Pain Management

Physicians writing on KevinMD about treating pain, alongside the pain patients who write back: chronic pain care, opioid prescribing and its reversal, the CDC guideline and forced tapers, pain contracts and monitoring, prosecution risk, and what non-opioid care can and cannot do. Most contributors treat pain or live with it. For a maintained record of what physicians and pain patients have said about opioids on KevinMD since 2007, from how the crisis happened to what the response did, attributed by author and date and organized by question, see Opioids: what physicians and pain patients say, in their own words.

October 7, 2026Oct 7, 2026

I write as a health care educator and author with thirty years of research experience and over three hundred papers published as author or co-author, several of them widely cited. In that role, I see thousands of emails and social media postings every month from people whose lives are being destroyed by misdirected and frequently outright fraudulent U.S. public health policy on treatment of pain and addiction. The …

Physicians

What doctors are talking about in 2026: AI, pain, burnout

Insights by KevinMD

October 4, 2026Oct 4, 2026

Clinicians wrote about AI more than anything else this quarter. Readers spent their time elsewhere: on burnout, on pain and opioids, and on what medicine costs the people who practice it. The first Insights by KevinMD report.

What doctors are talking about in 2026: AI, pain, burnout

Conditions

Studying chronic pain suicide risk after opioid tapering

Kayvan Haddadan, MD

October 4, 2026Oct 4, 2026

CSI:OPIOIDs (Clinical Context of Suicide Following Opioid Transitions) is a rigorous scientific research study that systematically examines suicides occurring after prescription opioid dose reductions or discontinuations in patients with long-term (chronic) pain. Using psychological autopsy methods using detailed interviews with bereaved survivors combined with medical record review where obtainable, it seeks to characterize the multifactorial demographic, societal, clinical, and health-system factors involved. The study began as a pilot supported by …

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Meds

Does CVS controlled substance policy put patients at risk?

Arthur Lazarus, MD, MBA

October 2, 2026Oct 2, 2026

Recently, a close friend called me in a panic. He was running dangerously low on lorazepam and asked if I could prescribe a small, bridging quantity over the weekend until his regular refill was due in a few days. As a physician, I wanted to help, but I first advised him to do what any reasonable patient would: call his pharmacy, CVS, explain the situation, and ask for a sliver …

Policy

How an AI tool explained Ruan v. United States to doctors

Richard A. Lawhern, PhD

October 2, 2026Oct 2, 2026

As a health care educator with three decades of experience in research and hundreds of published papers, I have written at some length both on KevinMD and in clinical journals, concerning the dangers of artificial intelligence in medicine. I have also recently written about the profound differences between meanings of the term “Red Flag” in legal versus clinical contexts. Moreover, I have declared that predictive algorithms on …

Patients

Believing patients with chronic pain is clinical rigor

Vidya Surti

September 26, 2026Sep 26, 2026

As a young person living with chronic pain, I entered a health care system that was built to find explanations to clinical problems. That is, of course, what medicine is supposed to do. Physicians are trained to identify patterns, order tests, interpret results, establish diagnoses, and develop treatment plans. When those pieces fit together, the process can feel almost reassuring. There is a problem; there is an explanation; and there …

Conditions

Workers’ compensation pain management puts function first

Kayvan Haddadan, MD

September 24, 2026Sep 24, 2026

This population, either injured workers under workers' compensation or personal-injury claimants, faces distinct drivers of delayed recovery, including secondary gain concerns, litigation, workplace psychosocial factors, fear-avoidance beliefs, and system-level incentives that can prolong disability. Guidelines from the American College of…

This population, either injured workers under workers’ compensation or personal-injury claimants, faces distinct drivers of delayed recovery, including secondary gain concerns, litigation, workplace psychosocial factors, fear-avoidance beliefs, and system-level incentives that can prolong disability. Guidelines from the American College of Occupational and Environmental Medicine (ACOEM), state workers’ compensation medical treatment guidelines (e.g., New York, California), the 2022 Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing …

Conditions

Physician reimbursement cuts collide with AI audits

Kayvan Haddadan, MD

September 19, 2026Sep 19, 2026

Physician reimbursement has faced sustained downward pressure for years, while insurers have expanded tools, including AI-driven audits, prior authorizations, and retrospective reviews, so that they can recover or limit payments after (or before) services are delivered. This dynamic contributes to practice strain, consolidation, and reduced patient access. Evidence from Medicare data, physician surveys, and industry analyses supports the core concerns. Not every claim of intentional misconduct or pure profit …

Conditions

4 fibromyalgia myths the current evidence doesn’t support

Kayvan Haddadan, MD

September 17, 2026Sep 17, 2026

Fibromyalgia is a chronic nociplastic pain syndrome characterized by widespread musculoskeletal pain, fatigue, non-restorative sleep, and cognitive difficulties (often called "fibro fog"), frequently accompanied by other symptoms such as mood changes or overlapping conditions like irritable bowel syndrome. It arises…

Fibromyalgia is a chronic nociplastic pain syndrome characterized by widespread musculoskeletal pain, fatigue, non-restorative sleep, and cognitive difficulties (often called “fibro fog”), frequently accompanied by other symptoms such as mood changes or overlapping conditions like irritable bowel syndrome. It arises primarily from altered central nervous system pain processing rather than peripheral tissue damage or inflammation.

Myth: Fibromyalgia is “all in the head” or purely psychological

Fact: While psychological factors and stress …

Meds

The nociplastic pain question new pain therapies avoid

Amir Friedman, MD

September 15, 2026Sep 15, 2026

Systematic review data puts the prevalence of central sensitization features among knee osteoarthritis patients at approximately 36 percent by validated instrument. More than one in three patients carrying an orthopedic diagnosis you trust, presenting with pain that structural intervention may…

In my last piece, I argued that glucagon-like peptide-1 (GLP-1) pharmacology and neurotechnology …

Conditions

How physician resilience is built in a busy pain clinic

Kayvan Haddadan, MD

September 14, 2026Sep 14, 2026

Walk into any busy pain clinic and the weight lands before you sit down. The pages never stop. The waiting room is packed with people who have already been through too many doctors. Chronic suffering hangs in the air. And…

Beneath it sits a quieter, more relentless set of pressures. Insurance companies keep cutting rates. Staff feel the squeeze of financial hardship and rightly expect …

Conditions

Why CDC opioid guidelines get the overdose data wrong

Richard A. Lawhern, PhD

September 14, 2026Sep 14, 2026

On Wednesday, September 9, 2026, the author spoke briefly at a hybrid conference conducted by the Reagan-Udall Foundation for the U.S. Food and Drug Administration in Washington, D.C. This was only the most recent such “listening session” conducted over a ten-year period. And from the first government speaker onward, the meeting reflected many of the historical biases and misdirection of U.S. health care agencies with respect to the so-called …

Conditions

Post-stroke pain management: what the 2026 guidelines say

Kayvan Haddadan, MD

September 12, 2026Sep 12, 2026

Pain management is rarely a blanket approach. Effective relief depends on the specific type of pain, its underlying mechanism, the patient's comorbidities, age, functional goals, and overall clinical context. This principle is especially important after stroke, where pain is common,…

Pain management is rarely a blanket approach. Effective relief depends on the specific type of pain, its underlying mechanism, the patient’s comorbidities, age, functional goals, and overall clinical context. This principle is especially important after stroke, where pain is common, often under-recognized, and can significantly hinder rehabilitation, sleep, mood, and quality of life.

Stroke survivors experience several distinct pain syndromes. Distinguishing them matters because treatments differ.

Central post-stroke pain (CPSP)

Central post-stroke pain …

Conditions

Opioid red flags mean caution in medicine, guilt in law

Richard A. Lawhern, PhD

September 11, 2026Sep 11, 2026

Anyone working as a clinician or pharmacist in pain medicine these days has heard the term "red flag" to the point of personal nausea. In everyday practice, the term has multiplied like termites, and with equally destructive effect on the…

Anyone working as a clinician or pharmacist in pain medicine these days has heard the term “red flag” to the point of personal nausea. In everyday practice, the term has multiplied like termites, and with equally destructive effect on the lives of patients and their doctors. It is almost always applied as a reason (actually an excuse) for denying patient access to safe and effective prescription opioid analgesics and/or benzodiazepine …

Conditions

Why opioids for chronic pain must stay on the table

Simon Feng, MD

September 4, 2026Sep 4, 2026

The American Society of Interventional Pain Physicians estimates the United States has fewer than 7,000 practicing interventional pain physicians. Meanwhile, approximately 60 million Americans live with chronic pain, including roughly 21 million with high-impact chronic pain, pain that substantially limits a person’s ability to work, care for themselves, or participate in social activities. These numbers translate to roughly 3,000 patients with high-impact chronic pain per interventional physician. This is an …

Physicians

When policy erased my post-operative pain control

Ronald L. Lindsay, MD

September 3, 2026Sep 3, 2026

The day I met my own system from the wrong side of the bed I've spent a career on the clinician side of the bed: explaining procedures, reassuring families, and signing orders that were supposed to make pain tolerable and…

The day I met my own system from the wrong side of the bed

I’ve spent a career on the clinician side of the bed: explaining procedures, reassuring families, and signing orders that were supposed to make pain tolerable and recovery humane. Then I had shoulder surgery in Florida.

I went in with a regional block, a plan, and the quiet confidence of someone with a high pain tolerance. Physical therapists have …

Meds

Are opioid prescribing rates really driving overdoses?

Hunter Dlugas

September 3, 2026Sep 3, 2026

There very well may have been times throughout our country's history where opioids have been overprescribed, such as the Civil War era and 2000 to 2010. Of course, determining whether opioid prescribing is actually excessive requires one to quantify an…

There very well may have been times throughout our country’s history where opioids have been overprescribed, such as the Civil War era and 2000 to 2010. Of course, determining whether opioid prescribing is actually excessive requires one to quantify an association of opioid prescription rates with some relevant population characteristic (e.g., opioid overdoses per capita). Failing to consider the relationship between opioid prescription rates and any other population characteristic …

Conditions

Why a pain management referral feels like an accusation

Francisco M. Torres, MD

September 2, 2026Sep 2, 2026

I vividly recall the expression on Tim's face during his initial visit to my exam room. Rather than relief, he exhibited suspicion. After enduring years of chronic pain, Tim had been referred to me, an interventional physiatrist, and had come…

I vividly recall the expression on Tim’s face during his initial visit to my exam room. Rather than relief, he exhibited suspicion. After enduring years of chronic pain, Tim had been referred to me, an interventional physiatrist, and had come to perceive a referral to “pain management” not as an opportunity for assistance, but as a judgment. He feared I would regard him not as a patient in need, but …

Physicians

The hidden payment gap crushing independent physicians

Kayvan Haddadan, MD

August 30, 2026Aug 30, 2026

The health care system is supposed to put the patient first. Physicians evaluate, diagnose, treat, and manage risk. Hospitals, insurers, administrators, and regulators exist to support that clinical relationship and not to displace it. Yet the current structure of American…

Yet the current structure of American medicine produces the opposite outcome. Patients face longer waits and higher barriers. Independent physicians confront declining real reimbursement and mounting administrative demands. Practices are acquired by health systems. Physicians spend more …

Conditions

What makes a pain management referral actually land

Emily Copps, PA-C

August 23, 2026Aug 23, 2026

I know things are busy right now. We are stressed, and not the kind of stress that lunch-hour chair yoga fixes. Stress shows up in small ways, like a grocery cart left in a parking lot instead of being returned to the corral. It’s not laziness, it’s bandwidth. But it also means the next person has a little more work to do.

The same thing happens with referrals. A referral that’s …

Pain Management

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