For years, a pain appointment has carried an extra question nobody should have needed to ask: Is the doctor treating the patient or protecting himself from the system watching him?
The opioid crackdown changed medicine far beyond the prescription pad. Patients with legitimate pain learned that asking for relief could invite suspicion. Doctors learned that prescribing an effective controlled medication could mean extra documentation, pharmacy calls, insurance fights, and scrutiny.
From the National Library of Medicine:
The erosion of trust in the patient-clinician relationship is an underappreciated, and vital, component of the prescription opioid crisis.
Drawing from lived experience of patients and clinicians, and a narrative evidence review, this report discusses how opioid use for persistent pain can impact the patient-clinician relationship from the vantage points of the patient and the family physician.
For patients, the stress of dealing with persistent pain, misalignment with clinicians regarding goals of care, experiences of disrespect and stigma, fear of abrupt tapers, and frustration with a fragmented health system, all combine to breed a lack of trust.
Clinicians, for their part, experience challenges due to inadequate resources for pain management and opioid safety, pressure to deprescribe opioids rapidly, inconsistent prescribing practices of colleagues, 'policing' opioid prescriptions when concern arises for opioid use disorder and adversarial relationships with frustrated patients wary of clinician intentions.
As a result, many clinicians struggle to maintain a therapeutic relationship with patients in great need of empathy and healing. To support implementation of evidence-based guidelines and achieve public health goals of safer prescribing and reducing harm from prescription opioids, we recommend steps health systems and clinicians can take to rebuild trust in the patient-clinician relationship, enable patient-centered pain care, and embed patient perspectives into opioid safety processes.
PERSPECTIVE: Erosion of patient-clinician trust is a barrier to implementing evidence-based guidelines that aim to improve opioid safety. This paper explores lived patient and clinician experiences and recommends steps for health systems and clinicians to rebuild this trust as a strategy to actualize the benefits of adherence to these guidelines.
A 2025 review of persistent pain and long-term opioid care found fear of forced tapering, stigma, pressure on physicians to deprescribe, and the feeling that doctors had been turned into opioid police all damaged the therapeutic relationship.
Pain medicine may finally be getting another path.
The FDA approved Journavx, or suzetrigine, in January 2025 for moderate-to-severe acute pain in adults. It became the first drug in a new class of non-opioid pain medicines.
Instead of acting on opioid receptors in the brain, it blocks a sodium channel involved in transmitting pain signals through peripheral nerves.
The numbers suggest doctors and patients are using it. About 900,000 Journavx prescriptions were filled during the first six months of 2026, and roughly 260 million Americans had reimbursed access by the end of June.
Another drug may be coming behind it. A Phase 2b trial published in July tested LTG-001, another drug targeting the NaV1.8 sodium channel.
A total of 343 patients underwent randomization. The least-squares mean SPID48 was 161.05 (95% confidence interval [CI], 142.93 to 179.16) in the low-dose group, 185.30 (95% CI, 167.26 to 203.34) in the high-dose group, 164.08 (95% CI, 146.02 to 182.14) in the hydrocodone bitartrate–acetaminophen group, and 123.22 (95% CI, 105.23 to 141.21) in the placebo group. The least-squares mean difference in the SPID48 between LTG-001 and placebo was significant for each dose (low dose: 37.82 [P=0.003]; high dose: 62.08 [P<0.001]), and that between hydrocodone bitartrate–acetaminophen and placebo was 40.86. High-dose LTG-001, but not low-dose LTG-001, was associated with significantly lower opioid use than placebo (11.00 MME vs. 18.35 MME, P=0.01), as well as a significantly higher percentage of patients who received no opioid rescue medication (52% vs. 22%, P<0.001). High-dose LTG-001 was associated with a higher incidence of pyrexia than placebo (7% vs. 2%) and a higher incidence of presyncope (6% vs. 1%). Conclusions LTG-001 led to significantly greater reductions in pain scores than placebo over the course of 48 hours after abdominoplasty.
The higher dose significantly reduced postoperative pain and opioid rescue use compared with a placebo. Some 52% of patients receiving the higher dose required no opioid rescue medication, compared with 22% receiving the placebo.
Nobody should confuse promising science with a cure for chronic pain. Journavx is approved for acute pain, and its pivotal trials didn't show superiority over hydrocodone and acetaminophen.
New candidates remain under study. Opioids will have a legitimate role for some patients. The breakthrough is a choice.
More choices could change the conversation inside the exam room. A doctor who has several effective treatments can make a medical judgment instead of choosing between inadequate pain control and a prescription surrounded by regulatory anxiety.
A patient can discuss pain without wondering whether the first concern will be addiction, compliance, or suspicion.
Washington has even begun nudging the system in that direction. Medicare now provides temporary additional payments for qualifying non-opioid pain treatments in hospital outpatient departments and ambulatory surgical centers.
Journavx joined a growing list of qualifying drugs and devices in January.
Then comes the familiar problem: insurance bureaucracy.
A 2026 physician survey found prior authorization consumed an average of 13 hours of physician and staff time each week. Some 95% of doctors said prior authorization delays necessary care, 79% said patients sometimes abandon recommended treatment because of it, and 94% said it contributes to burnout.
From the AMA:
Similar to previous findings, physicians most recently surveyed are concerned about how prior authorization delays interfere negatively with their patient’s health, and they continue to report that prior authorization strains them mentally and financially.
Below are some key findings from the 2025 survey. Among physicians:
- 26% reported that prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment or death.
- 95% said prior authorization delays access to necessary care.
- 79% reported that patients abandon treatment due to authorization challenges.
- 92% said prior authorization negatively affects clinical outcomes.
The data also shows the strain that prior authorization puts on physicians and their staff:
- Physicians on average complete 40 prior authorizations per week, with this weekly workload consuming an average of 13 hours of physician and staff time.94% reported that prior authorization contributes to burn out.
- 40% of physicians employ staff dedicated solely to prior authorization tasks.
- 32% reported prior authorization requests are often or always denied.
- 74% reported that denials have increased over the past five years, and six in 10 express concern that augmented intelligence (AI) may further increase denial rates.
Meanwhile, physicians reported that prior authorization creates inefficiencies and unnecessary costs across the health system as a whole, too. For example, 88% of physicians reported that prior authorization increases overall healthcare utilization, contributing to waste rather than savings.
- 75% said prior authorization leads to ineffective initial treatments.
- 73% said there are additional office visits.
- 47% said it results in urgent or emergency care.
- 32% said it results in hospitalizations.
Medicine can invent its way out of one problem, and bureaucracy can promptly build another one.
A non-opioid revolution won't mean much if insurers require patients to fail cheaper treatments first, reject newer therapies, or bury doctors under authorization forms.
Replacing opioid restrictions with non-opioid restrictions would leave the doctor-patient relationship exactly where it has been for years: crowded by people who aren't in the examination room.
The encouraging part of 2026 is that pain medicine finally appears to be widening. New drugs, nerve stimulation, better research into pain pathways, and efforts to identify who is likely to develop chronic pain are moving at the same time.
From the NIH:
To uncover signatures predictive of the transition to or resilience from chronic pain, the A2CPS clinical study will collect imaging, physical, sensory, and other data from two groups of people for six months; one group will have recently had Total Knee Arthroplasty (TKA) surgery and the other will have had a thoracic surgery. The hope is for differences in biomarkers observed between people who transition to chronic pain and those who do not will reveal biomarkers associated with the transition to chronic pain. The biomarkers could then be combined into signatures predictive of the transition. Clinical sites are now enrolling participants in this important research study.
A major challenge in pain management is preventing chronic pain from occurring after an acute pain event. For most people, acute pain resolves as the injury or trauma that caused it heals. Yet in many other people, acute pain from injury, surgery, or disease persists beyond the initial insult, and can last for years or throughout life. Many drugs, while effective early on, lose efficacy over time and make the transition from acute to chronic pain worse. In those who transition to chronic pain, maladaptive changes occur throughout the nervous system. Our ability to reverse these changes is very limited. Our lack of understanding of the mechanisms of transition to chronic pain is a major gap in knowledge that limits development of effective preventive therapies. The ability to identify those at risk for transitioning to chronic pain could inform future clinical trials, improve success of trials, and transform acute pain treatment approaches for prevention of chronic pain.
The Acute to Chronic Pain Signatures program will use advances in imaging, high-throughput biomedical experiments (‘omics), sensory testing, and psychosocial assessments to explore a range of characteristics from patients who transition or are resilient to chronic pain. The study will follow two groups from the time of acute pain event over a period of six months. One group will have undergone a total knee arthroplasty (TKA) and the other will have undergone thoracic surgery. The key deliverable of the program is a comprehensive data set for the research communities that should reveal “signatures” predictive of transition versus resilience to chronic pain.
Patients don't need another crusade against a class of medicine. Doctors don't need another Washington instruction manual.
They need enough good options to sit together, look at the evidence, and decide what treatment makes sense for the person in front of them.
Science may finally be giving them those options.
Now the bureaucrats need to get out of the way.
Pain patients have spent years fighting bureaucracy almost as much as pain itself. PJ Media VIP helps us keep digging into the policies, regulators, and institutions shaping American health care. Join today and get 60% off with promo code FIGHT.
Join the conversation as a VIP Member