Pain Management

How just culture can reduce burnout and boost health care staff retention

Physician
July 30, 2025

Health care systems acknowledge that how they respond to mistakes significantly impacts their workforce’s morale, retention, and overall productivity. The consequences of a punitive culture are costly in terms of financial and operational costs, as it discourages reporting, promotes burnout or fatigue, and aggravates staff turnover. Conversely, implementing a just culture promotes psychological safety, continuous learning, and fairness, which enables health care staff to remain engaged and resilient throughout their …

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Emphasizing empathy and equity in value-based health care delivery

Physician
July 26, 2025

The transformation of care delivery is driven by value-based health care (VBHC). In addition to its cost-effectiveness and clinical efficiency, the success of VBHC depends upon its ability to exemplify empathy and equity. Usually disregarded in pursuing metrics, data, and integrated payments, these two pillars are indispensable for implementing a system that provides dignity and equity to all patients. Embedding empathy and equity into health care delivery is no longer …

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Time theft: the unseen harm of abusive oversight

Physician
July 17, 2025

Theft, in its essence, is the unlawful taking of something valuable from another. While usually associated with material possessions, it also extends to intangible assets such as time, reputation, and emotional well-being. When authorities like medical boards or the Department of Justice (DOJ) engage in unfair practices grounded in presumptive guilt, they are not just misusing their roles but actively stripping individuals of these invaluable resources—an abuse of power that …

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Harassment and overreach are driving physicians to quit

Physician
July 16, 2025

In the noble pursuit of healing, physicians, especially those in pain clinics, are increasingly caught between the growing burden of patient expectations and a tightening web of regulatory scrutiny. A recent clinical study and a related article on KevinMD converge to highlight a deeply troubling reality: Clinicians are not only being harassed by distressed patients but are also being punished by the systems meant to regulate or protect health care.

A …

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Why specialist pain clinics and addiction treatment services require strong primary care

Conditions
July 13, 2025

Specialist pain clinics and addiction management services are vital in addressing some of the most complex and costly health care conditions. However, their success depends on stable and robust primary care systems. Without strong primary care as a foundation, these health care initiatives risk fragmentation, poor continuity, and low patient accountability. Stable primary care ensures timely access, coordinated care, longitudinal monitoring, and patient engagement, all essential elements for the value-based …

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How regulatory overreach is destroying innovation in U.S. health care

Physician
July 8, 2025

Health care regulatory bodies have embraced a dangerous “accuse first, prove later” strategy that is eroding the foundation of our health care system. Physicians, the bedrock of patient care, are being subjected to accusations based on flimsy, illegitimate reports or random audits. Rather than building cases on substantial initial evidence, these authorities thrive on retrospective scrutiny—analyzing old notes, reframing past actions, and bending interpretations of guidelines to validate their accusations. …

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How subjective likability practices undermine Canada’s health workforce recruitment and retention

Physician
July 5, 2025

In the face of worsening health workforce shortages, Canada must shift from a culture of personal likability to a system of objective qualifications or merits in recruiting and retaining physicians. While team cohesion and interpersonal compatibility are essential, an overemphasis on “fit” or likability excludes talented physicians, particularly immigrants and racialized minorities, who may not share the cultural background, communication style, or social behaviors preferred by decision-makers. This practice undermines …

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Pain is more than physical: the story your body is trying to tell

Conditions
June 25, 2025

Pain is a signal. It gets our attention. It arrests, alarms, and demands we listen. C.S. Lewis wrote in the problem of pain: “God whispers to us in our pleasures, speaks in our conscience, but shouts in our pain: it is His megaphone to rouse a deaf world.” And what a deaf world we have become.

Pain is physical—a sign of tissue damage. It’s defined as “physical suffering or discomfort caused …

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The silent crisis hurting pain patients and their doctors

Physician
April 17, 2025

The actions taken by the Medical Board against a compassionate physician dedicated to alleviating chronic pain are nothing short of egregious, deeply flawed, and emblematic of a system that seems intent on punishing rather than protecting. This esteemed doctor, who has spent years serving patients in dire need with integrity and professionalism, now finds himself ensnared by a process that appears more vindictive than just, more biased than fair.

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How the CDC’s opioid rules created a crisis for chronic pain patients

Conditions
April 15, 2025

Adapted from Greed to Do Good: The Untold Story of CDC’s Disastrous War on Opioids.

The 2016 CDC opioid guideline seemed to make obvious sense: Americans were consuming far too many prescribed opioids. Many users of illicit opioids reported that prescribed opioids had been their gateway to illicit usage, even addiction. And users of illegal opioids, whether addicts or not, were dying of overdoses—more and more each year. The prescription …

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Cutting opioid use in half: a hospital’s pain management breakthrough

Physician
March 23, 2025

I’ve witnessed what’s possible when we rethink pain management. By implementing a multimodal assessment approach at my hospital, I achieved a 50 percent reduction in inpatient opioid use, measured in morphine milligram equivalents (MMEs). The Numeric Pain Scale (NPS)—that 0-10 score we’ve leaned on too much—drives overuse when it’s the only guide, and with the U.S. consuming 80 percent of the world’s opioids as just 4.4 percent of its population, …

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When state legislators are given the opportunity, they vote overwhelmingly for doctor autonomy in pain treatment

Policy
March 20, 2025

As I have written elsewhere, the United States is now embroiled in a highly contentious debate concerning the causes of the so-called “opioid crisis.” Prescribing guidelines updated in 2022 by the Centers for Disease Control and Prevention (CDC) and Veterans Administration (VA) have become the basis for continuing scientifically unsupported restrictions on patient access to long-term prescription opioid therapy. Doctors …

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The criminal enforcement of HIPAA

Physician
January 29, 2025

Congress passed the Health Information Portability and Accountability Act (HIPAA) in 1996. This federal regulation was aimed at maintaining the privacy of medical records while ensuring the smooth flow of medical information pertinent to patient care. Penalties assessed for violations of the HIPAA Act mostly involve financial penalties (between $25,000 per violation up to $100,000 per violation). Congress also included criminal penalties for violations of HIPAA rules enacted under 42 …

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How a systems approach can revolutionize pain and depression treatment

Conditions
January 19, 2025

As a health care writer and patient advocate for over 27 years, I have interacted with thousands of patients who experience chronic severe pain, caregivers who support struggling family members, and clinicians who treat painful conditions. Depression and anxiety are very common in these patients and may significantly complicate treatment.   Untreated depression – or under-treated pain – can cause increases in healing times, suicidal ideation, and Read more…

Why the opioid crisis and youth mental health demand urgent parity reforms in 2025

Policy
January 16, 2025

At the beginning of 2024, the nation continued to experience the impact of three declared public health emergencies with significant behavioral health implications: COVID-19, Mpox, and the opioid crisis. At the same time, three major national associations continued to highlight what they first described in 2021 as a “youth mental health crisis.” As we enter 2025, emergency declarations for two of these — Mpox and COVID-19 — have …

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This perspective will change how physicians address pain and recovery

Conditions
January 11, 2025

I implore all physicians to watch the film Tipping the Pain Scale. Invited by a friend to view from the perspective of recovery, I accepted in support and out of curiosity for the proposed approach to the treatment of pain. As an osteopathic neuromusculoskeletal medicine physician, this is the chief complaint of many patients seeking care, often addressed with hands-on treatment considering structure and function and the unity of body, …

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From liquid handcuffs to miracle molecule: MOTAA would expand methadone access and help fight the overdose epidemic

Conditions
January 6, 2025

Kayla was referred to our addiction clinic after a visit to the emergency department for a skin infection, common in people who use drugs intravenously. Recognizing her fentanyl use was escalating out of her control, she made an appointment to discuss starting buprenorphine, a mainstay of treatment for opioid use disorder (OUD). While our initial office visit with Kayla was straightforward and optimistic, during subsequent visits she continued to experience …

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Acupuncture helped when nothing else did

Conditions
December 20, 2024

The waiting area in Kayla’s (name changed) practice was so peaceful that I felt better just sitting there. I had come to receive acupuncture treatments and didn’t quite know what to expect. While I sat and waited for Kayla to lead me back to a treatment room, I looked around. There were flowers on an end table next to a blue wooden bench. On the wall, there was a huge …

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How objective pain management can save lives and prevent addiction

Conditions
December 17, 2024

The management of pain in clinical practice often involves navigating the critical tension between compassionate care and ensuring patient safety. While subjective self-reports of pain are essential for understanding a patient’s experience, relying solely on these assessments may risk overtreatment, leading to adverse outcomes. Incorporating objective measures can enhance safety and maintain clinical integrity without compromising compassion.

The role of objective measures in pain management

1. Promoting patient safety

The U.S. Food and Drug Administration is talking when they should be listening

Physician
December 6, 2024

On May 9-10, 2017, the U.S. Food and Drug Administration (FDA) held a workshop titled “Training health care providers on pain management and safe use of opioid analgesics — exploring the path forward.” I attended the workshop in person to offer comments on behalf of chronic pain patients. A summary of my observations at the time was published by the now-defunct Pain News Network. The following extended extract is from …

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