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Articles by Gary Call
Recognizing pain in autism when there are no words
One of the hardest questions in intellectual disability psychiatry that I have found myself grappling with over the past year as a registrar in the subspecialty is surprisingly simple: Is this person in pain? Most people assume pain announces itself clearly. A broken bone hurts. A toothache hurts. An infection hurts. The body sounds an alarm and we respond. In practice, as I have encountered time and again, it is rarely that straightforward.
Chronic pain management: Match the treatment to the cause
Chronic pain affects millions and demands a nuanced, individualized strategy. Providers draw from training and comfort zones, but the scientific literature supports a multimodal framework that integrates pharmacological, rehabilitative, psychological, and interventional options. No single modality universally outperforms others.
Central sensitization is the key to treating chronic pain
Behavioral health is a core component of first-line, non-opioid treatment for chronic pain in most major medical guidelines, including the Centers for Disease Control and Prevention, the American College of Physicians, the World Health Organization, the American Academy of Neurology, the American Headache Society, and the American College of Gastroenterology. And yet, the concept of behavioral health to treat chronic pain still surprises many people, including many physicians.
The opioid crackdown is harming chronic pain patients
I once cared for a patient I’ll call Maria, a middle-aged professional with severe spinal disease and years of stable function on a carefully monitored opioid regimen. She’d never lost a prescription, never shown signs of misuse, and passed every urine drug screen. Then her clinic was acquired by a large health system, and new policies arrived with a single message: cut opioid doses or risk scrutiny. Within months, Maria’s dose was slashed.
Why military patients carry pain a chart can’t explain
He came to me with chronic neck pain and headaches that would not quit. The diagnosis was already there: neck pain, degenerative disc disease, chronic headaches. But a diagnosis is not the same thing as a story. We built a sports medicine treatment plan around what I could find on exam: trigger point injections, massage, soft tissue work. The pain would improve, then return. Every four weeks became every two because something at the base of his skull would not release. That was the clue.
Why are doctors prosecuted for prescribing opioids?
As a prominent health care educator and advocate for chronic pain patients and their clinicians, I receive a large number of emails and potential papers in venues where I am active. Every week, I hear from people who have been harmed by U.S. government misdirection and outright health care fraud. Increasing numbers of those who come to me are doctors who have been railroaded into prison and had their lives destroyed by federal or state law enforcement authorities run amuck.
The double standard at the heart of chronic pain treatment
For many years, the medical establishment has argued, and in my view correctly, that addiction is a legitimate neurobiological condition that may often require long-term pharmacologic treatment, including with an opioid such as buprenorphine or methadone. This is not, in itself, a controversial stance. However, when the subject turns to pain, whether acute or chronic, many of the same institutions abruptly change their tone and, more importantly, their mindset.
GLP-1s and neurotech are colliding over chronic pain
Fifty million Americans wake up in chronic pain every day. Not soreness. Not the dull ache of a hard week. Pain that has dismantled careers, ended marriages, and driven people, my patients, over 25 years, to suicide, overdose, and a slow erasure of self. I trained at USC and UCLA, spent three decades in interventional pain management, and I can tell you with clinical certainty: the system we built to treat these patients has been a catastrophe.
CDC opioid guidelines are harming chronic pain patients
As I watch my wife, Audrey, navigate yet another day of unrelenting pain, I am reminded that the so-called “opioid crisis” peddled by policymakers and media headlines is a dangerous myth, one that has inflicted needless suffering on millions of chronic pain patients like her. At age 67, Audrey is a living testament to human resilience, enduring a litany of medical ordeals that would break most people.
Interventional pain procedures for chronic back pain
Chronic back, leg, and pelvic pain frequently result from degenerative spine conditions, disc herniations, spinal stenosis, facet arthropathy, sacroiliac joint dysfunction, or vertebrogenic pain. When conservative measures such as physical therapy, medications, and activity modification fail, interventional pain procedures provide targeted, minimally invasive options to address specific pain generators.
Prescribing is down, opioid overdose deaths are not
It is often said in popular literature that figures lie and liars figure. However, sometimes in science, the lie is by omission. What we don’t say can be even more important in our conclusions than what we do. Two charts illustrate this principle in a centrally important issue of U.S. clinical practice. The first chart is compiled by Statista, a well-respected data services company known worldwide.
California opioid prescribing: what the data actually shows
As a physician managing patients with chronic pain in California, I’ve witnessed the tension between necessary regulations and the daily reality of helping people in genuine distress. In the meantime, as a chairman for the National Campaign to Protect People in Pain (NCP3), I know how important it is to advocate for our patients.
Why your patient’s biggest barrier isn’t pain. It’s walking through the door. [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! What keeps millions of people from sitting in a dentist’s chair, even when modern technology has made procedures more comfortable than ever? Kaushal Shah is a general dentist and dental director managing multiple practices in the Dallas area with 15 years of clinical experience.
How gold cards can drive California pain management reform
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.
The evolving structural challenges of modern pain medicine
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.
Doctors leave California over a tilted legal system
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.
How to treat chronic pain and depression together
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?
How CDC opioid guidelines harmed chronic pain patients
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.
How pain management solves a refractory headache
As a pain management specialist, I see patients every week who feel like they have tried nearly everything. They come to me after months, or even years, of battling chronic or refractory headaches. Their primary care doctor and neurologist have already walked them through the usual first-line options, yet the pain keeps coming back relentlessly. It steals their focus, disrupts their sleep, and robs them of the simple joys in daily life. These are the cases I love helping the most.
Knee osteoarthritis demands layered pain management
Knee osteoarthritis (OA) remains a leading cause of chronic pain and reduced mobility, affecting millions of adults worldwide, particularly those over age 50. As cartilage deteriorates and inflammation increases, patients often face pain, stiffness, swelling, and limitations in daily activities. Although no cure exists, a structured, escalating treatment plan can significantly alleviate symptoms, preserve function, delay disease progression, and help many individuals avoid or postpone surgery.
How to treat sacroiliac joint pain effectively today
If you have nagging pain deep in your lower back or one buttock that never seems to settle, you are not alone. Many people chase answers through discs, nerves, or muscles, yet the real source turns out to be the sacroiliac (SI) joint. This connection between the base of your spine and your pelvis is built for stability with just a hint of motion. When it becomes irritated or unstable, the pain can feel a lot like sciatica or a simple back strain, which is why it gets missed so often.
How prior authorization and step therapy harm pain management
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 pain and leave him groggy and nauseated.
Health insurance incentives and alternatives to opioids for chronic pain
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.
How spinal cord stimulation offers relief for chronic pain
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 back, legs, or neuropathic zones.
Why patient-centered care transforms chronic pain management
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.
Politics and fear have replaced science in U.S. pain management [PODCAST]
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 by sociopolitical factors rather than medical science. He traces the history from the “business corruption” phase of pill mills to the current “political phase” launched by the 2016 CDC guidelines.
How punitive board tactics are harming pain management physicians
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.
Chronic pain management: Balancing relief and regulation
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 limits life or work activities.
Ketamine therapy for chronic pain and substance misuse
Health care works best when it solves real problems in real lives. That is why recent research on ketamine therapy for chronic pain deserves attention. The peer-reviewed study looked at 20 adults living with chronic pain who also struggled with substance misuse. The results suggest that carefully designed pain treatment may help more than pain alone. It may also improve mood and support recovery from substance misuse.
Books that shape life values: a lifelong reading list
As much as I have written about pain and addiction care over the past three decades, daily life for most of my readers is about even larger values. This current conversation is about values that may change and shape our lives. I grew up in an age before computers, much less electronic books or Kindle or the internet. I am a dinosaur when it comes to remembering too many darned passwords these days.
AI in pain assessment: Balancing innovation with patient safety
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.
Why buprenorphine prescribing still lags after the X-waiver repeal
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.
The hidden cost of medical board regulation and prosecutorial overreach
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.
Peptides for chronic pain: Navigating safety and regulations
I have so many patients struggling with horrible arthritis pain! All the treatments we have either really don’t work well or have side effects, and many times cause more harm than good. I found myself having a risk-benefit discussion with every single patient with chronic pain, and at times, feeling like I was doing more harm than good when trying to help treat the pain.
Why men delay seeking help
A man notices it in a moment he did not plan to analyze. An erection that used to be straight now bends. There is a new ache. Sex feels different, less reliable, more tense. He tells himself it is temporary. He avoids looking too closely. He stops initiating intimacy. And most of the time, he does not say a word. That quiet delay is one of the most overlooked parts of Peyronie’s disease.
Autism comorbidities: the hidden link between POTS, GI issues, and hypermobility
Autism is typically framed as a neurodevelopmental condition defined by differences in social communication, sensory processing, and behavior. This framing is incomplete. In clinical practice, autistic individuals frequently present with a striking burden of systemic symptoms involving the gastrointestinal tract, cardiovascular regulation, immune signaling, connective tissue, and stress physiology. These are not side notes.
When diagnosis becomes closure: the harm of stopping too soon
Medicine prides itself on early diagnosis and decisive treatment. We are trained to recognize patterns, apply categories, and follow pathways designed to reduce uncertainty. This approach saves lives. But there is a quiet point at which it can also cause harm. That moment occurs when diagnosis becomes closure. I recently spoke with a young woman in her 20s with endometriosis. She had done everything medicine asked of her: sought care, underwent surgery, and followed instructions.
Why "just relaxing" doesn't work
During the COVID-19 pandemic, conversations about burnout and stress exploded, particularly among health care workers. Much of the advice centered on self-care practices: taking time off, scheduling massages and spa days, practicing mindfulness, protecting your evenings, using your PTO. While these strategies are valuable, they are not the full story. Positioning self-care as the solution to stress oversimplifies a much deeper physiological process.
What is palliative medicine and why is it so misunderstood?
After years of leading palliative medicine departments, as a Fellow of the American Academy of Hospice and Palliative Medicine, I’ve had countless conversations that start the same way. A colleague in the hallway says, “Oh, palliative care—that’s so important.
Sustainable legislative reform outweighs temporary discount programs [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! President and chief executive officer of the National Psoriasis Foundation (NPF) Leah M. Howard discusses her article “Pharmacy benefit manager reform vs. direct drug plans.” Leah analyzes the recent emergence of direct-purchase drug programs and argues that while innovative thinking is welcome, it cannot replace the need for deep systemic change.
Scrotal pain in young men: When to seek urgent care
Scrotal pain in young men is a frequent reason for emergency department visits and urology consultations. While many underlying causes are benign and self-limiting, others, most notably testicular torsion, represent true urologic emergencies in which delayed intervention can result in irreversible testicular damage. The clinical challenge lies in distinguishing conditions that allow for short-term observation from those requiring immediate evaluation.
Sjogren's, fibromyalgia, and the weight of invisible illness
Some illnesses do not storm the body to the brink of death. They don’t show up in emergency rooms or leave dramatic scans behind. Yet they quietly hollow a life from the inside, stealing ease, stealing spontaneity, turning ordinary days into endurance tests. Autoimmune disease and chronic pain often live in that space: not terminal, but relentless; not fatal, yet capable of dimming the world so deeply that survival becomes an act of will rather than biology.
Emotional awareness and expression therapy explained
Most people assume that pain and illness are caused only by injury or disease. If your back hurts, it must be damaged; abdominal pain must come only from inflammation, infection, or tumor. Most physicians learn this in medical school, as I did. But treatment based on this assumption often fails to provide relief for persistent pain, leaving millions of patients and countless well-intentioned physicians frustrated and in despair.
Is tramadol really ineffective and risky?
For nearly half a century, tramadol has been used as a pain reliever. It is not perfect, no analgesic is, but it has helped millions upon millions of patients with chronic pain. That is why recent headlines declaring tramadol “less effective” and “more risky” caught my attention. These stories were based on a single meta-analysis, which concluded that this medication offers “limited analgesic benefits” and that its harms, especially cardiac-associated harms, “likely outweigh” its effectiveness.
The blind men and the elephant: a parable for modern pain management
Most of us have heard the ancient Indian and Buddhist parable “the blind men and the elephant.” Regardless of source, the parable usually contains these elements: A ruler assembles several blind men and brings an elephant before them.
The AI innovation-access gap in medicine
Artificial intelligence has transformed pharmaceutical science more rapidly than any other part of health care.
Understanding factitious disorder imposed on another and child safety
Factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy (MSBP), represents one of the most egregious and dangerous forms of child maltreatment encountered in clinical practice. Although terminology has evolved, the core phenomenon described decades ago remains unchanged: A caregiver, most often the mother, intentionally fabricates, exaggerates, or induces illness in a child to meet psychological needs.
Gender bias in medicine: Who deserves to be saved?
The nurse adjusted my father’s blanket for the third time that hour, her voice soft as velvet. “We just hate to see him suffer like this,” she whispered. My mom and I watched her check his IV with the tenderness reserved for wounded pups. Three floors down, four years earlier, this same hospital discharged me mid-vomit with a gastric outlet obstruction and a white blood cell count that screamed infection.
Why your migraine might be causing your tinnitus [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Otolaryngologist Brian F. Worden discusses his article, “The surprising link between migraine and tinnitus.” He reveals that for the 26-47 percent of tinnitus patients who also report migraines, the tinnitus may actually be an atypical migraine symptom, even without a headache.
What is shared truth and why does it matter?
In our diverse world, where everyone sees things through their own lens, shaped by life experiences, beliefs, and facts, chasing after one absolute “truth” often sparks arguments instead of solutions. But what if we aimed for something better: a “shared truth”? This is about coming together, respecting each other’s opinions, and teaming up to find common ground that works for everyone. It’s like turning a debate into a friendly conversation, where we build something stronger together.
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