from their interpersonal relationships to being able to hold a job, have a family, and maintain psychological well-being.”

In analyzing patient data, researchers looked for comorbidities linking endometriosis with other medical conditions, and found over 600 of them. Some were previously known, such as infertility, autoimmune disease, and migraine. Some were unexpected: certain cancers, asthma, and eye-diseases. The findings support the growing understanding of endometriosis as a “multi-system” disorder that causes dysfunction throughout the body. 

“This is the kind of data we need to move the needle, which hasn’t moved in decades,” Giudice said. “We’re finally getting closer to faster diagnosis and, eventually, we hope, tailored treatment for the millions of women who suffer from endometriosis.”

The association of endometriosis with migraine, for example, opens the possibility of treating endometriosis pain with medications that block calcitonin gene–related peptides (CGRPs), a relatively new class of migraine drug. In recent years, the FDA has approved over half a dozen CGRP medications for migraine prevention and/or treatment.

CGRP medications tend to be expensive, but so is endometriosis. One study estimates that the lifetime cost of having endometriosis in the U.S. is about $27,855 per year per patient, or about $22 billion annually.