Pain Management

Health care lobbying is destroying the U.S. system

Conditions

April 9, 2026

In modern times, we frequently encounter messes in our public life. This seems particularly true in American health care, and it is certainly true in our politics. But few citizens seem to put the two issues together sufficiently to effectively demand change. Putting them together is what this article is about.

According to the nonprofit public interest group Open Secrets, individuals and political action committees spent a record $4.5 billion in …

How the opioid superagonist DFNZ challenges pain medicine

Olumuyiwa Bamgbade, MD

Meds

April 5, 2026

A publication in Nature in April 2026 reports that N-desethyl-fluornitrazene (DFNZ), a modified nitazene and µ-opioid receptor (MOR) superagonist, produced potent analgesia in rodents with less respiratory depression, weaker dopamine-linked reward signaling, lower withdrawal burden, and no clear tolerance or MOR downregulation. The study challenges the usual assumption that very high MOR efficacy must inevitably produce the full adverse-effect profile seen with conventional opioids. Opioid pharmacology has long been …

How prior authorization and step therapy harm pain management

Kayvan Haddadan, MD

Physician

April 1, 2026

Imagine a 54-year-old construction worker named Mike living with debilitating chronic lower back pain after years on the job. His doctor recommends a targeted epidural steroid injection and a short course of physical therapy combined with a non-opioid medication that has helped many patients in similar situations regain function and avoid surgery. But the insurance company says no. First, Mike must try cheaper generic pain pills that barely touch his …

The synthetic opioid market: Why cartel arrests do not stop the crisis

Carlos N. Hernandez-Torres, MD

Conditions

March 28, 2026

Recently, I started a patient on high-dose buprenorphine because he could no longer get to his methadone clinic. He lost his leg this year to xylazine-associated wounds. The amputation was not the result of a single dramatic overdose, but of months of progressive tissue necrosis from repeated exposure to fentanyl adulterated with “tranq.” The infection spread. The vascular compromise worsened. Eventually there was nothing left to salvage. He now moves …

The truth about opioid analgesics and nonsteroidal anti-inflammatory drugs

Pat Irving, RN & Richard A. Lawhern, PhD

Conditions

March 28, 2026

We live in a nation of needless pain! According to CDC data from 2021, over 50 million Americans (21 percent of adults) experienced chronic pain that persisted for more than three months. Among these, approximately 17 to 21 million U.S. adults currently experience persistent, high-impact pain on most days: pain that severely limits daily life or work activities.

Increasing numbers of these patients are being denied pain relief …

Health insurance incentives and alternatives to opioids for chronic pain

Molly Candon, PhD and Daniel Clauw, MD

Conditions

March 24, 2026

The opioid crisis rages on, and there is plenty of blame to go around: pharmaceutical companies, drug distributors, reckless prescribers, the FDA. One entity that has been overlooked is health insurance, whose incentives pushed chronic pain patients to take opioids in the first place.

Check out your insurance plan and the copays you pay for different services. In one of ours, a generic medication costs $10 a month, at most. Physical …

How hindsight bias distorts clinical medicine

Olumuyiwa Bamgbade, MD

Physician

March 24, 2026

Hindsight flatters certainty. Clinical medicine does not. After a bad outcome, everyone becomes smarter. The diagnosis looks obvious. The warning signs seem bright. The missed clue appears unforgivable. In the calm of retrospective review, people ask, “How could the doctor not have seen it?” That question sounds fair. Often, it is not. Real-world medicine does not happen in hindsight. It happens in the presence of noise, time pressure, incomplete information, …

The truth about short-term opioid prescribing and opioid use disorder

Kayvan Haddadan, MD

Conditions

March 23, 2026

In the thick of the opioid epidemic, there is this widespread fear called “opiophobia,” which basically means people, including patients and doctors, are scared to use opioids even when they are really needed for serious medical issues. This fear comes from the idea that even a short stint on opioids for acute pain, like after surgery, often leads to addiction or worse. John A. Bumpus’s 2025 review in ACS Pharmacology …

How spinal cord stimulation offers relief for chronic pain

Kayvan Haddadan, MD

Conditions

March 22, 2026

Spinal cord stimulation (SCS) continues to be a solid option for people dealing with chronic pain that just will not budge with the usual approaches like medications, physical therapy, or injections. It is a minimally invasive way to deliver low-level electrical pulses through electrodes placed in the epidural space near the spinal cord, helping to change how pain signals reach the brain and often providing relief in areas like the …

Why patient-centered care transforms chronic pain management

Kayvan Haddadan, MD

Physician

March 20, 2026

The real magic in chronic pain care isn’t just the pills or the procedures, but it’s the connection between doctor and patient. When a physician shows genuine empathy and truly listens, patients feel seen, trust deepens, and outcomes improve in ways that often outshine standard treatments. Take this striking study: Among more than 1,400 people with chronic low back pain, those cared for by highly empathic doctors ended up with …

How to manage a difficult patient and survive a high-conflict encounter

Olumuyiwa Bamgbade, MD

Physician

March 20, 2026

Every difficult patient is not dangerous. But every high-conflict encounter carries risk. Doctors like to think clinical skill will protect them: It will not. In modern practice, a physician can make a sound decision, communicate it poorly, and still walk into a complaint, a licensing problem, a lawsuit, or public reputational damage. That risk becomes even sharper in the care of chronic pain, substance misuse, insurance-driven visits, and patients whose …

Politics and fear have replaced science in U.S. pain management [PODCAST]

The Podcast by KevinMD

Podcast

March 18, 2026

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Patient advocate Richard A. Lawhern discusses the article “U.S. opioid policy history: How politics replaced science in pain care.” Richard argues that for decades, public policy on pain treatment has been driven …

How punitive board tactics are harming pain management physicians

Kayvan Haddadan, MD

Physician

March 18, 2026

A systematic review was conducted following PRISMA 2020 guidelines. Databases (PubMed, Embase, Scopus, Westlaw, LexisNexis) and gray literature were searched from January 2010 to November 2025 using terms related to medical board discipline, pain management, and overreach. Eligibility included studies, legal cases, and reports on disciplinary actions, due process violations, or consequences for physicians/patients.

Findings of 1,847 records, 42 were included (28 journal articles, eight legal cases, six reports). Key abusive …

Chronic pain management: Balancing relief and regulation

Kayvan Haddadan, MD

Physician

March 17, 2026

As a pain physician with over 20 years of experience treating patients with chronic pain, I hear the same plea almost every day: “Doctor, it hurts, please help.”

As an author and patient advocate, I wanted to verbalize the daily reality of chronic pain.

Chronic pain affects an estimated 24.3 percent of U.S. adults (approximately 60 million people) as of 2023, with 8.5 percent (about 21 million) experiencing high-impact chronic pain that …

Why false accusations against doctors destroy careers

Olumuyiwa Bamgbade, MD

Physician

March 15, 2026

A false accusation or unfair allegation can destroy a doctor long before any court delivers a verdict. That is the part the public rarely sees. A charge alone can shatter a medical career. It can trigger suspension, isolation, gossip, media exposure, loss of referrals, financial collapse, and permanent reputational injury. In many cases, the accusation becomes the punishment. The acquittal verdict arrives later. By then, the damage is already carved …

AI in pain assessment: Balancing innovation with patient safety

Kayvan Haddadan, MD

Physician

March 5, 2026

In Northern California and beyond, health care systems are rapidly integrating artificial intelligence (AI) and digital tools to transform how pain is recognized, measured, and managed. From algorithm-guided assessments to wearable sensors and predictive analytics, these tools promise to augment clinical decision-making and improve patient outcomes. Yet significant controversies remain, including concerns over algorithmic accuracy, bias, data privacy, and the extent to which technology should complement or potentially displace human …

Why buprenorphine prescribing still lags after the X-waiver repeal

S. Hillary Kim-Vences, MD, MPH

Conditions

March 2, 2026

The repeal of the “X-waiver” in the Consolidated Appropriations Act of 2023 was widely celebrated as a long-overdue step toward expanding access to buprenorphine for opioid use disorder (OUD). By removing the requirement for supplemental training and a special DEA designation, policymakers hoped to normalize treatment and reduce barriers for clinicians.

Yet nearly two years after, buprenorphine prescribing remains inconsistent across the country. Only one in four Americans …

Why doctors struggle with health care system delays

Kayvan Haddadan, MD

Physician

February 27, 2026

As a pain physician, I spend my career advocating for patients who struggle to access appropriate pain management. I write often on hurdles like restrictive opioid policy, excessive regulatory scrutiny, prior authorization, and administrative burdens that detract from patient care. Yet nothing prepared me for the visceral reality of being the patient on the other side of the system.

From physician advocate to patient in the system

My recent experience, unrelated to …

Understanding Moore’s Law and the exponential growth of technology

Richard A. Lawhern, PhD

Conditions

February 25, 2026

When I was a teenager, practical computers did not yet exist. In 1966, my first exposure to a computer in engineering school was a room-sized mainframe whose fast memory consisted of a foot-tall rotating magnetic disc that could store 8,000 “bytes” (each byte containing eight “bits,” which allow for 256 possible values representing alphabetic letters or numbers).

At the time, we could forget about storing the full text of the King …

The hidden cost of medical board regulation and prosecutorial overreach

Kayvan Haddadan, MD

Physician

February 22, 2026

Close your eyes and imagine a health care system that truly prioritizes patients above all else, one that is free from political interference, financial incentives, or secondary gains that distort decision-making. In this ideal framework, regulatory bodies such as the Medical Board, Centers for Disease Control and Prevention (CDC), and Drug Enforcement Administration (DEA) would enforce guidelines uniformly and based on evidence, without inadvertently inflating costs or compromising care quality …

Pain Management

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