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Opinion: That pain in your back? It's really a pain in your brain

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Opinion: That pain in your back? It's really a pain in your brain

As a chronic pain sufferer, I sometimes surprise people by telling them that my pain doesn’t have a physical cause. It’s a mind-body thing, I say, related to stress and emotions. To many, this sounds like admitting to being a little bit crazy. And when I up the ante by suggesting they’ve probably had this kind of pain too, some become outright angry, interpreting my words to mean their pain is “all in their head.”

All of which makes a new study published in the Journal of Pain a big deal. It offers robust evidence that the overwhelming majority of chronic back and neck pain cases — among the most common chronic pain complaints — come from the mind, despite the fact that most diagnoses cite a physical cause, such as bulging disks or bone spurs.

In the new study, doctors assessed 222 consecutive pain patients at an orthopedic care clinic in Louisiana — everyone who showed up, as long as they could complete a questionnaire. Just 12% showed evidence of a structural problem as the root of their pain. Eighty-eight percent, on the other hand, had what the researchers call “primary pain,” which refers to symptoms generated by neural circuits in the brain rather than by “structural” damage to the body.

Based on this and prior research, the authors believe that a process in the brain initiates the non-structural pain. The sensations could be the residual pain from a bodily wound that healed but didn’t notify the brain. Or the brain may have generated pain in the absence of any injury, perhaps in an effort to protect the patients from emotional wounds by occupying their attention with physical sensations instead.

The role of the brain and emotions in producing pain has long been known, and it has been validated by neuroimaging that shows that the brain processes physical pain and emotional distress in the same regions. Observational studies indicate that people feel more pain when primed with negative emotional stimuli. And additional research has shown that therapeutic interventions that help patients understand and reinterpret their pain can significantly reduce the symptoms. The theory is that pain is a danger signal, so as we come to feel safer and less threatened, our nervous systems shift out of fight-or-flight mode, and stop firing the pain signals.

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As a result, scientists now believe that all pain is essentially brain pain. The idea is that just as the brain generates sensory experiences such as vision and hearing, it also generates pain by consulting our memories, expectations and emotions, as well as whatever physical inputs our nerves may sense, and creating pain when it determines we are under threat. While our nerves detect sensations, it’s the brain that decides if we’ll experience them as pain.

The implications for healthcare are profound. Chronic pain is among the top reasons people seek medical care. More than 1.5 billion people worldwide suffer from chronic pain, including 50 million to 100 million Americans. For the most part, these patients are spending billions of dollars pursuing physical treatments. If the cause is non-physical, the money is wasted and the suffering only mounts.

And not only are we failing to alleviate the pain, we are creating dangerous side effects that include the opioid crisis as well as surgeries that may be unnecessary and can leave patients worse off.

Of course, sometimes chronic pain does have a physical cause, and distinguishing between when it does and doesn’t is crucial. To address this key challenge, the researchers at the Louisiana clinic devised a rule-out/rule-in diagnosis method that should be adopted far and wide.

The process starts with a thorough patient exam and review of scans to rule out physical causes of the pain. There is a nuance: Just because an anomaly — a squished disk in your back, for example — shows up on a scan, it is not necessarily the cause of pain. As the study explains, research repeatedly shows that the majority of people without pain show similar anomalies. In other words, doctors diagnosing the source of chronic pain need to be aware of the poor correlation between scary scans and pain.

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The rule-in process further clarifies whether a patient has structural or mind-body pain. It consists of taking a detailed history of the patient’s pain and life. Doctors need to know if prior treatments that should have resolved structural causes have failed; if treatments associated with a placebo response brought relief; if a patient’s history contains significant stress or adversity; if they have other ailments associated with mind-body causes (headaches, gut and bladder conditions, fibromyalgia, chronic fatigue, tendonitis and more can have such associations). And they need to know if the pain is inconsistent — does it move around in the body or come and go; is it triggered by biologically irrelevant stimuli like the weather, smells or sounds? These variables don’t track well with structural causes.

The process may sound a bit subjective, and it is. But no more than any other diagnostic approach. Medicine is not an exact science, and doctors must act on imperfect information. “We deal in probabilities,” said Dr. Howard Schubiner, lead investigator of the Louisiana study and a clinical professor at Michigan State University College of Human Medicine. Using the careful criteria developed for the study offers as well-grounded a basis for action as anything: “When there is strong evidence using these criteria, a physician can be confident that what they’re seeing is a mind-body problem.”

The existing medical paradigm assumes a physical cause for most chronic pain. The findings in the Louisiana study suggest that’s often wrong.

Fortunately, my pain is much improved after years of pain education and good therapy helped my brain dial down my nervous system. Everyone deserves access to this new pain paradigm. And that requires ending the stigma still associated with mind-body symptoms, and understanding them as a universal human condition, not as the lot of people who are a little bit crazy.

Nathaniel Frank is the director of the What We Know Project at Cornell University’s Center for the Study of Inequality. He is writing a book about mind-body pain to be published by Mayo Clinic Press.

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Video: NASA Announces Artemis III Crew

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Video: NASA Announces Artemis III Crew

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NASA Announces Artemis III Crew

NASA announced the crew of Artemis III mission, which will fly to low-Earth orbit to test rendezvous and docking maneuvers with one or two lunar landers.

“I am excited to welcome you as the next crew in the Artemis journey to successfully return to the moon — this time to stay.” “I’m honored by the role that I’ve been given. I’m also very humbled by the task in front of us. But first and foremost, I’m grateful.” “So with that, the Artemis II crew, comrade, hands you the baton. You got the controls.” “As you know, we had a significant anomaly at our Launch Complex 36A on May 28. We’ve redoubled our efforts and are moving forward.”

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NASA announced the crew of Artemis III mission, which will fly to low-Earth orbit to test rendezvous and docking maneuvers with one or two lunar landers.

By Alisa Shodiyev Kaff

June 9, 2026

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Santa Monica Mountains’ last steelhead trout survived the Palisades fire — and even had babies

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Santa Monica Mountains’ last steelhead trout survived the Palisades fire — and even had babies

Scientists feared the Santa Monica Mountains’ last remaining steelhead trout were dead, smothered by debris flows unleashed by the Palisades fire.

But the endangered fish surprised them: A team of biologists recently spotted 30 of the rare trout — and 21 babies — in Topanga Creek.

“There was a lot of happy dancing in the creek,” said Rosi Dagit, principal conservation biologist for the Resource Conservation District of the Santa Monica Mountains, which works with public and private landowners to conserve natural resources.

That’s because the steelhead here are endangered, at both the state and federal levels. Once, they swam in most streams of the Santa Monicas, but their numbers plummeted amid overfishing and coastal development. Increasingly frequent wildfire has further stressed their habitat. Topanga Creek, a biodiversity hot spot, is home to their last known population in the mountains that stretch from the Hollywood Hills to Point Mugu in Ventura County.

The trout that were spotted, including this one, are part of a distinct Southern California population that’s listed as endangered at the state and federal levels.

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(RCDSMM Stream Team)

The California Department of Fish and Wildlife spearheaded a complex mission to rescue trout threatened by the Palisades fire that sparked in January 2025.

Time was of the essence. The fire hadn’t yet been fully contained. But rain was on the way, which would sweep massive amounts of sediment from the denuded hillsides into the water. Fish are often killed this way.

Crews stunned the fish with electricity, scooped them up in buckets, trucked them to a hatchery and ultimately moved them to Arroyo Hondo Creek in Santa Barbara County.

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Within days, Topanga Creek was choked with mud. Some assumed the fish left behind were goners.

But in March, the conservation district’s team found four. The following month, when water conditions were clearer, they saw more.

“These fish continue to amaze me,” said Kyle Evans, environmental program manager for the state Department of Fish and Wildlife, who had seen the damage to the creek. “I had seen populations get wiped out in similar situations. So when I heard, I was thrilled.”

Evans surmises the fish that survived were in an area of the creek where less charred material and sediment were swept in.

“These fish likely hunkered down, were hiding under some rocks or places to try to get away from the main concentration of flow,” he said. “And luckily they weren’t buried.”

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The ones that were spotted were fairly small, around 6 to 14 inches. Rainbow trout and steelhead trout are the same species, but with different lifestyles. If the fish remain in freshwater, they’ll be considered rainbows. However, they can migrate to the ocean and become steelhead, where they typically grow larger before returning to their natal waters to spawn.

Topanga Creek hasn’t fully recovered from the damage it sustained, but scientists say it’s looking better. Surveys last year were “so depressing,” Dagit said, with very few animals, and stretches that were essentially transformed into flat roads from all the sediment buildup. Some of the riparian canopy burned right down to the creek.

Then came 32 inches of rain over the last nine months, scouring out and moving sediment, creating deeper pools. Dagit said they recently found newt egg masses for the first time in years, as well as a few adult newts and many frogs. Plants that provide cover are starting to recover.

She provided photos comparing certain pools last year and this year, some dramatically transformed. In September 2025, the Shrine Pool could have been an overgrown hiking trail. This April, it was filled with shallow water.

Shrine Pool, Sept. 2025, left, and the same location, April 2026, right.

The Shrine Pool in September 2025, left, and the same location in April 2026, right, with RCDSMM’s Isaac Yelchin donning a wetsuit.

(RCDSMM Stream Team)

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Topanga Creek is home to another endangered fish, the small but hardy northern tidewater goby, often described as cute. Not long before the trout operation, Dagit led a rescue of hundreds of these fish too. Many were repatriated to the lagoon at the mouth of the creek in a moving ceremony last June.

There’s still the matter of what to do with the trout that were moved to Santa Barbara County last year. Evans would like to bring them home to the Santa Monicas at some point, but isn’t sure if it will happen. On one hand, they could bolster the small, genetically isolated surviving population. On the other, they might inadvertently bring in a disease or bacteria. There is some time to decide. Evans estimates the creek still needs to recover for two to three more years.

For now, the fish are functioning fine in their adopted creek. Experts worried the trauma wrought by the move would disrupt their spawning process, but they had babies that spring. This year, they spawned again.

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Pacifica pier cracks, another coastal casualty as seas continue to rise

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Pacifica pier cracks, another coastal casualty as seas continue to rise

The Pacifica Municipal Pier was shut down and taped off Thursday after city workers noticed cracks running through the landmark structure and concrete chunks falling into the ocean.

It’s just one of many coastal California structures that have recently crumbled under pressure from a rising and relentless ocean.

Officials from the small, beach city south of San Francisco said the pier was closed due to “cracking, separation, and displacement of the concrete walkway and structural elements.”

It will stay closed while structural engineers asses its safety.

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Photos taken by city employees show a wide crack that runs from top to bottom and across the structure as well. Other photos show a large horizontal crack under the foundation of a small restaurant on the pier, the Chit Chat Cafe.

The cafe was also shut down.

This is not the first time the 53-year-old pier has shown signs of stress. In 2021, part of it was shut down after handrails along the edge collapsed. And in 2023, after a series of storms pummeled the Central California coast, damaging parts of the pier, the structure was partially closed for more than year.

Those same storms caused extensive damage in Aptos and Capitola, 70 miles south, where piers and waterfront infrastructure were swept away or damaged.

In 2024, a 150- to 180- foot section of the Santa Cruz wharf was ripped off by powerful waves.

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At least 10 of the state’s dozens of coastal public piers were closed for part or all of 2024 due to structural damage sustained in winter storms since 2022. At least five others have longer-term upgrades planned to address structural issues.

“These things are costly to maintain,” said Zach Plopper, senior environmental director at Surfrider. “They are a part of our California coastal culture in many ways, but we’re going to need to reckon with, one, the state that they’re in, and two, the continuous and worsening threats they’re going to experience,”

He said most of the piers were constructed in the early 1900s, and they weren’t built to withstand decades of rough seas, storms and rising sea level.

“With this incoming El Niño, which is forecasted to be significant, and this marine heat wave we’re in the midst of, we’re kind of in uncharted waters as far as what this winter could bring in terms of storms and swells to the California coast, and we’re likely going to see a lot more damage,” he said. “Not just piers, but roads and other coastal infrastructure up and down the state.”

There was no storm in Pacifica earlier this week, so no single event could be blamed for the destruction.

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However, a 2025 report from an outside engineering firm, GHD, found that several sections of the pier were in “poor” or “serious” condition, and they recommended closure before anticipated storms or events that could “subject the piles to high winds, swells and large waves.”

The firm found several areas of the pier where concrete was missing and rebar was exposed and corroding.

“The pier has continued to experience high winds and large waves in a harsh marine environment,” the engineers wrote in the report, noting that continuous exposure to seawater or marine spray was “detrimental” to the structure.

A 2023 city report estimated it would cost $19 million to repair.

That same year, a state law was enacted to require local governments along the California coast to plan for sea level rise in the coming decades.

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Sea level has risen some 8 inches, on average, along the coast in the past 150 years, Plopper said, and researchers anticipate another foot in the next 25 years.

“We’re going to see profound shifts on our coastline, none that we have ever experienced before, and building static structures on the coast just doesn’t work all that well,” he said. “We’re going to have to make some really hard decisions.”

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