Pain management

May 14, 2026May 14, 2026

Key issues in California's health care system highlight some structural problems that hit patients, doctors, and communities hard. These aren't abstract policy debates; they are day-to-day realities in pain management, chronic care, and everyday practice. Core issues, which were pulled…

Key issues in California’s health care system highlight some structural problems that hit patients, doctors, and communities hard. These aren’t abstract policy debates; they are day-to-day realities in pain management, chronic care, and everyday practice. Core issues, which were pulled from the previously published articles, include but are not limited to:

Physician exodus and shortages: High taxes, aggressive board scrutiny, and a tough environment drive doctors out of California

…

How workers compensation reform can cut litigation costs

May 5, 2026May 5, 2026

As a pain physician treating injured workers daily as well as being a qualified medical examiner (QME) or Independent Medical Examiner (IME) providing independent opinions, and a business owner cutting checks for workers’ comp premiums, I see the system’s strengths and serious strains up close. It started with good intentions: a no-fault safety net, so workers get care and some income if they’re hurt on the job, without dragging employers …

Real physician voices, twice a week

Free, and one click to unsubscribe.

Dharam Persaud-Sharma, MD, PhD

The evolving structural challenges of modern pain medicine

May 2, 2026May 2, 2026

Pain medicine has expanded rapidly in both scope and technical complexity over the past two decades. At the same time, uncertainty surrounding fellowship recruitment, workforce stability, and long-term career sustainability has become more visible. While pain medicine is often described as an evolving interdisciplinary specialty, current trends suggest a broader structural question: whether the systems supporting training, research, and workforce development are evolving at the same pace as the therapies …

Doctors leave California over a tilted legal system

April 29, 2026Apr 29, 2026

As a practicing pain management physician in good standing in California, I've observed how accusations against physicians are actively encouraged, while meaningful accountability for false or exaggerated claims is largely ignored. This creates a system that rewards a "throw mud…

As a practicing pain management physician in good standing in California, I’ve observed how accusations against physicians are actively encouraged, while meaningful accountability for false or exaggerated claims is largely ignored. This creates a system that rewards a “throw mud until something sticks” strategy for financial gain by patients, insurers, and other parties. This is precisely why I wrote the book Legal Mind in Medicine to highlight the legal …

How to treat chronic pain and depression together

April 23, 2026Apr 23, 2026

As a physician who has spent years managing patients with persistent pain, I often encounter the same frustrating cycle. A patient arrives with unrelenting back pain that has lasted for months. They describe not just physical discomfort but a deepening sense of hopelessness, fatigue, and withdrawal from life. Is the pain causing the depression, or did underlying depressive symptoms amplify an initially manageable ache into something chronic and debilitating? It …

How CDC opioid guidelines harmed chronic pain patients

April 18, 2026Apr 18, 2026

The 2016 Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain, aggressively promoted by former Health and Human Services (HHS) Secretary Tom Price and CDC Director Tom Frieden, represents one of the most damaging public health missteps in recent U.S. history. Far from curbing the overdose epidemic, CDC guidelines triggered widespread, preventable suffering among legitimate chronic pain patients while leaving illicit fentanyl, the true driver …

Health care lobbying is destroying the U.S. system

Richard A. Lawhern, PhD

April 9, 2026Apr 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…

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

Drugs and prescribing

How the opioid superagonist DFNZ challenges pain medicine

Olumuyiwa Bamgbade, MD

April 5, 2026Apr 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

April 1, 2026Apr 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 …

Carlos N. Hernandez-Torres, MD

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

March 28, 2026Mar 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 …

Pat Irving, RN & Richard A. Lawhern, PhD

The truth about opioid analgesics and nonsteroidal anti-inflammatory drugs

March 28, 2026Mar 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 …

Daniel Clauw, MD & Molly Candon, PhD

Health insurance incentives and alternatives to opioids for chronic pain

March 24, 2026Mar 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…

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

March 24, 2026Mar 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

March 23, 2026Mar 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…

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

March 22, 2026Mar 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

March 20, 2026Mar 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…

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

March 20, 2026Mar 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 …

The Podcast by KevinMD

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

The Podcast by KevinMD

March 18, 2026Mar 18, 20263

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 by sociopolitical factors rather than medical science. He…

Listen on Apple Podcasts · Spotify

Listen and followApple Podcasts Spotify YouTubeMore apps · Browse all 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 by sociopolitical factors rather than medical science. He traces the history from the “business corruption” phase of pill …

How punitive board tactics are harming pain management physicians