5 Ways to Support a Loved One With Chronic Pain

By Crystal Lindell

Recently I wrote that one of the most important things you need to enjoy life with chronic pain is supportive loved ones.

But what does that look like in practice?

Below are some tips on how to realistically help loved ones who deal with chronic pain.

And if you’re the person in pain reading this, perhaps you can pass this on to your friends, family and other loved ones. Afterall, sometimes getting advice from a third party can help it land better.

Also, of course, if you have your own tips to share, we’d love to read them in the comments!

1. Keep in Touch With Them

If you care about someone with pain, maybe the most important thing you can do is to just stay in contact with them.

Having chronic pain makes it difficult to attend in-person events, but that doesn’t mean we lose the need for human connection. In fact, it just makes that need much stronger.

Sometimes friends fall off because they don’t see you as often, but other times it’s because they don’t want to have to talk to someone with chronic health issues. Those conversations can force them to face the fact that their own body is also fragile and mortal.

But if you actually care about someone, I encourage you to push past all that.

Texting and phone calls can be a lifeline for people with chronic pain — as can in-person visits.

Your interactions with them may be the majority of human interaction they have, and it can be enough to keep them going for another day.

2. Give Them Meals and Help with Chores

When I first started having chronic pain, one of my friends did one of the nicest things anyone has ever done for me – either before or since. She drove 2 hours to come visit me and then cleaned my entire apartment, including the bathroom.

It is not possible to express how grateful I was and how much of a difference that made in my ability to keep going through one of the darkest times in my life. Just having a clean space to exist was like having a weight lifted off my very painful ribs.

While healthy people can take for granted the ability to do daily household tasks like cooking meals and doing the dishes — a person with chronic pain knows how easy it is to fall behind on those things.

And when that happens, on top of the stress of dealing with a broken body, you also have to deal with a messy house. That can come with a lot of guilt and even physical discomfort.  

So, if you’re able to help them with housework in any capacity, that can also lift a truly heavy burden.

Having someone make or drop off meals once a week, or even once a month can also be a massive help. There’s also the option of sending meals with services like DoorDash or Uber Eats, or giving them food delivery gift cards.

It may seem like cooking and cleaning for someone is no big deal, but when you do it for someone with chronic pain, it can be as helpful as the best medication.

3. Don’t Be Offended If Someone Needs Rest

I need more sleep than the average person, I assume because my body is using so much energy to just exist with chronic pain. I also need more time to recover after big events like parties.

It can mean that I can’t respond to calls or text, and that I need a lot of time alone to sleep and rest.

But even my most well-meaning loved ones can take this need for rest as some sort of indictment — as though I just don’t want to be around them or to interact with them.

It’s not about them though, it’s about me and my defective body.

If someone you love has chronic pain and they need a nap, or a couple days to respond to a text, don’t take it personally. It probably just means they needed some extra rest.

4. Go to Doctor’s Appointments With Them

Chronic pain can make it more important than ever to have productive doctor appointments — but it can also make that task more difficult.

That’s why having a loved one attending doctor’s appointments with you is truly invaluable.

A second person being there to focus on what the doctor is saying and to ask questions on your behalf can mean the difference between finding treatments that actually work or not.

It also usually makes doctors take a patient more seriously when they know that a loved one is keeping tabs and will be holding them to account for their treatment outcomes.

So, if you’re able to go to doctor appointments with your loved one with chronic pain, I highly recommend doing so.  

5.  Be Accepting of their Use of Pain Medications

A lot of people face stigma for using pain medications, especially opioids.

But oftentimes, pain medication can become a point of friction between patients and loved ones, who don’t fully understand the importance of alleviating chronic pain.

Other people’s pain is always easy to endure, so it’s always easy to tell someone else that they don’t need to treat their pain.

While loved ones who say such things are usually well-meaning, those conversations can cause a lot of unnecessary stress for people in pain.

It’s best just to assume that if someone is using pain medication, then they need that pain medication.  

In the end, the best advice for supporting a loved one with chronic pain is to treat them how they want to be treated. And to accept that whatever they are going through is at least as bad as they are describing.

When you approach help from that mindset, you’ll often naturally find the best ways to support them.

Having support from loved ones can mean the difference between being able to endure a life with chronic pain or not. It’s just as important for their health as a good doctor is, and it can have just as much impact. 

It’s a Bird! It’s a Plane! It’s a Chemtrail? New Conspiracy Theory Takes Wing at HHS

By Stephanie Armour

While plowing a wheat field in rural Washington state in the 1990s, William Wallace spotted a gray plane overhead that he believed was releasing chemicals to make him sick. The rancher began to suspect that all white vapor trails from aircraft might be dangerous.

He shared his concern with reporters, acknowledging it sounded a little like “The X Files,” a science fiction television show.

Academics cite Wallace’s story as one of the catalysts behind a fringe concept that has spread among adherents to the Make America Healthy Again, or MAHA, movement and is gaining traction at the highest levels of the federal government. Its treatment as a serious issue underscores that under President Donald Trump, unscientific ideas have unusual power to take hold and shape public health policy.

The concept posits that airplane vapor trails, or contrails, are really “chemtrails” containing toxic substances that poison people and the terrain. Another version alleges planes or devices are being deployed by the federal government, private companies, or researchers to trigger big weather changes, such as hurricanes, or to alter the Earth’s climate, emitting hazardous chemicals in the process.

Several GOP lawmakers and leaders in the Trump administration remain convinced the concepts are legitimate, though scientists have sought to discredit such claims.

Health and Human Services Secretary Robert F. Kennedy Jr. is planning to investigate climate and weather control, and is expected to create a task force that will recommend possible federal action, according to a former agency official, an internal agency memo obtained by KFF Health News, and a consultant who helped with the memo.

The plans, along with comments by top GOP lawmakers, show how rumors and conspiracy theories can gain an air of legitimacy due to social media and a political climate infused with falsehoods, some political scientists and researchers say.

“When we have low access to information or low trust in our sources of information, a lot of times we turn to our peer groups, the groups we are members of and we define ourselves by,” said Timothy Tangherlini, a folklorist and professor of information at the University of California-Berkeley. He added that the government’s investigation of conspiracy theories “gives the impression of having some authoritative element.”

HHS is expected to appoint a special government employee to investigate climate and weather control, according to Gray Delany, former head of the agency’s MAHA agenda, who said he drafted the memo. The agency has interviewed applicants to lead a “chemtrails” task force, said Jim Lee, a blogger focused on weather and climate who Delany said helped edit the memo, which Lee confirmed.

“HHS does not comment on future or potential policy decisions and task forces,” agency spokesperson Emily Hilliard said in an email.

The memo alleges that “aerosolized heavy metals such as Aluminum, Barium, and Strontium, as well as other materials such as sulfuric acid precursors, are sprayed into the atmosphere under the auspices of combatting global warming,” through a process of stratospheric aerosol injection, or SAI.

“There are serious concerns SAI spraying is leading to increased heavy metal content in the atmosphere,” the memo states.

The memo claims, without providing evidence, that the substances cause elevated heavy-metal content in the atmosphere, soil, and waterways, and that aluminum is a toxic product used in SAI linked to dementia, attention-deficit/hyperactivity disorder, asthma-like illnesses, and other chronic illnesses. The July 14 memo was addressed to White House health adviser Calley Means, who didn’t respond to a voicemail left by a reporter seeking comment.

High-level federal government officials are presenting false claims as facts without evidence and referring to events that not only haven’t occurred but, in many cases, are physically impossible, said Daniel Swain, a climate scientist at the University of California.

“That is a pretty shocking memo,” he said. “It doesn’t get more tinfoil hat. They really believe toxins are being sprayed.”

Kennedy has previously promoted debunked chemtrail theories. In May, he was asked on “Dr. Phil Primetime” about chemicals being sprayed into the stratosphere to change the Earth’s climate.

“It’s done, we think, by DARPA,” Kennedy said, referring to a Department of Defense agency that develops emerging technology for the military’s use. “And a lot of it now is coming out of the jet fuel. Those materials are put in jet fuel. I’m going to do everything in my power to stop it. We’re bringing on somebody who’s going to think only about that.”

DARPA officials didn’t return a message seeking comment.

‘This Really Matters to MAHA’

Deploying chemtrails to poison people is just one of many baseless conspiracy theories that have found traction among Trump administration health policy officials led by Kennedy, a longtime anti-vaccine activist before entering politics. He continues to promote a supposed link between vaccines and autism, as well as make statements connecting fluoride in drinking water to arthritis, bone fractures, thyroid disease, and cancer. The World Health Organization says fluoride is safe when used as recommended.

Delany, who was ousted in August from HHS, said Kennedy has expressed strong interest in chemtrails.

“This is an issue that really matters to MAHA,” said Delany, referring to the informal movement associated with Kennedy that is composed of people who are skeptical of evidence-based medicine.

The memo also alleges that “suspicious weather events have been occurring and have increased awareness of the issue to the public, some of which have been acknowledged to have been caused by geoengineering activities, such as the flooding in Dubai in 2024.” Geoengineering refers to intentional large-scale efforts to change the climate to counteract global warming.

“It is unconscionable that anyone should be allowed to spray known neurotoxins and environmental toxins over our nation’s citizens, their land, food and water supplies,” Delany’s memo states.

Scientists, meteorologists, and other branches of the federal government say these assertions are largely incorrect. Some points in the memo are accurate, including concerns that commercial aircraft contribute to acid rain.

“I expected there were documents like this, but seeing it in print is nevertheless shocking. Our government is being driven by nonsensical dreck from dark corners of social media.”

— David Keith, PhD, University of Chicago.

But critics say the memo builds on kernels of truth before veering into unscientific fringe theories. Efforts to control the weather are being made, largely by states and local governments seeking to combat droughts, but the results are modest and highly localized. It isn’t possible to manipulate large-scale weather events, scientists say.

Severe flooding in the United Arab Emirates in 2024 couldn’t have been caused by weather manipulation because no technology could create that kind of rainfall event, Maarten Ambaum, a meteorologist at the University of Reading who studies Gulf region rainfall patterns, said in a statement on the floods. Similar debunked claims emerged this year after central Texas experienced devastating floods.

The Government Accountability Office concluded in a 2024 report that questions remain as to the effectiveness of weather modification.

Research into changing the climate has been conducted, including work by one private company that engaged in field tests. Still, federal agencies say no ongoing or large-scale projects are underway. Study of the concept remains in the research phase. The Environmental Protection Agency says there are no large-scale or government efforts to affect the Earth’s climate.

“Solar geoengineering is not occurring via direct delivery by commercial aircraft and is not associated with aviation contrails,” the agency says on its website.

Widespread Misinformation

Misperceptions about weather, climate control, and airplane contrails extend beyond the Trump administration, scientists said.

In September, a congressional House committee hearing titled “Playing God With the Weather — A Disastrous Forecast” involved two hours of debate on the once-fringe idea. Rep. Marjorie Taylor Greene (R-Ga.), who chaired the hearing, has introduced legislation to ban weather and climate control, with a fine of up to $100,000 and up to five years in prison.

Some Democrats objected to the nature of the discussion. Rep. Melanie Stansbury (D-N.M.) accused Greene of using “the platform of Congress to proffer anti-science theories, to platform climate denialism.”

Frequently citing chemtrails, GOP lawmakers have introduced legislation in about two dozen states to ban weather modification or geoengineering. Florida passed a bill to establish an online portal so residents can report alleged violations.

“The Free State of Florida means freedom from governments or private actors unilaterally applying chemicals or geoengineering to people or public spaces,” GOP Florida Gov. Ron DeSantis said in a press statement this spring.

Meanwhile, the chemtrail conspiracy has permeated popular culture. The title track on singer Lana Del Ray’s seventh studio album is entitled “Chemtrails Over the Country Club.” Bill Maher dove into the chemtrail myth on his podcast “Club Random,” saying, “This is nuts. It’s just nuts.” And “Chemtrails,” a psychological thriller, wrapped filming in July.

Social media has given wing to the chemtrails concept and other fringe ideas involving public health. They include an outlandish belief that Anthony Fauci, who advised both Trump and President Joe Biden on the government response to the covid-19 pandemic, created the AIDS epidemic. There is no evidence of such a link, public health leaders say.

Researchers say another false belief by those on the far right holds that people who received covid vaccines could shed the virus, causing infertility in the unvaccinated. There is no evidence of such a connection, scientists and researchers say.

More severe weather events due to global warming may be driving some of the baseless theories, scientists say. And risks occur when such ideas take hold among the general population or policymakers, some public health leaders say. Climate researchers, including Swain, say they’ve received death threats.

Lee, the blogger, said he disagrees with some of the more far-fetched beliefs and is aware of the harm they can cause.

“There are people wanting to shoot down planes because they think they are chemtrails,” said Lee, adding that some believers are afraid to venture outside when plane vapor trails are visible overhead.

There is also no evidence that plane contrails cause health problems or are related to intentional efforts to control the climate, according to the EPA and other scientists.

The memo and focus at HHS on climate and weather control are alarming because they perpetuate conspiracies, said David Keith, a professor of geophysical sciences at the University of Chicago.

“It’s unmoored to reality,” he said. “I expected there were documents like this, but seeing it in print is nevertheless shocking. Our government is being driven by nonsensical dreck from dark corners of social media.”

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

3 Things You Need to Enjoy Life, Even With Chronic Pain

By Crystal Lindell

If you want to enjoy life again while also living with chronic pain, you need just three things.

1. An effective pain medication.
2. The ability to pace your activity level
3. Supportive loved ones

If you have all three of those things, it’s very possible to enjoy life while also enduring chronic pain. In fact, you could have a very happy life even with severe, debilitating pain every single day.

Unfortunately, of course, many chronic pain patients do not have all three of those things.

Even if they have access to opioids and other pain medications, they may not have the option to pace their activity levels due to things like work and parenting commitments. Or they may not have loved ones who show sympathy for what you’re going through and offer accommodations to make your life easier.

Sadly though, most doctors don’t recognize the importance of having all three things when they are treating chronic pain patients.

“Enjoying life” is usually not something doctors measure during treatments or appointments.  

Personally, I don’t think I have ever had a medical doctor ask me how much I’m enjoying life. Rather, they ask you to rate your pain level, and then either ignore you or send you off to another random specialist.

It’s why they don’t value the importance of prescribing pain medications that actually work, and why they rarely offer education for loved ones about how to better support the people in their life who have chronic pain.

It’s also why doctors rarely explain the importance of pacing your activity levels.

While I have had medical doctors tell me to quit working, I’ve had only one psychologist explain to me that instead of fully quitting, I could just cut back on some activities and plan more rest days.

In other words, stop pushing myself to the point of exhaustion before taking time to rest.

I assume that many doctors don’t grasp the concept of pacing, in large part because of their medical training. Residency scheduling makes it so that they are often working 24-hour shifts, with little time to recover before the next one.

In other words, the exact opposite of pacing.

When you have chronic pain, you can’t live that way though. Of course, technically, you can live that way, but you won’t enjoy life if you do.

If you accept the fact that you need to rest your body from time-to-time, you can actually do more activities in the long run.

However, under a capitalist system that prizes work, sometimes that is just not possible, no matter how much you want to pace yourself. In fact, the same applies to the other two things you need to enjoy life: Sometimes doctors just won’t give you pain medication and sometimes loved ones just will not support you.

There is good news though.

Even if you don’t have all three of those things, you can still find some joy in a life with chronic pain, as long as you are very stubborn and tenacious.

You just have to find alternative pain medications, like kratom or cannabis. And insist on creating a life that allows for pacing, whether that means changing jobs or moving in with family to help with daily life tasks. 

Then you have to educate your loved ones on how they can better accommodate you – and be prepared to pull back if they are mean or rude about it.

When I first developed chronic pain, I genuinely thought life was not worth living. That was more than a decade ago, and I’ve experienced countless joys since then: trips to Europe, meeting the love of my life, getting cats, and hugging my new niece.

Not to mention all the little joys, like fresh baked bread, cozy heated blankets on a cold winter night, and getting lost in a corn maze with my family.

I am very lucky to now have effective pain medication, a life that allows for pacing, and supportive loved ones. But I didn’t start that way. I rearranged my priorities to make it so. And it is possible that you can do the same.

You just have to stop trying to fight the pain, and instead learn to accept it. Then you can be free to live your life, while finding as many joys as you can along the way. 

Two-Thirds of Chronic Pain Patients Eat Comfort Foods to Help Them Cope

By Pat Anson

A slice of apple pie or a bowl of ice cream are comfort foods to many people, giving us a mood boost (not to mention a sugar rush) during times of stress, loneliness or anxiety.

For many people with chronic pain, comfort foods are also a way to cope and distract during pain flare-ups. A small study in Australia recently found that over two-thirds of people with chronic pain eat to feel better.

“People who live with pain every day need to find ways of coping. We think about medication, physiotherapy or heat packs as pain management strategies, but we don’t usually think about food in the same way. Yet two-thirds of our sample said they turned to food at least once a fortnight when pain flared,” says lead author Toby Newton-John, PhD, a clinical psychologist and Head of the Graduate School of Health at the University of Technology Sydney (UTS).

“Managing daily pain is incredibly tough, and medication often only goes so far. It’s understandable that people reach for something that feels good.”

The study, Eating to Feel Better: The Role of Comfort Eating in Chronic Pain, was recently published in the Journal of Clinical Psychology in Medical Settings.

Newton-John and his colleagues surveyed 141 adults with chronic pain, asking why they turn to food during pain flares. Given a choice of nine possible answers (and being allowed to select more than one) the results show that over half (51.8%) ate comfort foods to “give myself a pleasant experience,” followed by “distract myself” (49.6%) and “reduce my emotions” (39%).

“That was the somewhat unexpected finding,” Burton said in a press release. “Comfort eating wasn’t just for the purpose of distraction or numbing negative feelings, although those were important too. For many, eating comfort foods provided a nice experience in their day and something to look forward to. If you’re living with pain all the time, that moment of pleasure becomes a pretty powerful motivator.”

To be clear, not everyone in pain eats for distraction or pleasure. Nearly one in five (18.4%) said they tend to eat less when in pain, and a fair number said they eat as usual (11.3%), whether they’re in pain or not.

The frequency of comfort eating ran the gamut from multiple times a day (14.2%) to several times a week (19.9%), to never (18.4%).

The survey did not ask participants what foods they ate, but researchers believe pain can trigger cravings for certain foods.  

“There may also be a biological explanation. Research shows high-calorie foods can have a mild pain-relieving effect. Even in animal studies, rats in pain will seek out sugar. It seems it’s not just psychological. It's possible that there is a real analgesic property to these foods as well,” said co-author Amy Burton, PhD, a lecturer in Clinical Psychology at the UTS Graduate School of Health.

But eating for comfort comes at a cost. Nearly two thirds of participants in the study were obese (29.8%) or overweight (37.6%).  Newton-John warns that food-driven relief can become part of a vicious cycle.

“Short-term, high-calorie food makes people feel better. It reduces pain symptoms and enhances pain tolerance. Long-term, it can fuel weight gain and inflammation, which increases pressure on joints and makes pain worse; and that can trap people in a spiral that’s very hard to break,” he said.

Pain management programs usually focus on medication, physical therapy, and cognitive behavioral therapy. This research suggests a need to integrate diet and nutritional advice into pain management programs.

“We usually teach skills like relaxation, stretching exercises or how to pace activities, but we rarely talk about food in this context,” Newton-John says. “This work shows we need to help people recognise if they’re using food as a pain-management tool and give them alternatives.”

Previous studies have shown that healthy eating can reduce the severity of chronic pain. Regular consumption of vegetables, fruit, lean meat, fish, legumes/beans, and low-fat dairy products can lower pain levels and improve physical function, especially for women.

High fiber diets also reduce the risk of obesity, diabetes and cardiovascular disease, while promoting the growth of healthy bacteria in the gastrointestinal system to slow the progression of arthritis and reduce joint pain.

Ketamine Infusions Safe and Effective in Treating Chronic Pain

By Pat Anson

There are many pros and cons about the therapeutic effects of ketamine. When misused, the anesthetic drug can lead to tragedy – such as the accidental drowning death of actor Matthew Perry. And although ketamine is increasingly used to treat depression and other psychiatric disorders, the FDA “has not determined that ketamine is safe and effective for such uses.”  

Even ketamine’s use as a pain reliever has been challenged, with a recent study finding “a lot of uncertainty” about its effectiveness in treating difficult chronic pain conditions such as Complex Regional Pain Syndrome (CRPS). The authors of that study said they could find “no convincing evidence” that ketamine delivered meaningful benefits to people in pain.

A new study at the Cleveland Clinic debunks many of those findings. After following over 1,000 pain patients who received ketamine infusions, researchers concluded the infusions are safe and effective for people with chronic pain.

“We know millions of Americans are suffering from chronic pain and this research addresses critical gaps in pain management and shows a significant step forward in improving care for those patients who have otherwise exhausted all other treatment options,” said co-author Pavan Tankha, DO, medical director of Comprehensive Pain Recovery in the Cleveland Clinic’s Neurological Institute.

“The findings of the research represent a meaningful step toward improved quality of life and may accelerate access to this treatment option for patients all over the country.”

Tankha and his colleagues focused on outpatients who received low dose ketamine infusions – 0.5 mg/kg over 40 minutes for five consecutive days. Their findings, recently published in the journal Regional Anesthesia & Pain Medicine, show that over 90% of patients completed all five treatment days, demonstrating the feasibility of outpatient infusions.

Although pain relief in most patients “did not reach clinically meaningful thresholds,” up to 46% reported improvements in their pain, daily functioning, sleep, anxiety, depression, fatigue and quality of life. The improvements were sustained over 3 and 6-month follow up periods, with 80% of patients returning for additional infusions, a telling sign the treatment has benefits.

The research also demonstrated that low-dose ketamine has minimal side effects. Hallucinations, the most common side effect, were rare. No serious adverse events were reported by any patients.

“This study provides evidence for ketamine's role in chronic pain management,” said co-author Hallie Tankha, PhD, a clinical pain psychologist in the Cleveland Clinic’s Primary Care Institute.

“This is in line with my clinical experience as a pain psychologist, as patients often describe ketamine infusions as ‘life changing.' I'm encouraged by treatments that can be integrated into comprehensive care approaches, and this study demonstrates ketamine can be safely and effectively implemented in pain management settings.”

Researchers say their findings demonstrate that ketamine infusions can be part of a pain management program, when combined with behavioral therapies and patient education. The findings also give hope to millions of pain sufferers with complex conditions that have not responded to conventional treatment.

“Given the limited evidence for ketamine infusion protocols in chronic pain and existing access barriers, these real-world findings may help inform patients, payers, and healthcare systems about the potential of standardized KIT (ketamine infusion therapy),” researchers concluded.  “Our findings support integration into multidisciplinary pain centers and lay the groundwork for generating evidence needed for policy and coverage decisions.”

Although the FDA has not approved the use of ketamine in treating pain, some professional medical organizations have for certain conditions. 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. 

No Healthcare for Lawmakers Until Every American Has Affordable Health Insurance

By Dr. Lynn Webster

Millions of Americans stand on the brink of losing the Affordable Care Act (ACA) subsidies that make their health insurance barely affordable. Without congressional action to extend those subsidies, families will face staggering premium hikes — forcing impossible choices between health coverage and rent, groceries or prescription drugs. Many will simply go without insurance.

Meanwhile, every member of Congress continues to enjoy taxpayer-funded health insurance, untouched by the very uncertainty they allow their constituents to endure. That disparity is indefensible.

A simple idea that would change the equation is that no elected representative in Congress should receive taxpayer-funded health care until every American has access to affordable health care.

If lawmakers had to share the same risks as their constituents, the urgency of reform would shift overnight. They would feel, in their own lives, the dread of losing coverage or facing premiums that devour a paycheck. They would no longer be insulated from the hardships they are sworn to alleviate.

This is not about punishment — it is about accountability and alignment. When lawmakers see their own well-being depends on fixing the system, solutions would rise above partisan theater.

Skeptics will point out that the Constitution protects congressional compensation, and they are right. Courts might interpret health benefits as part of that protection. That is why this should not be ordinary legislation. It should be a constitutional amendment — one that makes the principle unambiguous: members of Congress cannot enjoy taxpayer-funded health coverage until the people they serve have genuine access to affordable care.

Passing an amendment is never easy. But history shows it can be done when fairness demands it. Women’s suffrage, civil rights, and lowering the voting age all required constitutional change. Each once seemed out of reach — until public demand made it unstoppable.

This proposal does not dictate the specific policy mechanism — whether through extended subsidies, a public option, or another path. It sets only the principle that Congress must solve the problem before claiming benefits for itself. That principle is fairness.

And fairness should transcend party lines. At a time when the nation feels divided on nearly every issue, the idea that our leaders should not receive what they deny their constituents ought to unite, not separate us.

Making congressional health care contingent on achieving affordable care for all Americans could become a rare opportunity to bridge political divides and move the country toward greater unity.

Healthcare is not a privilege reserved for the political class. It is a necessity for every family. Across the nation, millions face losing coverage while their elected representatives remain fully protected. The injustice is clear.

Until every American has access to affordable healthcare, no member of Congress should accept it either. If they want the benefits, they must deliver them for the people they represent.

Anything less is a betrayal of public trust.

Lynn R. Webster, MD, is a pain and addiction medicine specialist and serves as Executive Vice President of Scientific Affairs at Dr. Vince Clinical Research, where he consults with pharmaceutical companies. He is the author of the forthcoming book, “Deconstructing Toxic Narratives -- Data, Disparities, and a New Path Forward in the Opioid Crisis,” to be published by Springer Nature. Dr. Webster is not a member of any political or religious organization.

Amazon Is Putting Pharmacy Kiosks in Its Own Medical Clinics

By Crystal Lindell

Have you ever dreamed of skipping the hassle of going to a pharmacy to pick up a prescription after you’ve seen your doctor?

Amazon wants to eliminate that extra trip by putting pharmacy kiosks — vending machines — in its One Medical clinics to dispense drugs on site. The move will increase Amazon’s growing share of U.S. pharmacy sales, at a time when many retail pharmacies are struggling. 

It also raises questions about a conflict of interest when doctors at One Medical – a wholly owned subsidiary of Amazon – steer their patients to Amazon Pharmacy kiosks to fill their prescriptions on the spot. 

In an Amazon promotional video, a One Medical doctor does just that:

Amazon is framing this as an issue of convenience that will improve the healthcare of One Medical patients, pointing out that nearly a third of all prescriptions are never filled.

"As clinicians, we see firsthand how delays in starting medication can impact treatment outcomes," Andrew Diamond, MD, Chief Medical Officer at One Medical, said in a press release. "The ability to know a patient is leaving our office with their medication in hand – especially for conditions requiring immediate treatment like infections – can make a meaningful difference in their care journey."

Starting in December, Amazon Pharmacy kiosks are being installed at One Medical clinics in the Los Angeles area, with expansion to additional clinics soon after.   

"By bringing the pharmacy directly to the point of care, we're removing a critical barrier and helping patients start their treatment when it matters most — right away," said Hannah McClellan, Vice President of Operations at Amazon Pharmacy.

To use the kiosks, patients must already have an account with Amazon Pharmacy, which requires them to provide their insurance information and other payment options. 

Once a prescription is scanned at a kiosk and the patient is verified, an Amazon pharmacist will begin to process the prescription remotely and be available to answer questions. If the prescription is approved, a robotic arm will pick out the medication from a vault inside the kiosk, label it, and drop it through a bay door for the patient to pick up.

The kiosks won’t carry controlled substances like opioids or drugs that need to be refrigerated, but that still leaves a lot of medication options for One Medical doctors to prescribe.

One Stop Shopping

Will Amazon’s doctors be incentivized to prescribe unnecessary or high-cost medications just to make extra money for their parent company?

Unfortunately, that’s not a far-fetched question to ask, given the well-known influence of pharmaceutical sales reps. The reps often give free meals, paid speaking engagements, and other financial incentives to doctors in hopes of getting them to prescribe their company’s medications. 

Amazon Pharmacy currently has a small market share compared to big chain pharmacies like CVS and Walgreens, but its home delivery system is rapidly growing and gaining in popularity. Amazon Pharmacy sales were projected to reach $1.8 billion in 2024 and some analysts say it could eventually be the leading drug store in the U.S.  

I fear that adding Amazon Pharmacy kiosks to One Medical clinics is just the first step. The company could place kiosks in other non-Amazon locations such as hospitals, medical offices, and urgent care clinics. Amazon admitted as much when it said its kiosk expansion plans include “additional One Medical offices and other locations.”

Amazon, which has a market cap of over $1 trillion, could wind up doing to pharmacies what it did to book stores 30 years ago: drive them out of business. Of course, chain pharmacies have already done a good job of doing that to themselves.

Millions of low-income and rural Americans already live in "pharmacy deserts" and have to drive long distances to fill a prescription. What will happen to them when additional pharmacies close? Or the patients who need controlled substances or refrigerated medications that the kiosks don’t dispense and Amazon won’t deliver? 

In the end, when it comes to healthcare, we should be extra cautious about the financial incentives at work and putting too much power in the hands of one company. 

Maybe the pharmacy kiosks will be convenient. Maybe Amazon’s doctors won’t prescribe unnecessary medications just to reach a kiosk sales goal. But I’m not willing to bet my health on that.

Medical Cannabis Works Best for Neuropathic Pain

By Pat Anson

Medical cannabis is most effective for managing neuropathic pain, but doesn’t work as well for migraine, headache and acute pain, according to a new report that is one of the first to look at the efficacy of cannabis in treating different types of pain conditions.

The comprehensive report by Green Health Docs, a company that connects patients with licensed medical marijuana doctors, is based in part on a recent survey of 1,450 patients who use medical cannabis.

The vast majority (86%) of those surveyed reported moderate-to-significant pain improvement. Nearly 73% said they use cannabis daily and nearly 88% said it was a long-term option for their pain management.  

The survey also found that many patients were able to reduce their use of opioids and other prescribed analgesics once they started using medical cannabis. Over a third (35%) stopped using all prescription pain medications, nearly 15% stopped some medications, and nearly 12% reduced the dosage or frequency. Only 18% reported no change in their use of pharmaceuticals.

Many respondents, especially seniors, also reported better sleep, appetite, mood, mobility and quality of life.

Researchers say medical cannabis works best for neuropathic pain, but further studies are needed to demonstrate its effectiveness in treating other types of pain.

“One of the most important findings across cannabis research is that not all types of chronic pain respond equally to cannabinoid-based therapies,” the Green Health Docs report found.

“Neuropathic pain -- caused by damage or dysfunction in the nervous system -- is one of the most studied and responsive categories for cannabis treatment. Conditions such as diabetic neuropathy, postherpetic neuralgia, and multiple sclerosis-related pain fall into this category.”

The evidence is either mixed or lacking for cannabis relieving cancer-related pain and musculoskeletal pain, which includes back pain, arthritis, fibromyalgia, and pain involving bones, joints, and connective tissue.  

Cannabis also appears to be less effective for headache or migraine pain, visceral pain in the internal organs, and surgical or acute pain.

“Taken together, these findings suggest that while medical cannabis is not a universal solution, it holds promise as a viable component of multimodal pain management—especially when other treatments prove inadequate or intolerable,” the report concluded.

38 states and Washington, D.C. have legalized medical marijuana, and “chronic pain” or “intractable pain” are two of the top qualifying conditions.

Many patients use different methods to consume medical cannabis. Tinctures, edibles and capsules are often used for steady symptom control; vapes and smoking provide faster relief from breakthrough pain; and patches and topical creams are popular for localized musculoskeletal pain.

The "entourage effect" is also an important consideration. Medical cannabis products seem to work best when they combine THC and other cannabinoids with terpenes and other compounds found in cannabis. This supports the use of full-spectrum cannabis for managing chronic pain.

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

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

No. Stop it.

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

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

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

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

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

Study Finds Tramadol Not That Effective for Chronic Pain

By Pat Anson

One of the most widely prescribed opioid painkillers in the world is not that effective at relieving chronic pain and increases the risk of serious side effects such as heart disease, according to a new study.

Tramadol is a synthetic opioid used to treat moderate to severe pain. It is widely perceived as a weaker and “safer” opioid, but the new research found otherwise.

“Tramadol may have a slight effect on reducing chronic pain, while likely increasing the risk of both serious and non-serious adverse events,” wrote lead author Jehad Barakji, MD, a researcher at the Copenhagen Trial Unit at the Centre for Clinical Intervention Research in Denmark.

“The potential harms associated with tramadol use for pain management likely outweigh its limited benefits.”

Barakji and his colleagues analyzed findings from 19 clinical trials of tramadol involving over 6,500 pain patients, making it the first study to assess tramadol’s efficacy and safety across a range of chronic pain conditions.

Five of the studies looked at the impact of tramadol on neuropathic pain; nine focused on osteoarthritis; four looked at chronic lower back pain; and one focused on fibromyalgia.

The findings, published in BMJ Evidence Based Medicine, show that while tramadol eased pain, the effect was small and below what would be considered clinically effective. Tramadol also appeared to increase the risk of cardiac events, such as chest pain, coronary artery disease, and congestive heart failure. 

Use of tramadol was also associated with a higher risk of neoplasms, an excessive growth of tissue that could be an early sign of cancer. However, researchers say the evidence of a tramadol-cancer connection was “questionable” because the studies analyzed were not long enough.

Non-serious side effects caused by tramadol include nausea, dizziness, constipation and somnolence.

Tramadol is considered a weak opioid because it does not bind directly to opioid receptors in the brain like other opioids do. Many patients say tramadol gives them little or no pain relief, but it’s often the only opioid their doctor is willing to prescribe.

In 2023, over 16 million prescriptions were written for tramadol in the United States, down from 25 million prescriptions a decade earlier. Tramadol is classified as a Schedule IV controlled substance in the U.S., indicating it has a low potential for abuse and addiction compared to other opioids.

The consumer watchdog group Public Citizen unsuccessfully petitioned the FDA and DEA in 2019 to upschedule tramadol to a more restrictive Schedule II substance, saying tramadol was “an increasingly overprescribed, addictive, potentially deadly narcotic.”

Tramadol is widely abused by youths in Asia and Africa, where it is often mixed with soft drinks, energy drinks and alcohol to induce euphoria.

Should Doctors Show More Empathy?

By Carol Levy

So many of us have complained, rightly so, about doctors not listening to us. They often ignore our words.

We tell them where the pain is (my back, my foot, my face, etc.) and how it feels (achy, sharp, throbbing, etc.). But when they repeat it back to us or write it into our medical records, the words are no longer ours. Doctors substitute words that are nothing like the ones we spoke.

Then there is the second part of listening -- of truly hearing what we say – and the feelings and emotions behind our words.

Pain makes me feel desperate, soul sick, and depressed. But in the 40 plus years that I’ve had pain from trigeminal neuralgia, not once have I been asked, “How do you feel emotionally? What is the pain doing to your life?”

In a TV commercial, a doctor describes the difficulty some of his older patients have with numbness in their legs or feet --- and how it’s a safety issue for those who have stairs in their homes. He says he never really understood what they were talking about until he started experiencing the same problem.

What is it about empathy? Is it inherent within us? Or is it something we have to learn and cultivate? Does a doctor have to experience the same things we do before he or she can honestly understand what we are going through?

For a doctor to feel empathy for every patient, to understand and feel viscerally what they are describing, might overwhelm them and cloud their judgement.

The opposite of that, a doctor who is detached or standoffish with patients, may think that allows him to be more objective when deciding on a diagnosis or course of treatment. But it can make them seem cold and uncaring.

Research repeatedly shows that patients want their doctors to see them as a person, not as a list of signs and symptoms. They want a doctor who listens on both levels, hearing our words and the “feelings” behind them.

Beth Israel Deaconess Medical Center, a teaching hospital in Boston, has taken steps to incorporate empathy into the doctor-patient experience. The hospital’s patient intake forms have two questions designed to build empathy.

The first is “How would you like to be addressed?” This allows for a patient to be spoken to respectfully, as opposed to the times when a doctor enters the room and immediately calls us by our first name -- whether we want them to or not. I'm not sure that is a form of empathy, but it is at least treating us like a person, not just “Patient X.”

The second question is “What is your main concern for this visit?" This is asked -- on an intake form -- to ensure the doctor will know our priority. But isn't that the point of interviewing us when they come into the exam room? True empathy would require the doctor to ask us face-to-face, “What is your major concern?” 

So here's the conundrum: Is the better doctor the one who is detached, looks at us as symptoms and test results, and computes the proper treatment?

Or is it the doctor who takes the time to listen to us, to understand our aches and pains, who hears why we’re upset about our symptoms and what they might mean?

If we're lucky, maybe the doctor will be a combination of the two.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 40 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.  

What You Should Know About Tylenol and Autism

By Mark Louie Ramos

Claims from the Trump White House about links between use of the painkiller acetaminophen – often sold under the brand name Tylenol in the U.S. – during pregnancy and development of autism have set off a deluge of responses across the medical, scientific and public health communities.

As a father of a child with level 2 autism – meaning autism that requires substantial support – and a statistician who works with such tools as those used in the association studies cited by the White House, I find it useful to think about the nuances of association versus causation in observational studies. I hope that this explanation is helpful to parents and expecting parents who, like me, are deeply invested in the well-being of their children.

Association Is Not Causation, But…

Most people have heard this before, but it bears repeating: Association does not imply causation.

An often-cited example is that there is a very strong association between ice cream sales and incidents of shark attacks. Of course, it goes without saying that shark attacks aren’t caused by ice cream sales. Rather, in the summertime, hot weather drives more appetite for ice cream and beach time. The increased number of people at the beach does, in turn, cause the likelihood of shark attacks to increase.

Yet pointing this out on its own is neither intellectually satisfying nor emotionally appeasing when it comes to real-life medical concerns, since an association does suggest potential for a causal relationship.

In other words, some associations do end up being convincingly causal. In fact, some of the most consequential discoveries of the past century in public health, like the links between smoking and lung cancer or the human papillomavirus (HPV) and cervical cancer, started out as findings of very strong association.

So when it comes to the issue of prenatal acetaminophen use and autism development, it is important to consider how strong the association found is, as well as the extent to which such an association could be considered causal.

Establishing Causal Association

So how do scientists determine if an observed association is actually causal?

The gold standard for doing so is conducting what are called randomized, controlled experiments. In these studies, participants are randomly assigned to receive treatment or not, and the environment where they are observed is controlled so that the only external element that differs among participants is whether they received treatment or not.

In doing this, researchers reasonably ensure that any difference in the outcomes of the participants can be directly attributed as being caused by whether they received the treatment. That is, any association between treatment and outcome can be considered causal.

Yet oftentimes, conducting such an experiment is impossible, unethical or both. For instance, it would be highly difficult to gather a cohort of pregnant women for an experiment and extremely unethical to randomly assign half of them to take acetaminophen, or any other medication for no particular reason, and the other half not to.

So when experiments are simply infeasible, an alternative is to make some reasonable assumptions on how observational data would behave if the association was causal and then see if the data aligns with these causal assumptions. This can very broadly be referred to as observational causal inference.

Parsing What the Studies Mean

So how does this apply to the current controversy over the potential for acetaminophen use during pregnancy to affect the fetus in a way that could result in a condition like autism?

Researchers who try to understand causal roles and links between one variable and potential health outcomes do so by considering: 1) the size and consistency of the association across multiple attempts to estimate it, and 2) the extent to which such association has been established under observational causal inference frameworks.

As early as 1987, researchers have been working to measure possible associations between acetaminophen use during pregnancy and autism. A number of these studies, including multiple large systematic reviews, have found evidence of such associations.

For instance, a 2025 review of 46 studies that examined association between acetaminophen use and an array of neurodevelopmental disorders, including autism, identified papers with five positive associations between acetaminophen and autism.

In one of those studies, which examined 73,881 births, the researchers found that children who were exposed to acetaminophen prenatally were 20% more likely to develop borderline or clinical autism spectrum conditions. Another examined 2.48 million births and reported an estimated association of only 5%.

Both of those are weak associations. For context, estimations of increased lung cancer risk from smoking in the 1950s were between 900% to 1,900%. That is, a smoker is 10 to 20 times more likely than a nonsmoker to develop lung cancer. By comparison, in the two autism studies above, a pregnant woman who takes acetaminophen is 1.05 to 1.20 times more likely than one who does not take the drug to have a child who would be later diagnosed with autism.

Not All Studies Are Created Equal

It’s also important to keep in mind that many factors can affect how well a study is able to estimate an association. In general, larger sample sizes provide both greater power to detect an association if one does exist, as well as improved precision over estimating the value of the association.

This does not mean that studies with smaller sample sizes are not valid, only that from a statistical perspective, researchers like me place greater confidence in an association drawn from a larger sample size.

Once an association – even a small one – is established, researchers then must consider the extent to which causation can be claimed. One way to do this is through what’s called dose-response. This means looking at whether the association is higher among women who took higher doses of acetaminophen during pregnancy.

The study mentioned above that looked at 2.48 million births shows an example of dose-response. It found that pregnant women who reported taking higher doses have higher autism risk.

Another way to examine possible causality in this context is to analyze sibling outcomes, which that same paper did. Researchers looked at whether associations between acetaminophen and autism persisted within families with more than one child.

For example, in a family with two children, if the mother used acetaminophen during one pregnancy and that child was later diagnosed with autism, but she did not use it during the other pregnancy and that child was not diagnosed, then this strengthens the causal claim.

Conversely, if acetaminophen was used during the pregnancy of the child who was not diagnosed with autism and not used during the pregnancy of the child who was, then that weakens the causal claim. When this was included in the analysis, the dose-response disappeared, and in fact the overall 5% increased risk mentioned before likewise disappeared. This weakens the claim of a causal relationship.

At present, there is clearly not enough evidence to establish a causal association between prenatal acetaminophen use and autism.

Yet as a parent who wonders if my daughter will ever be able to write her name, or hold a job or raise kids of her own, I understand that such explanations may not appease the fears or concerns of an expecting mother who is suffering from a fever.

Naturally, all of us want absolute certainty. But that’s not possible when it comes to acetaminophen use, at least not at this time.

Your doctor will be able to provide you with much sounder advice than any existing study on this topic. Your OB-GYNs are very likely aware of these studies and have much better judgment as to how these results should be considered in the context of your personal medical history and needs.

Researchers, meanwhile, will continue to dig deeper into the science of this critically important issue and, hopefully, provide greater clarity in the years to come.

Mark Louie Ramos, PhD, is an Assistant Research Professor of Health Policy and Administration at The Pennsylvania State University.

His research experience includes statistical development and multidisciplinary projects involving large datasets such as the United Kingdom Biobank, the National Health and Nutrition Examination Survey, and the United States Military Health System. He has taught mathematics and statistics subjects for over 20 years.

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

Magic Mushrooms May Relieve Chronic Pain and Depression

By Crystal Lindell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How Much Is Your Pain Worth?

By Crystal Lindell

How much pain would you be willing to endure if someone paid you?

That’s the question an international team of researchers posed in an unusual new study looking for an alternative to the 1-10 pain scale.

In a series of experiments, they offered 330 healthy volunteers in Switzerland money to undergo mild electric shocks, heat pain or no pain at all. Someone opting for a painful stimulus was paid about $20, while those who opted for having no pain received only $10.

The idea behind putting a price on pain was to see if the responses would be a better way to measure pain than the subjective and much criticized pain scale, which has been used for decades to have patients self-evaluate their pain levels.

“We’ve all been asked to rate our pain from one to ten—but one person’s three might be another’s five, and those numbers can shift with experience. Our research proposes a better way: turning pain into money — not to commodify suffering, but to create a scale we can all share,” explained lead author Carlos Alós-Ferrer, PhD, a Professor of Economics at Lancaster University Management School in the UK. 

The study findings, published in the journal Social Science & Medicine, suggest that people’s willingness to accept money in exchange for pain is a more reliable way to measure discomfort than self-reported methods.

Researchers say their economic incentives “greatly outperformed” traditional pain scales. It helped them distinguish more clearly between different levels of pain; detect the effects of pain relief more consistently; and allowed for more meaningful comparisons between people.

Interestingly, no participant chose to avoid pain completely. Everyone had a price for pain if it was high enough.  

Different people put different prices on the same pain, but they had an easier time rating their pain than they did when using the 1-10 pain scale.

“As a result, measurements are more precise and the shift from low to high levels of pain is clearly reflected in the monetary scale,” Alós-Ferrer said. “This makes it useful for clinical trials to study the effectiveness of painkillers and treatments, because participants are randomly assigned to different groups.”

I believe if a money-incentivized pain scale is used only for research studies, it might be useful. Afterall, there is definitely a need for more accurate pain measurements in research, as well as treatment.

However, my concern is that it could be misused in a clinical setting, just like the pain scale is. Researchers said “inaccurate pain measurements can lead to inadequate pain management,” and pointed to emergency medical situations and quality of life issues for people with chronic pain.

However, in most cases, the reason pain is not adequately treated has nothing to do with the pain scale. It’s because doctors tend to dismiss people’s pain and then withhold one of the most effective treatments: opioids.

I’ve written before about why I don’t like the 1-10 pain scale, which doctors tend to ignore even if you say your pain is a 10. But I don’t think replacing it with a question about how much money you’d need to endure more pain is the answer.

Rather, the best solution I’ve seen from a patient perspective — at least when it comes to chronic pain — is a scale that asks how pain is impacting daily life activities, known as the Quality of Life Scale, (QOLS).

It's a reverse of the traditional pain scale, in that 0 is the worst pain, while 10 means you're doing pretty well.

It features descriptions like:

0: Stay in bed all day. Feel hopeless and helpless about life.

1: Stay in bed at least half the day. Have no contact with the outside world.

All the way up to:

10: Go to work/volunteer each day. Normal daily activities each day. Have a social life outside of work. Take an active part in family life.

While QOLS probably isn’t ideal for studies on acute pain, it is a great way to communicate pain levels between patient and doctor. In fact, I’d say it’s significantly better than trying to assign a monetary value to pain.

Because as anyone with severe chronic pain will tell you, there’s not enough money in the world to make me want to endure my pain even one second longer than I need to.

Government Shutdown Halts Many Public Health Services

By KFF Health News

Threats of a federal government shutdown have gone from being an October surprise to a recurring theme. This time around, though, the stakes are higher.

Federal funding ran out at midnight on Oct. 1, after Congress failed to pass even a stopgap budget while negotiations continued.

Now the question is how long the deadlock will last, with Democrats pitted against Republicans and a presidential administration that has broken with constitutional norms and regularly used political intimidation and primary threats to achieve its ends. Because Republicans hold only a slim majority in the Senate, any deal will need to attract at least a few Democratic votes.

Ramifications from a shutdown on public health systems and health programs will be felt far beyond Washington, D.C., halting almost all of the federal government’s nonessential functions, including many operations related to public health.

Even on Sept. 30, as the clock ticked toward midnight, President Donald Trump renewed threats about mass firings of federal workers if Democrats didn’t acquiesce to GOP demands. Some people worry that such workforce reductions would further enable the administration to undermine federal government operations and reduce the budget impasse to what’s been described as three-dimensional chess or a game of chicken.

Such threats to fire, rather than temporarily suspend, federal workers are “unprecedented,” said G. William Hoagland of the Bipartisan Policy Center. The lack of negotiations between Capitol Hill Republicans and Democrats in advance of the shutdown is also unprecedented in his experience, said Hoagland, a longtime GOP Senate Budget Committee aide.

The stalemate centers largely on health coverage, with Democrats and Republicans clashing over the Affordable Care Act and Medicaid cuts. For Americans with ACA marketplace plans, government subsidies cap the percentage of household income they must pay toward premiums. Lawmakers expanded the subsidies in 2021 and extended that additional help through the end of 2025, and the looming expiration of those expanded subsidies would increase costs and reduce eligibility for assistance for millions of enrollees.

Democrats want a further extension of the subsidies, but many GOP lawmakers are resistant to extending them as is and say that debate must wait until after a budget deal to keep the federal government afloat. Antagonism has grown, with the parties in a pitched battle to convince voters the other party is to blame for the government’s closure.

Said Senate Minority Leader Chuck Schumer on the Senate floor Sept. 30: “Republicans have chosen the losing side of the health care debate, because they’re trying to take away people’s health care; they’re going to let people’s premiums rise.”

But Senate Majority Leader John Thune accused Democrats of attempting to “take government funding hostage.”

What the Shutdown Will Do

The longer a shutdown lasts, the more impacts could be felt. For example, some community health centers would be at risk of closure as their federal funding dries up.

Long-term projects by the Federal Emergency Management Agency to reduce damage from future natural disasters will stop, for example. Rescue services at national parks that stay open will be limited. And at the National Institutes of Health, many new patients awaiting access to experimental treatments may not be admitted to its clinical center.

Entitlement programs such as Medicaid and Medicare will continue, as will operations at the Indian Health Service. But disease surveillance, support from the Centers for Disease Control and Prevention to local and state health departments, and funding for health programs will all be hampered, based on federal health agencies’ contingency plans.

The Department of Health and Human Services is expected to furlough about 40% of its workforce, which has already been downsized by about 20,000 positions under the Trump administration. Across the federal government, roughly 750,000 employees will be furloughed, according to an estimate released Sept. 30 by the Congressional Budget Office, a nonpartisan agency that calculates the cost of legislation. While furloughed employees won’t be working, eventually they will get back pay, totaling about $400 million daily, the CBO estimated.

At HHS, research is expected to pause on the links between drug prices and the Inflation Reduction Act, the major law enacted under former President Joe Biden to boost the economy. Despite reports that Food and Drug Administration Commissioner Marty Makary said the FDA would basically be untouched, the agency won’t accept new drug applications and food safety efforts will be reduced. Federal oversight of a program that helps hospitals save lives and evacuate individuals in environmental crises is expected to stop.

Fewer federal staff will be available to provide help to Medicaid and Medicare enrollees. CDC responses to inquiries about public health matters will be suspended. And the work of a federal vaccine injury program is also anticipated to stop.

Democrats Want ACA Subsidies Renewed

Congressional Democrats insist the ACA subsidies must be renewed now because enrollment for the Obama-era health program opens on Nov. 1. Without the extended subsidies, health insurers are warning of double-digit premium hikes for millions of enrollees.

House Democratic Leader Hakeem Jeffries has argued that a “Republican-caused health care crisis” is hanging over Americans as a result of Trump’s new tax-and-spending bill, which adds restrictions to Medicaid that are expected to kick millions off the program. Republicans have also advanced mass layoffs and funding cuts at the nation’s health department and caused widespread confusion over access to some vaccines.

“We’re not going to simply go along to get along with a Republican bill that continues to gut the health care of everyday Americans,” Jeffries told reporters Sept. 29. “These people have been trying to repeal and displace people off the Affordable Care Act since 2010.”

Republicans, meanwhile, have blasted Democrats for holding up funding over the subsidies and say any deal will require concessions.

“If there were some extension of the existing policy, I think it would have to come with some reforms,” Thune, the Senate Republican leader, said Sept. 26.

Such a deal may involve changes to a policy that caps what consumers have to pay for ACA marketplace plans at 8.5% of their income, no matter how much they earn. It could also alter their ability to obtain plans with no premiums, an option that became more widely available because of the beefed-up subsidies.

Adding restrictions to the ACA subsidies is likely to decrease enrollment in the program, which saw declines during the first Trump administration and did not reach 20 million for the first time until last year, a milestone reached in large part due to the subsidies.

Several Republicans have expressed interest in extending the subsidies, including a group of GOP representatives who proposed legislation to do so last month.

Democrats may be betting that the timing of the shutdown will put pressure on their Republican colleagues to come to the negotiation table on the ACA subsidies.

Within days of the government’s closure, ACA enrollees are expected to get notices from their health insurers advising them of steeper premiums. Insurers have said the expiring subsidies have forced those large premium hikes because the healthiest and youngest people are more likely to opt out of coverage when prices go up.

The White House, meanwhile, ramped up its pressure campaign on Democrats. White House press secretary Karoline Leavitt insisted Sept. 29 that Trump wants to keep the government open.

“Our most vulnerable in our society and our country will be impacted by a government shutdown,” she said.

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