The Brief

Pain is universal. It's also extremely personal.

Almost everyone has experienced some kind of pain in their life, be it emotional or physical. Many of us, millions in fact, also suffer from chronic pain. I know I have. And while we might think we know exactly where the pain stems from, many times, the source of the pain is not what we think.

Every year, the medical community is learning more and more about pain — its origins, its function, and its relationship to the mind and body. While research has long shown that pain comes from the brain, many scientists and doctors haven't necessarily engaged with this critical information. Remember the last time you went to the doctor for pain? You were probably prescribed medication, maybe you got an X-ray and perhaps that did the trick.

Unfortunately, for the millions of Americans suffering from chronic pain, simple interventions often don't work. Why? Because we're often misdiagnosing the source of the pain and thus, mistreating it as well.

This illustration image shows tablets of opioid painkiller Oxycodone delivered on medical prescription taken on Sept. 18, 2019 in Washington, DC.

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Thankfully, a new study published in the Journal of Pain provides new data to help us understand pain — where it comes from, why we experience it, and how we can not only better manage it, but in some cases eradicate it completely.

So, where does pain come from?

Scientists now believe that all pain is generated in the brain, but that doesn't make the pain any less real. And it's understandable if this is triggering for some. Many people, women especially, aren't heard when they say they feel pain. There's even a term for it — "medical gaslighting." Have you ever had a doctor say to you "it's all in your head" in a dismissive way?

"It's not all in your head, but it is coming from your head," said Nathaniel Frank, an author and historian who is writing a book about the mind-body connection to pain. Frank recently wrote an op-ed in the LA Times called "The pain in your back? It's really a pain in your brain." His article cites the new research on pain, which further proves this premise.

"Pain experience is generated from a whole variety of experiences," said Frank, who also directs Cornell University's "What We Know" project, which collects scholarship on cultural and policy issues for the general public. "If you've broken a bone, slipped a disc, torn a muscle, you likely experienced structural pain. What's fascinating is that over time, even as the injury heals, our pain can get worse."

So, why does our pain get worse even when your bodies are getting better?

The mind-body connection to pain

Michigan State University Clinical Professor Dr. Howard Schubiner recently led a study that revealed something about pain that's counterintuitive — back pain can occur in the absence of tissue damage due to learned neural circuits in the brain.

"We see this all the time," said Schubiner. "Normally when you have an injury it will heal. It may take weeks. In chronic pain sufferers, it increases over time and spreads to different areas of the body."

In Schubiner's study, doctors examined 222 patients suffering chronic neck and back pain. After running MRI tests and physical exams, the researchers found that nearly all the patients had spinal anomalies. However, only 12% of the participants showed a structural problem as the root of their pain. The other 88% of participants had what the researchers call primary pain, meaning the pain was generated by neural circuits in the brain, not by structural damage.

Jess Breach of Harlequins walks off with crutches after the Allianz Premier 15's Semi-Final match between Harlequins Women and Wasps FC Ladies at the Twickenham Stoop on May 22, 2021 in London, England.

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"The existing medical paradigm assumes a physical cause for most chronic pain," Frank wrote in his LA Times op-ed. But the results of Schubiner's study show that's often not the case.

"The results are really remarkable. If you have chronic neck or back pain and you get an MRI, the MRI will be abnormal. But it turns out, that most people have an abnormal MRI even if they have no pain. So mild findings on an MRI may not be the cause of the pain," said Schubiner.

To further conclude that most participants were experiencing non-structural pain, the researchers looked at patient histories and the characteristics of their pain.

"If the pain comes and goes, shifts and moves, turns on and off, is triggered by an innocuous stimuli, that's what was the determining factor," Schubiner said.

These findings confirm a suspicion I had about about my own experience with chronic pain — that while it likely began with my head injury, over time it morphed into an emotional pain.

"All injuries heal, but sometimes the brain will continue to send these pain signals," said Schubiner. "It creates a spiraling process. Especially when people think they're in danger."

Why do we experience pain?

Your pain is not trying to hurt you. It's actually trying to help you.

"The brain has a danger alarm mechanism. It turns on and it turns off. And so the brain is actually in charge of whether or not we experience pain in any given situation," says Schubiner.

Even after our pain alerts us that we've been harmed, it doesn't always turn off. The danger has passed, but our bodies don't know it.

"Anxiety can make the pain worse," said Schubiner. "This has actually been proven. So when we go to the doctor for an MRI and it reveals an abnormality, it's critical that we remember that the brain can cause pain. In fact, functional MRIs have shown that physical pain lights up a similar part of the brain as emotional pain."

How can we manage our pain?

New treatments are helping people reverse or eliminate chronic pain without invasive treatment or medications.

"This is an epidemic of fear as much of anything else," said Nathaniel Frank. "Of course, you need to go to an M.D. and rule out anything life-threatening. But once that's been ruled out, there are all these resources online now who can help you understand that others have gone through similar experiences."

Pain education is important, said Frank, who has dealt with his own chronic pain.

"For some people this happens quickly when they learn about pain education. But for others, particularly those who may have had real adversity of trauma when there young, it can take a long time to rewire your brain," says Frank.

Going to different doctors and getting different diagnoses are important steps — the more perspective you have on your pain, the more likely it is you'll be able to address it.

But pain can also be an incredibly lonely experience, which may seem odd given how universal and ubiquitous it is. But it can carry with it a degree of shame, stigma and certainly misery. Frank suggests finding community, reaching out to folks who are also struggling and researching the mind-body connection.

My personal pain story

My own story with chronic pain begins and ends with the mind-body connection. A couple years ago I sustained a concussion after I was violently mugged. When the headaches lasted past two weeks, and then past a couple months, I started to worry. Is my brain bleeding? Am I permanently damaged? Will I ever be OK? The more I worried, the worse it got. If you’ve dealt with chronic pain you know the cycle can be vicious. I decided to get a CT scan for peace of mind, and yet even with normal results, it didn't bring me any. The headaches persisted.

Three months into the head pain, and after changing my whole lifestyle appease it, I decided to do something a little more drastic and entirely experimental — I booked a 10-day trip to Hawai'i. Maybe I knew something intuitively that I would soon find out, or maybe I was just that desperate, but from the moment we took off the throbbing, pounding, pulsating stopped. Just like that, I felt like myself again.

But this is the part that astounds me and lends itself to the paradigm shift around pain — while I likely sustained a concussion that caused my headaches for the days and weeks that followed, at some point, it is also likely that my pain was no longer being caused by the physical injury but by the emotional one. My body still thought I was in danger.

In the end, my pain lasted for only months. I'm one of the lucky ones — many people suffer for years with no end in sight. This is why Frank and Dr. Schubiner believe a paradigm shift around pain is necessary. And why everyone, as Frank wrote in his op-ed, deserves access to that paradigm shift.

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A stinging new report from a union stuck in going-nowhere labor negotiations with health giant Kaiser Permanente makes clear the union’s position: Kaiser, sitting on $67 billion in reserves, can well afford to address glaring staffing shortages and close pay gaps that the union says were years in the making.

Will the report move the needle in negotiations? Not likely. And that almost certainly means that a massive employee walkout against Kaiser, the second such job strike in four months, will go off as planned on Jan. 26.

With more than 31,000 registered nurses, pharmacists, physical therapists and other health professionals involved, the strike has the potential to significantly disrupt Kaiser patients’ experiences, including the likely cancellation or rescheduling of some appointments and elective surgeries. A five-day strike last October prompted Kaiser to bring in 6,000 contract nurses and clinicians.

This strike is open-ended, meaning its impacts could be felt for weeks or months. Nurses say they hate that idea for their patients — but it may be the only way to focus Kaiser’s attention on the chronic staffing issues that they say negatively affect those patients on a regular basis.

“I see the end result of the poor staffing every single day,” said Zach Pritchett, an emergency room nurse at Kaiser Permanente Medical Center in Los Angeles. “What I’m seeing in the ER are Kaiser members who can’t get appointments for months at a time with their own primary care physicians — so they wind up here.”

Kaiser officials, meanwhile, have mostly waved off those concerns, saying in a prepared statement that union leaders “continue to talk about improving care, when this strike, and their actions over the past several months, are really all about higher wages.”

It adds up to a toxic stalemate, nearly 10 months after the union delivered its first proposal for a new contract and almost four months after its previous contract expired. Patient care for some of California’s 9.5 million Kaiser members will almost certainly suffer as a result.

The Jan. 26 strike date, set by the United Nurses Association of California/Union of Health Care Professionals, follows a tumultuous month in which Kaiser officials at one point cut off negotiations entirely, claiming a UNAC/UHCP representative had threatened to release damaging information about the company unless a settlement was reached. (Disclosure: UNAC/UHCP is a financial supporter of Capital & Main.)

“I certainly didn’t threaten Kaiser, and I made it clear in that meeting that I was not threatening them,” said union representative Joe Guzynski, referring to a December conference at which an independent mediator was also present. Instead, Guzynski said, he informed Kaiser that the union would be releasing much of the information publicly and offered to let company officials read it. They declined, he said.

The union has now made the information public, in an 84-page document that notes Kaiser’s astounding profitability despite the organization’s claim to nonprofit status in several areas of its operation. In 2024, the report notes, Kaiser generated $12.9 billion in what the report calls profits, which Kaiser generally refers to as net revenue or net income. The profit or surplus for the first three quarters of 2025 was $7.9 billion, with fourth-quarter totals not yet known.

On its website, Kaiser Permanente describes itself as “one of the nation’s largest not-for-profit health plans.” That designation applies strictly to its health insurance arm and the foundation that owns Kaiser’s hospitals. The company’s Permanente Medical Groups, the vast physician organizations that actually provide the care to patients, are for-profit ventures. Some union members work in Kaiser Foundation Hospitals and others in the individual clinics that comprise the for-profit medical groups, but their contract is negotiated with Kaiser as a whole.

Kaiser’s reserves, estimated at $67 billion (they fluctuate with market investments, among other things), are unrestricted. That means they can be used for any purpose.

Nurses and other Kaiser employees say they’ve been pleading with Kaiser for years to use some of that money to beef up staffing, to little avail. In its report, UNAC/UHCP says its members filed nearly 14,000 complaints related to unsafe staffing levels in Southern California Kaiser facilities alone from November 2023 to November 2025. That includes instances in which the staffing is out of compliance with the union’s contractual agreed-upon levels.

Kim Mullen, a union negotiator and a nurse who works primarily with stroke victims at Kaiser’s South Bay Medical Center near Long Beach, described what such staffing shortages look like. In her telemetry unit, she said, charge nurses often have to leave their posts in order to provide direct care for patients, meaning they are not doing their main job: running the overall shift, coordinating care and managing assignments.

On a short-staffing day, Mullen said, she doesn’t have enough nurses and other professionals to cover the need, plain and simple. “There’s no extra set of hands,” she said. “You give it your all, put your whole heart and soul in it, and then at the end of the day you’re exhausted, beat up, and you know that you didn’t give the patients all the care that they needed. And that’s what sucks.”

Kaiser officials have acknowledged staffing issues during these negotiations, union reps say. But in their public communications, the organization has repeatedly hammered the union as being interested only in raises that Kaiser says are “out of step” with economic realities.

“Our focus remains on reaching agreements that recognize the vital contributions of our employees while ensuring excellent, affordable care,” the company said in an emailed statement that it attributed to Senior Vice President Camille Applin-Jones.

Kaiser did not respond to a series of specific questions about the negotiations from Capital & Main. With regard to the union’s report, Kaiser’s statement said it “appears to be a collection of misrepresentations of facts across a broad range of issues, already published news stories, and information we have publicly reported.”

The wage negotiation has been stuck for months, with Kaiser offering a 21.5% raise over four years and the union proposing 25%. Neither side has budged. Union officials say their members agreed to much smaller increases during their last contract, negotiated during and just after the COVID-19 pandemic, and are trying to recoup some of the buying power they lost.

In October of 2025, UNAC/UHCP staged a five-day strike, and that did appear to prompt Kaiser to renew bargaining. For the most part, though, the medical behemoth has only erratically agreed to sit down. Union officials say that Kaiser showed up for negotiating sessions only seven days in November and five in December.

Such stalling is a longstanding corporate negotiating tactic, meant to frustrate and wear down union members whose contracts have expired and who want new deals in order to get on with their lives. In this case, the union’s Guzynski says, Kaiser may have picked the wrong opponent.

“I don’t think they know our members,” Guzynski said. “Our members understand and really feel these issues of staffing, when the employer has billions of dollars in reserves and says they can’t do anything to help them provide the patient care they want to provide.”

Copyright 2026 Capital & Main

California Gov. Gavin Newsom’s $200 million plan to revive the state’s stalling electric-car market faces several fundamental problems: It isn’t enough money, it may not reach consumers quickly enough and the state hasn’t decided whether to subsidize – or exclude – wealthier buyers.

The Newsom administration’s budget proposal — rolled out after President Donald Trump dismantled federal electric vehicle incentives and blocked California’s clean-vehicle mandate — would cover rebates for only about 20% of last year’s EV sales. That CalMatters estimate assumes the state follows the model of the Clean Vehicle Rebate Program, which offered rebates of up to $7,500 toward some electric and hybrid cars before the California Air Resources Board ended it in 2023.

So far the administration has released few details about the proposal, leaving experts and lawmakers circling a basic question: Who should get the money?

“It is better than nothing, which is what a lot of things are getting right now,” said Mars Wu, a senior program manager with the Greenlining Institute, which advocates for investments in communities of color. “How far that $200 million goes really depends on how the program is going to be structured.”

A small incentive in a huge market

California’s electric car market is one the governor celebrates on the world stage. While at the World Economic Forum in Davos, Switzerland earlier this week, Newsom highlighted that California has surpassed 2.5 million clean car sales, saying the achievement came after the state “invested in this future when others said it was impossible.” He framed the number against a modest goal to get 1.5 million clean cars on the road, set more than a decade ago.

California officials remain confident the state’s policies will succeed in pushing the transition to electric cars. Even as sales have slipped, EVs will drive future electricity demand, according to a long-term forecast approved Wednesday by the California Energy Commission.

But the limits of the governor’s $200 million EV proposal become clear in the numbers. A CalMatters analysis found the incentive would cover only one out of every five EV sales, assuming similar sales to last year, and the same average rebate level as the state’s last mass-market rebate program.

Advocates are also raising concerns about how quickly the money can get to consumers. Christopher Chavez, deputy policy director at the Coalition for Clean Air, a California-focused advocacy group, warned that the proposed rebates may not reach consumers until 2027, given how long it takes to approve the budget and to set up a new program. If the funding only lasts a year, the program would leave out buyers who need time to plan or save, he added.

“It's not going to be enough — just to be blunt about it,” Chavez said. “Two-hundred million for a mass-market program will go very quickly.”

The proposal comes as the latest sales numbers show an electric car market slump. Nationally, the loss of the uncapped, popular federal tax credit has accelerated manufacturer write-downs and sales declines as automakers adjusted to a tougher EV market.

In California, the slowdown has pushed the state further off course from its climate goals: even before Congress and President Trump blocked its vehicle mandate last year, California was struggling to hit a requirement that 35% of new cars sold in 2026 be zero-emission. Last year electric and other zero emission cars made up about 23% of new car sales in 2025, down from roughly 25% the year prior, California Energy Commission data shows.

Sales slowed down dramatically at the end of the year, when EVs and other clean cars accounted for just under 19% of new car sales in the fourth quarter of 2025 — the lowest quarterly share since mid-2022.

The Newsom administration will likely lay out the details of its proposal in a draft bill tied to the state budget. The Clean Vehicle Rebate Program would be “the foundation we’d be building from,” wrote Lindsey Buckley, an air board spokesperson, in an email, adding that the goal would be to deploy the $200 million “as soon as possible to support the market.”

Buckley said it is “speculative” to predict the impact of a new EV incentive or how quickly the money would reach consumers.

An environmental activist places signage calling for increased electric vehicle use outside the California Environmental Protection Agency building in Sacramento on June 9, 2022. Environmental activists urged the California Air Resources Board to push for a transition toward 100% electric vehicle consumer use. Photo by Rahul Lal, CalMatters With limited funding, advocates say the question of who qualifies for the rebates becomes critical.

“What we really don't want to see is that money going towards higher-income folks for whom it would just be kind of like a bonus coupon,” said Wu, of the Greenlining Institute.

Fast or targeted: lawmakers face a choice

How the Newsom administration and lawmakers design the state’s next EV incentive will determine how quickly the air board can deliver rebates — and whether the program avoids recreating past inequities. California ended its last, broad EV rebate program in 2023 over concerns it benefited higher-income buyers. Targeting lower-income drivers delivers the greatest benefits because they tend to drive the most, and switching to EVs saves them money on fuel and maintenance, said Ethan Elkind, a climate law expert at UC Berkeley.

But income-based “means testing” can slow programs down, requiring income verification and layers of bureaucracy that eat up funding and discourage participation.

That’s a critique of one California program aimed at low-income buyers, Clean Cars 4 All, which offers grants to help drivers trade in older, more polluting vehicles for cleaner alternatives. As the state moved from budget surplus to deficit, the Newsom administration and lawmakers never adequately funded it, advocates say.

Lawmakers provided no new funding in the 2024–25 budget year, and in the current budget cycle, the state provided only about $45 million through a combination of funds and one-time budget actions, according to the Legislative Analyst’s Office. That falls well short of a sustained, long-term commitment, said Chavez, of the Coalition for Clean Air.

“It's become — especially as the budget has become more difficult — more of a secondary priority, which is unfortunate,” he said.

Competing ideas, no clear consensus

California’s EV problem has no shortage of potential solutions — only disagreement over which one to choose.

Some policy analysts argue the state should focus on first-time adoption. A recent brief from Atlas Public Policy found that incentives are most cost-effective when they bring a household’s first electric vehicle into the garage — because once a family owns one EV, it is far more likely to buy another.

Elkind, of UC Berkeley, said a simpler approach — a point-of-sale rebate tied to lower-priced vehicles — would be easier for the air board to administer while avoiding subsidies for high-income buyers.

“If it's just tied to the price of the vehicle, that's pretty straightforward,” Elkind said.

Some lawmakers told CalMatters the air board should tightly target the rebates to communities most affected by pollution and transportation costs. State Senator Ben Allen, a Democrat from El Segundo, said incentives should focus on communities that suffer the most from air pollution, “so as to increase the bang for air quality buck.”

Senator Josh Becker, a Democrat from Menlo Park, said new incentives should go to the people “who are most burdened by transportation costs and drive the most."

Fewer easy EV buyers in California

California needs to design its next rebate program well because its most eager EV buyers are gone and the state now faces a harder, more price-sensitive market, experts said.

“California is one of the first states to sort of get into that mainstream market: and it's a harder market to convert,” said Loren McDonald, a Danville-based EV analyst. Potential buyers now expect seamless charging and balk at waiting 30 to 40 minutes. They also are not keen to install home chargers or pay more upfront. Many, he says, stick with traditional gasoline-powered vehicles.

“We burned through the innovators and the early adopters — those people who want to save the planet, those people who make good money,” McDonald said.

Staff writer Erica Yee contributed to this report.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.